ICTworks

Mental health is a basic human right, and a quality, coordinated mental health care system is necessary for Universal Health Coverage.

Despite its critical importance to health and human flourishing, there is a massive mental health coverage gap, which can be as large as 85% in LMICs, even though we know that treating the most common mental disorders, such as depression, can improve health and social outcomes, such as TB, HIV, and Maternal, Newborn and Child Health (MNCH), educational attainment, income generation, and more.

While there is always an acute need for specialist support services for individuals with serious mental illness, a comprehensive mental health system should integrate services into primary care and include elements of self-care and community-based care (informal and formal). (WHO).

Promisingly, there are a number of community-based programs, including Frontline Worker (FLW)-led interventions, which have the potential to scale and expand access to services for common mental disorders and to promote mental wellbeing.

This includes programs implemented by LMIC-focused organizations such as Friendship Bench, Sangath, StrongMinds, Basic Needs Basic Rights (Kenya, Ghana, etc.), Grassroots Soccer, Zvandiri and the myriad of health departments and organizations using the WHO Thinking Healthy or IPT-G  programs such as Nama Wellness and Komo Learning Center.

Current digital tools can support these types of community-based and FLW-led programs’ expansion and improvement in 5 key ways outlined below.

In addition to these currently available digital tools that can improve program effectiveness, many community-based organizations (and technology companies) are exploring how generative AI can enhance and expand their program models both on the programmatic and client-sides.

1. Training Frontline Workers

Once developed, digital training tools can have a low-marginal cost for deployment and may reduce variation in the quality and content of training delivered. Digital training is designed to incorporate adult learning techniques such as spaced repetition of practice, just-in-time delivery, and engagement techniques like gamification. This can provide effective means of training workers and can be used to supplement in person or virtual (but synchronous) training as well, amplifying impact.

A number of organizations and researchers are working to scale up training of FLWs.  The WHO & UNICEF’s free Ensuring Quality in Psychological Support (EQUIP) digital program, available in 6 languages, provides a digital platform for programs to assess FLW competency and can be used alongside intervention-specific training, adding flexibility and robustness to training programs. EMPOWER, based out of Harvard Medical School, is working to dramatically expand the number trained in evidence-based psychological treatments and mental health interventions utilizing digital training.

Further, there are a number of Massively Open Online Courses (MOOCs) such as OpenWHO’s Introducing Mental Health and Psychosocial Support (MHPSS).  A number of courses on how to deliver Psychological First Aid, such as CYP Psychological First Aid from the UK Health Security Agency, or Johns Hopkins University’s Psychological First Aid (8 languages) are readily available and can kick-start basic supportive services.

2. Digital Job Aid & Case Management

A digital job aid for FLWs can provide simplified client registration, screening tools, built in agendas for counseling sessions, automatic scheduling, SMS reminders for clients, and client information tracking over time.

These job aids can provide structured support for FLWs delivering an intervention to improve quality and consistency in delivery. For example, Dimagi’s CommCare platform was used to develop digital apps to support FLWs delivering counseling (IPT-G) by Nama Wellness (Uganda) and by the “grandmothers” of Friendship Bench in Zimbabwe.

3. Supportive Supervision

A supportive supervision approach, whereby FLWs can improve performance with regular self evaluation and data-driven follow-up with clear and effective feedback from supervisors, is rarely implemented thoroughly, but can be supported by digital tools.

Specific to Mental Health, WHO/UNICEF’s free, competency-based EQUIP platform can be used to support ongoing supervision (and training) of workers. Sangath & EMPOWER are also testing a mobile app to digitize the workflows for an innovative model of peer supervision, incorporating session audio-recordings and ratings from FLWs, their peers, and supervisors using a quality assessment checklist.

4. Data for M&E and QA

Data collected during program delivery can be used for monitoring and evaluation purposes including tracking session attendance, operational data, and even client outcomes.

Outcome data can be collected via pre-post screenings and surveys, or by ongoing utilization of validated screening tools embedded in apps to provide measurement-based care. Supervisors can review dashboards to identify sites, or individuals, that may have variations in performance, which can then be investigated in a timely, data-driven manner.

A myriad of data collection tools can be used, including ONA, CommCare, DHIS2, Kobo Toolbox, etc.

5. Client-Facing Tools

Digital apps and chatbots (AI-driven or otherwise) for clients can be built for coaching, between counseling session practice, and self-care.

These can be part of hybrid programs, such as the WHO Step-by-Step, a self-help program, which has been digitized with light-touch support from a FLW. Further the MindLAMP project has built a client-facing app collecting passive and active user data on a variety of measures and incorporates self-care, mindfulness, and other helpful tools for users.

EMPOWER India is testing out PracticePal, a client-facing chatbot used at home between sessions to support clients to practice techniques they have learned from FLWs in sessions. There is the KeepChatty app from Uganda’s Awesome Minds Speaks, which provides real-time, private support services to young people.

Wysa, a client-facing conversational agent, utilizes cognitive-behavioral therapies and has strong clinical evidence on its use to impact mental health, and they have announced they are developing support in additional languages.

 By Lauren Magoun of Dimagi