Panel Discussion 10 - Doing More with less:using Low Intensity, Digital and Task Shifting Approaches to Improve Access to Psychological Therapies Globally

Every country faces a major gap between the prevalence and impact of mental health problem and the resources and expertise available to address these. Some initiatives (e.g. The English Talking Therapies IAPT programme) rely on significant public funding to train many additional clinicians with specialist training in evidence based psychological therapies. However, in low- and middle-income countries (LMICs), funding universal public mental health services is not feasible and professionally qualified mental health clinicians are unavailable. Thus, creative solutions must be found.

In this panel discussion international experts working in North America, Europe, Africa and Australia and at the WHO will describe innovations in delivering evidence based psychological treatments that are culturally and context specific and can be scaled to meet the needs of underserved communities.

Services can be made more accessible if they are provided in community settings, e.g. schools and if they minimise stigma and are culturally sensitive. The WHO’s develop scalable psychological interventions (e.g. PM+ and Step-by- Step) and implementation support in LMICs.
In low and middle income countries (LMICs) -task shifting approaches are often used to implement assessment and therapy. This involves recruiting and training non-professionals including parents, community health workers and near peers. Examples of task shifting include the Friendship Bench in Zimbabwe where low intensity problem solving therapy is delivered in community settings by trained lay counsellors. Similarly, in South Africa, Nigeria and Kenya, Grassroots Soccer provides MindSkillz training to young people, delivered by near-peers in community sports settings. The approach can be adapted for high income countries, and combined with digital delivery of psychological interventions.

Multiple challenges arise In this work. The panel will discuss using co-design and co-production to develop interventions that culturally acceptable, the ethical and practical difficulties of ensuring that interventions are safe and effective, and the lessons that can be shared by low and middle income countries to help increase access to mental health care and support in high income countries.