Step 2. Build Capacity of General Healthcare Workers
Capacity building includes theoretical and practical training, as well as ongoing technical support and supervision for general health workers such as doctors and nurses as well as community health workers. Additional MHPSS workers to be trained is dependent on the context and can include social workers, counsellors, psychosocial workers and volunteers.
Treatment coverage for people with mental disorders is increased significantly by offering accessible and affordable mental health services as part of general health care.
- Building the knowledge and skills of facility and community level general health care providers and non-specialist MHPSS providers through training, supervision and mentorship over time helps ensure that trainees are confident and able to apply their skills to provide quality services.
- Raising Awareness among health care providers and other trainees about mental health and their roles in mental health integration (e.g. access, combating stigma, affordability, etc.) makes such services more accessible and acceptable.
- Select up to 51 priority mental health priority conditions to focus on (based on situational analysis/national guidelines), in addition to covering general principles of care.
- Identify targeted geographical regions and health facilities and select the number and types of trainees to include.
- Develop the training curriculum content (based on WHO mhGAP materials and guidelines), and adapt it to the context (local, social, and cultural considerations) and to the capacity and roles of trainees.
- Prioritize topics to emphasize better quality training on a smaller number of conditions vs training on all conditions. Training on additional conditions can be rolled out over phases as needed.
- Develop a training and supervision schedule which allocates the needed time and resources for on the job supervision sessions, with follow up sessions and refresher trainings as needed, avoiding a one-off training with no supervision.
- Engage local mental health professionals (where possible) in conducting training and providing longer term support, consultation and supervision (e.g. as co-trainers, to receive a training of trainers (TOT)) to ensure sustainable and quality mental health care.
- Engage mental health care providers (e.g. international psychiatrist, national psychiatrist, psychiatric nurse) to provide training as well as ongoing supervision (e.g. on the job mentorship, case discussions).
- Monitor and evaluate baseline and improvement in knowledge and skills to determine follow up and refresher training focus and content.
1 More than 5 mental health priority conditions may be chosen if in line and in accordance with national level discussions, policy and planning.
- Provide training and supervision sessions to local health professionals over a minimum of 4 months to recognize and treat and refer persons with mental disorders.
- Ideally, train on one mhGAP topic per day (2 maximum topics depending on assessment of foundational knowledge). If fewer training hours are restricted and few due to budget or logistical constraints or political/institutional considerations, consider reducing the number of priority conditions covered and include more supervision hours.
- Provide supervision (e.g. on the job supervision, group and/or individual supervision sessions) following completion of foundation training for a minimum of 3 months (e.g. 3 sessions per trainee, 1 session per month).
- Train community level non-specialists (e.g. community health workers, volunteers, psychosocial workers) to assist with case identification, follow up, community awareness raising and provide basic psychosocial support (e.g. Psychological First Aid (PFA)).
- Use M&E tools to track knowledge (pre-post test), and skills (on the job supervision checklist) among trainees.
- Carry out periodic evaluations (FGDs, interviews, questionnaires, supervision visits etc.) to assess remaining training gaps in knowledge and competencies, and develop follow up and refresher trainings.
- Set up peer level supervision between PHC staff.
- Develop additional supplemental materials (e.g. job aids).
- Support national stakeholders and health facilities in developing resources and strategies to promote staff well-being.
- Develop longer term strategy with national stakeholders to leverage role of national mental health professionals to provide training and ongoing supervision and support to general health workers and non-specialist MHPSS providers, and to to provide consultation or manage complex cases.
- Collaborate with academic institutions and professional associations to integrate mental health into pre-service training and continuing education for health professionals.
- Develop capacity of local non-specialist MHPSS providers (e.g. community health workers, social workers, psychosocial workers) in mental health case management, and evidence based scalable psychological interventions2 (e.g. cognitive behavior therapy, Problem Solving Plus (PM+) or interpersonal therapy (including group IPT)).
2 Use the manuals in the Psychological Interventions category resource below if you are developing an integration program with a component that teaches local non-specialist MHPSS providers to deliver evidence-based scalable psychological interventions for common mental disorders
After conducting the initial needs assessment and planning which would inform the selection of target facilities, trainees, geographical locations and training content as well as the identification of resources, partnerships, and local capacities to support in the short, medium, and longer term.
Use information from the initial assessment (step 1) and identify capacities as well as existing gaps in knowledge and skills among general health workers and other targeted trainees. Plan capacity building activities which can include pre-service trainings (at academic training institutions), foundational theoretical and practical training, and ongoing technical support and supervision.