Task-shared psychological treatments play a critical role in addressing the global mental health treatment gap, yet their integration into routine care requires further study. This study evaluated the causal association between an implementation factor of a task-shared psychological treatment and participant outcomes to strengthen the implementation-to-outcome link within global mental health. This secondary analysis utilized cohort data from the Program for Improving Mental Health Care (PRIME) implemented in Sehore, India where trained non-specialist health workers delivered treatment for depression and alcohol use disorder (AUD). Propensity scores and inverse probability of treatment weights examined the impact of mental health service users’ treatment attendance on users’ symptom severity (PHQ-9 scores for depression; AUDIT scores for AUD) at 3 and 12-month follow-ups. Among the 240 patients with depression, higher treatment session attendance led to 1.3 points lower PHQ-9 scores (vs. no attendance) and 2.4 points lower PHQ-9 scores (vs. low attendance) at 3 months, with no significant effects at 12 months. Among the 190 AUD patients, treatment session attendance did not have a significant impact on AUDIT scores. Our findings have implications for enhancing treatment session attendance among those with depression within task-shared psychological treatments.

There is a scarcity of psychological interventions for self-harm in young people, either developed or adapted for use in low and middle-income countries (LMICs). ATMAN is a psychological intervention developed in India for youth with three key modules: problem-solving, emotion regulation and social network strengthening skills in addition to crisis management. ATMAN was delivered in 27 youth with a history of self-harm (14–24 years old) sequentially by a specialist and it a non-specialist counsellor. Out of 27, 18 youth who started the ATMAN intervention completed it, and 13 completed the 10-month follow-up. There was a significant reduction in post-intervention scores on Beck’s Scale for Suicidal Ideation (BSI) (mean difference [confidence interval]: 14.1 [17.2, 10.9]) and Patient Health Questionnaire (PHQ-9) (9.6 [12.8, 6.4]) from the baseline scores, irrespective of who delivered the intervention (non-specialist vs. specialist). The difference remained significant at the 10-month follow-up (BSI: 17.0 [20.5, 13.6] and PHQ-9: 10.5 [14.5, 6.6]). Themes such as improved understanding of self-harm acting as a deterrent, using ATMAN strategies to deal with daily life distress, and the importance of addressing stigma in self-harm emerged during the qualitative interviews. Although requiring further evaluation, ATMAN shows promise as a scalable intervention that can be used in LMICs to reduce the burden of suicide in young people.

Task-sharing holds promise for bridging gaps in access to mental healthcare; yet there remain significant challenges to scaling up task-sharing models. This formative study aimed to develop a digital platform for training non-specialist providers without prior experience in mental healthcare to deliver a brief psychosocial intervention for depression in community settings in Texas. A 5-step development approach was employed, consisting of: blueprinting, scripting, video production and digital content creation, uploading digital content to a Learning Management System and user testing. This resulted in the development of two courses, one called Foundational Skills covering the skills to become an effective counselor, and the second called Behavioral Activation covering the skills for addressing adult depression. Twenty-one participants with a range of health-related backgrounds, including 11 with prior training in mental healthcare, completed the training and joined focus group discussions offering qualitative feedback and recommendations for improving the program’s usability. Participant feedback centered around the need to make the content more interactive, to include additional engaging features, and to improve the layout and usability of the platform. The next steps will involve evaluating the training program on developing the skills of non-specialist providers and supporting its uptake and implementation.

Our systematic review aims to synthesise the evidence on interventions targeting improvement in patient adherence to psychological treatments for common mental disorders. A search was conducted on six electronic databases using search terms under the following concepts: common mental disorders, adherence, psychological treatments and controlled trial study design. Due to the heterogeneity in intervention content and outcomes evaluated in the included studies, a narrative synthesis was conducted. Risk of bias was assessed using the Cochrane Risk of Bias Version 2 tool for randomised controlled trials and the Cochrane ROBINS-I tool for non-randomised controlled trials. The search yielded 23 distinct studies with a total sample size of 2,779 participants. All studies were conducted in high-income or upper-middle-income countries. Interventions to improve patient adherence to psychological treatments included reminders and between-session engagement (e.g., text messages), motivational interviewing, therapy orientation (e.g., expectation-setting) and overcoming structural barriers (e.g., case management). Interventions from 18 out of 23 studies were successful in improving at least one primary adherence outcome of interest (e.g., session attendance). Some studies also reported an improvement in secondary outcomes – six studies reported an improvement in at least one clinical outcome (e.g., depression), and three studies reported improvements in at least one measure of well-being or disability (e.g., days spent in in-patient treatment). By incorporating these interventions into psychological treatment services, therapists can better engage with and support their patients, potentially leading to improved mental health outcomes and overall well-being.

