Where there is no specialist – Improving Mental Health Literacy of Frontline Community Health Workers in a Rural District of Pakistan: The mPareshan Project

Abstract

Background In low- and middle-income countries (LMICs), four out of five people with mental illness do not receive specialized treatment. Utilizing non-specialist frontline workers to deliver basic mental health services at the community level therefore needs to be explored. Aims This study assessed improvement in knowledge and skills of frontline community workers in identifying symptoms of anxiety and depression, making appropriate referrals, and providing psychosocial counselling in a rural district of Pakistan. Methods Project mPareshan developed a training manual to improve mental health literacy of government’s Lady Health Workers (LHWs) and Lady Health Supervisors (LHSs). The content was adapted from WHO mhGAP 2.0 intervention guide to suit the local context. 72 LHSs and LHWs (36 each) from District Badin, Sindh, Pakistan received the training. A pre- and post-test was conducted to assess the change in knowledge and skills of participants using paired sample T-tests. Results The overall mean knowledge score of all participants increased significantly from 4.37 (SD = 1.45) before the mPareshan mental health literacy training, to 9.02 (SD = 1.48) after training (p < 0.01). The overall mean skills score for all participants was 8.07 (SD = 2.14) at pre-test and reached 9.84 (SD = 0.63) in post-test (p < 0.01). Mean scores of LHSs’ knowledge and skills were higher in most domains compared to LHWs. Conclusions This training in mental health has the potential to improve the overall knowledge and competencies of community health workers. Such endeavours can be upscaled so that frontline workers can serve as a useful workforce in the absence of specialist mental health services.