Opening up the ‘black-box’: what strategies do community mental health workers use to address the social dimensions of mental health?

Abstract

Purpose Community-based workers promote mental health in communities. Recent literature has called for more attention to the ways they operate and the strategies used. For example, how do they translate biomedical concepts into frameworks that are acceptable and accessible to communities? How do micro-innovations lead to positive mental health outcomes, including social inclusion and recovery? The aim of this study was to examine the types of skills and strategies to address social dimensions of mental health used by community health workers (CHWs) working together with people with psychosocial disability (PPSD) in urban north India. Methods We interviewed CHWs (n = 46) about their registered PPSD who were randomly selected from 1000 people registered with a local non-profit community mental health provider. Notes taken during interviews were cross-checked with audio recordings and coded and analyzed thematically. Results CHWs displayed social, cultural, and psychological skills in forming trusting relationships and in-depth knowledge of the context of their client's lives and family dynamics. They used this information to analyze political, social, and economic factors influencing mental health for the client and their family members. The diverse range of analysis and intervention skills of community health workers built on contextual knowledge to implement micro-innovations in a be-spoke way, applying these to the local ecology of people with psychosocial disabilities (PPSD). These approaches contributed to addressing the social and structural determinants that shaped the mental health of PPSD. Conclusion Community health workers (CHWs) in this study addressed social aspects of mental health, individually, and by engaging with wider structural factors. The micro-innovations of CHWs are dependent on non-linear elements, including local knowledge, time, and relationships. Global mental health requires further attentive qualitative research to consider how these, and other factors shape the work of CHWs in different locales to inform locally appropriate mental health care.

Task-shifting or problem-shifting? How lay counselling is redefining mental healthcare

“…In the Solomon Islands, Christian counselling practices described locally as 'disentangling' or 'straightening out' take as their object women's broken social relations with family members and God [8]. While lay counsellors in some regions of India have been mobilized to enforce medicine compliance, other innovative programmes support counsellors to address social problems such as isolation [9,10]. And in the UK, an emerging cadre of peer counsellors operate on the assumption that, rather than illness, they are addressing deficits of connection and community in modern society, making their interventions more analogous to vitamins than to medicines [11].…”