Applying lessons from task sharing in global mental health to the opioid crisis.

Abstract

The current opioid crisis in the United States has been considered an "epidemic of poor access to care." Similar to the shortage of trained providers to prescribe medications to treat opioid use disorder (OUD), there is a severe shortage of trained providers to meet the mental health needs of patients with OUD. These workforce shortages are evident nationwide, yet are particularly salient in rural areas. In this commentary in response to the article "Integrating Addiction Medicine into Rural Primary Care: Strategies and Initial Outcomes (Logan et al., 2019)," we propose that we can apply lessons learned from working in resourceconstrained settings globally to improve access to mental health care for patients with OUD in rural areas in the United States. We expand upon Logan et al. ( 2019) by discussing how non-specialist health workers, including community health workers and peer providers, under the supervision of psychologists and other specialists, can expand access to evidence-based mental health care for patients with OUD, particularly those receiving medications for opioid use disorder (MOUD). We draw from established models in global mental health that rely on "task sharing" mental health care to discuss ways in which lessons learned from scaling up evidence-based interventions with lay health workers in low and middle-income countries can directly inform efforts to increase access to mental health care to address the opioid crisis. What is the public health significance of this article?The opioid crisis is considered an epidemic of poor access to care, which includes poor access to medication for opioid use disorder and treatment for mental health comorbidities. Lessons learned from lay health worker interventions in low-resource international settings could help expand access to OUD treatment and mental health treatment locally.

“That person stopped being human”: Intersecting HIV and substance use stigma among patients and providers in South Africa

“…In many health/behavioral interventions in low-resource settings including South Africa, task-sharing-training lay health workers to safely deliver care that has traditionally been delivered by specialists-is essential (Magidson et al, 2019a(Magidson et al, , 2019c(Magidson et al, , 2017b. Our prior work has demonstrated that HIV/AOD patients perceive an intervention task-shared to peerspeople with similar lived experiences to be less stigmatizing (Magidson et al, 2019b).…”

Implications of Increased Access to Buprenorphine for Medical Providers in Rural Areas: A Review of the Literature and Future Directions

“…Additionally, there must be increased support and resources for clinicians in rural areas who prescribe buprenorphine for MOUD. This may be done through the creation of a clinician collaboration network for experienced buprenorphine prescribers to share insight and education with new prescribers [ 30 ], increased education and staff support for primary care clinicians [ 35 ], implementation of lay healthcare workers, and task sharing into treatment plans [ 45 ], and utilization of community pharmacies as a point of access to care in rural communities as an added layer of support [ 46 , 47 ]. We also suggest the consideration of incentives that will increase the level of provider participation, including but not limited to decreased prescriber regulations (i.e., prior authorization requirements) and increased reimbursements for services provided.…”

Future Directions in Lay Health Worker Involvement in Children’s Mental Health Services in the U.S.

“…As has been highlighted, we know that LHWs can be trained to deliver EBPs with fidelity from efforts in LMICs (Barnett, Gonzlez, et al, 2018;Singla et al, 2017); however, their roles in the U.S. may impact adoption of these interventions. For example, it has been noted that peer providers in the U.S. typically focus more on sharing lived experiences and providing support, with more formal interventions being seen as outside of the scope of their job description (Magidson et al, 2019). Relatedly, the systems they work within will impact if they have the job flexibility, supervision, and support to adopt EBPs.…”

“…LHWs have identified a need for training and supervision to support their work with families and communities (Klein et al, 2020). In LHW models of care, implementation is often overseen or evaluated by clinical psychologists, who provide training and ongoing supervision Magidson et al, 2019). At the same time, psychologists providing training or supervision need to engage in cultural humility and embrace the importance of shared knowledge and skills (Mundeva et al, 2018).…”