Nearly 30% of U.S. adults report trying – and failing – to get mental health treatment, with many blocked by barriers like cost, inadequate insurance and provider shortages. Training and hiring new mental health providers is one solution, but a recent report suggests training other healthcare workers – whether or not they have expertise in mental health – to help deliver this care is another promising option.
The report, from the McKinsey Health Institute, focuses on task sharing. That is, “training lay workers or non-specialists in basic mental healthcare,” explains Erica Coe, a co-author of the report and global executive director of MHI. Task sharing has proven effective in countries around the world, as detailed in the report, but it has yet to reach wide-scale adoption globally.
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U.S. News spoke with Coe and report co-author Kana Enomoto, director of brain health at MHI, about the promise and challenges of mental health task sharing, in the U.S. and beyond. This conversation has been edited for length and clarity.
Why is task sharing promising in the context of mental health? Why not just train more specialists?
EC: One of the misconceptions is that task sharing hasn’t scaled because we need more evidence. We know that this works. At this point, it really is about implementation and sustainable financing.
What would you say to someone who fears task-sharing means offering lower-quality care, or pushing specialists to the side?
EC: Task sharing actually helps strengthen the mental health specialist community. It helps support them and it helps them work at the top of their licenses by giving that extra capacity. There can be a nice triage system where somebody is first seen by a lay worker trained in mental health task sharing. Then, if they meet certain conditions or have a certain level of severity, they would be triaged to a mental health specialist. It can be highly complementary in many places. This helps address access challenges and bottlenecks for patients, but it has a beneficial effect on providers as well.
Plus, in many settings, workers who have gone through the mental health task sharing training are more trusted and more approachable than the specialists. Often they come from the community and they know the community. It gets over the fear or the stigma around going to see a mental health specialist.
KE: It is not supplantation. This is not a strategy to replace specialists; we are investing in creating more access at a population level.
Are there promising applications for task sharing that go beyond mental health?
KE: Task sharing wasn’t invented for mental health specifically. Community health workers, for example, are task sharing providers who work in HIV and maternal-child health and other areas of healthcare all over the world. You can get closer to population-level coverage if you are sharing routine medical or clinical tasks with non-specialists or lay providers. By advocating for task sharing in mental health, we’ve really borrowed a page out of the playbook of public health.
As you write in your report, it will likely take policy-level change, as well as buy-in from insurers, for mental health task sharing to truly scale in the U.S. But if health system leaders are interested in this approach, where could they start now?
KE: Where health systems, specifically, could look is where they have value-based arrangements – where they are bearing risk for the length of treatment or the acuity and level of care that someone gets, then it is in their interest as a health system to deliver rapid access to effective care. And they may have the flexibility to introduce a new type of service, or a complementary service.
EC: There are significant comorbidities with mental health needs and other physical conditions, like cancer or diabetes. There are a lot of opportunities to be thinking about mental health task sharing to augment the ability to do that upfront screening and treatment alongside other physical health needs that will help the patient and outcomes overall.