Improving mental health literacy of frontline community health workers in a rural district of Pakistan: mPareshan project

Background In low- and middle-income countries, four out of five people with mental illness do not receive specialised treatment. Utilising non-specialist frontline workers to deliver basic mental health services at the community level therefore warrants exploration. Aims This study assessed improvement in the 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. Method Project mPareshan developed a training manual to enhance the mental health literacy of government-employed lady health workers (LHWs) and lady health supervisors (LHSs). Content was adapted from the World Health Organization’s Mental Health Gap Action Programme 2.0 intervention guide to suit the local context. A total of 72 participants (36 LHSs and 36 LHWs) from the Badin District, Sindh, Pakistan, received the training. Pre- and post-tests were conducted to assess changes in knowledge and skills, using the Wilcoxon signed-rank test. Results There was a statistically significant improvement in both knowledge (p < 0.01, r = 0.85) and competency (p < 0.01, r = 0.81) median scores following the mPareshan training. LHSs demonstrated higher percentage increase in knowledge and competencies in domains requiring practical application, such as coping mechanisms, psychosocial support and referral pathways, compared with LHWs, highlighting the importance of their supervisory role and support in mental health service delivery. Conclusions The mPareshan mental health training has the potential to improve the knowledge and competencies of community health workers. Such initiatives can be scaled up to enable frontline workers to function as an effective workforce in the absence of specialist mental health services.