Task Sharing or Task Dumping: Counsellors Experiences of Delivering a Psychosocial Intervention for Mental Health Problems in South Africa

Abstract

Given task-sharing mental health counselling to non-specialist providers is a recognised strategy to increase service capacity, ensuring that their training, supervision, and support needs are met is necessary to facilitate the sustainable delivery of a high-quality service. Using in-depth interviews, we qualitatively explored the experiences of 18 facility-based counsellors (FBCs) tasked with delivering a counselling intervention within chronic disease services offered within primary care facilities participating in the project MIND cluster randomised controlled trial. Findings show that project MIND training with a strong emphasis on role playing and skills rehearsal improved FBCs’ confidence and competence, complemented by highly structured supervision and debriefing provided by a registered counsellor, were key strategies for supporting the implementation of task-shared mental health counselling. FBCs perceived many benefits to providing mental health counselling in primary healthcare but systemic interventions are needed for sustained implementation.

Towards an integrated model for supervision for mental health and psychosocial support in humanitarian emergencies: A qualitative study

“…The importance of supervision in MHPSS programming is recognised across various guidelines [ 6 , 8 , 9 ]. This recognition is consistent with decades of research within broader global health programming, which highlights supervision as a key determinant of health worker performance, satisfaction, wellbeing, commitment, motivation, and retention [ 10 – 13 ]. In addition to the benefit of supervision for practitioners, research suggests that supervision may also be an important determinant of client outcomes.…”

Implementation outcomes of a health systems strengthening intervention for perinatal women with common mental disorders and experiences of domestic violence in South Africa: Pilot feasibility and acceptability study

“…Yet delivery of the counselling by CHWs in patients' homes was not feasible or acceptable, contributing to poor delity of delivery and adoption, consistent with ndings from a task-shared psychosocial intervention for perinatal depression in Cape Town [32]. In LMIC, task-sharing has been proposed as a strategy for scaling up mental healthcare, and has been successfully implemented in several countries including South Africa [33][34][35]. However, in our study, patients reported mistrust of CHWs as well as lack of con dence in their abilities, as CHWs lived in the same community they worked in and were known to many patients.…”

Integrating task-sharing psychological treatments within primary health care services: Systems considerations

“…1 Task dumping refers to transferring tasks to general health care workers without the necessary supervision and support 5 and has also been used to refer to the expansion of the scope of work of health care workers without due recognition. 6 The designated approach requires that counselling for mental health and substance use (MHSU) problems be clearly specified as part of the scope of work of the designated health care workers. There is also a need for indicators and targets for MHSU counselling, as is the case for other activities, 4 with health care workers understandably focusing on activities that are used to measure their performance.…”