Task-shifting psychosocial interventions in public mental health : a review of the evidence in the South African context

With a high prevalence rate in South Africa, mental disorders and their associated psychosocial and physical disabilities contribute substantially to the burden of disease and to health costs. Inadequate public health resources and a chronically overburdened health system result in limited access to psychiatric care. Task-shifting psychosocial interventions from specialised to non-specialised health workers (NSHWs) to treat common mental disorders has been widely proposed as a strategy for expanding access to mental health care. While the research regarding task-shifting approaches to psychosocial interventions is increasing, no review of the data on task-shifted interventions to address mental disorders in South African public mental health setting has been conducted to date.The aim of this chapter is to review such data and consider this evidence in the context of a new mental health policy that seeks to make health services more equitably accessible.A thematic analysis was conducted on nine South African studies that reported on (i) NSHW-delivered psychosocial interventions; (ii) outcome data pertaining to intervention efficacy; and (iii) at least one outcome that addressed mental illness specifically. This was done by organising extracted data according to themes that might reflect emerging patterns in this area of research.Thus far, most South African task-shifting studies have focused on depression and substance-use problems. A particular interest in pregnant women as subjects was noted, with a striking absence of interventions aimed at children and adolescents. Across the studies, cadres of health workers were employed to deliver a variety of interventions, all of which had some previous evidence-based support and were manualised. The majority of studies provided evidence for the effectiveness of task-shifted interventions.Some efforts have been made to test task-shifted interventions, and the results provide preliminary support for the adaptation of manualised, evidence-based programmes to South African contexts. Greater emphasis is now needed on studies that establish the costs and sustainability of such interventions, as well as optimal upscaling and implementation methods.