Measurement-based peer supervision is one strategy to assure the quality of psychological treatments delivered by non-mental health specialist providers. In this formative study, we aimed to 1) describe the development and 2) examine the acceptability and feasibility of PEERS (Promoting Effective mental healthcare through peER Supervision)—a novel smartphone app that aims to facilitate registering and scheduling patients, collecting patient outcomes, rating therapy quality and assessing supervision quality—among frontline treatment providers delivering behavioral activation treatment for depression. The PEERS prototype was developed and tested in 2021, and version 1 was launched in 2022. To date, 215 treatment providers (98% female; ages 30–35) in Madhya Pradesh and Goa, India, have been trained to use PEERS and 65.58% have completed the supplemental, virtual PEERS course. Focus group discussions with 98 providers were examined according to four themes—training and education, app effectiveness, user experience and adherence and data privacy and safety. This yielded commonly endorsed facilitators (e.g., collaborative learning through group supervision, the convenience of consolidated patient data), barriers (e.g., difficulties with new technologies) and suggested changes (e.g., esthetic improvements, suicide risk assessment prompt). The PEERS app has the potential to scale measurement-based peer supervision to facilitate quality assurance of psychological treatments across contexts.

We evaluated a digital learning programme for non-specialists to develop knowledge-based competencies in a problem-solving intervention for adolescents to examine the overall impact of training on knowledge-based competencies among learners; and to compare the effects of two training conditions (self-guided digital training with or without coaching) in a nested parallel, two-arm, individually randomised controlled trial. Eligible participants were 18 or older; fluent in Hindi or English; able to access digital training; and had no prior experience of delivering structured psychotherapies. 277 participants were enrolled from 31 March 2022 to 19 June 2022 of which 230 (83%) completed the study. There was a significant increase in competency score from pre-training (Mean = 7.01, SD = 3.29) to post-training (Mean = 8.88, SD = 3.80), 6 weeks after the pre-training assessment. Knowledge competency scores showed larger increase among participants randomised to the coaching arm (AMD = 1.09, 95% CI 0.26–1.92, p = 0.01) with an effect size (d) of 0.33 (95% CI 0.08–0.58). More participants completed training in the coaching arm (n = 96, 69.6%) compared to the self-guided training arm (n = 56, 40.3%). In conclusion, a coach-supported remote digital training intervention is associated with enhanced participation by learners and increased psychotherapeutic knowledge competencies.

We evaluated the effectiveness of community-based rehabilitation (CBR) in reducing depressive symptoms, alcohol use disorder, food insecurity and underweight in people with schizophrenia. This cluster-randomised controlled trial was conducted in a rural district of Ethiopia. Fifty-four sub-districts were allocated in a 1:1 ratio to the facility-based care [FBC] plus CBR arm and the FBC alone arm. Lay workers delivered CBR over 12 months. We assessed food insecurity (self-reported hunger), underweight (BMI< 18.5 kg/m2), depressive symptoms (PHQ-9) and alcohol use disorder (AUDIT ≥ 8) at 6 and 12 months. Seventy-nine participants with schizophrenia in 24 sub-districts were assigned to CBR plus FBC and 87 participants in 24 sub-districts were assigned to FBC only. There was no evidence of an intervention effect on food insecurity (aOR 0.52, 95% CI 0.16–1.67; p = 0.27), underweight (aOR 0.44, 95% CI 0.17–1.12; p = 0.08), alcohol use disorder (aOR 0.82, 95% CI 0.24–2.74; p = 0.74) or depressive symptoms (adjusted mean difference − 0.06, 95% CI −1.35, 1.22; p = 0.92). Psychosocial interventions in low-resource settings should support access to treatment amongst people with schizophrenia, and further research should explore how impacts on economic, physical and mental health outcomes can be achieved.

Mental health service delivery needs radical reimagination in the United States where unmet needs for care remain large and most metrics on the burden of mental health problems have worsened, despite significant numbers of mental health professionals, spending on service provision and research. The COVID-19 pandemic has exacerbated the need for mental health care. One path to a radical reimagination is “Community Initiated Care (CIC)” which equips and empowers communities to address by providing brief psychosocial interventions by people in community settings. We co-developed a theory of change (ToC) for CIC with 24 stakeholders including representatives from community-based, advocacy, philanthropic and faith-based organizations to understand how CIC could be developed and adapted for specific contexts. We present a ToC which describes ways in which the CIC initiative can promote and strengthen mental health in communities in the United States with respect to community organization and leadership; community care and inclusion and normalizing mental health. We propose 10 strategies as part of CIC and propose a way forward for implementation and evaluation. This CIC model is a local, tailored approach which can expand the role of community members to strengthen our response to mental health needs in the United States.

Kelvin–Helmholtz (KH) instability plays a significant role in transport and mixing in various media such as hydrodynamic fluids, plasmas, geophysical flows and astrophysical situations. In this paper, we numerically explore this instability for a two-dimensional strongly coupled dusty plasma medium with rotational shear flows. We study this medium using a generalized hydrodynamic fluid model which treats it as a viscoelastic fluid. We consider the specific cases of rotating vorticity with abrupt radial profiles of rotation. In particular, single-circulation and multi-circulation vorticity shell profiles have been chosen. We observe the KH vortices at each circular interface between two relative rotating flows along with a pair of ingoing and outgoing wavefronts of transverse shear waves. Our studies show that due to the interplay between KH vortices and shear waves in the strongly coupled medium, the mixing and transport behaviour are much better than those of standard inviscid hydrodynamic fluids. In the interest of substantiating the mixing and transport behaviour, the generalized hydrodynamic fluid model is extended to include Lagrangian tracer particles. The numerical dispersion of these tracer particles in a flow provides an estimate of the diffusion in such a medium. We present the preliminary observations of tracer distribution (cluster formation) and diffusion (mean square displacement) across the medium.