An evaluation of mental health capacity building among Community Rehabilitation Officers in Malawi: A mixed-methods case study

Abstract

BackgroundThe World Health Organisation's Mental Health Gap Action Programme (mhGAP) training has been delivered throughout sub-Saharan Africa to enhance health workers' capacity to provide mental health care. mhGAP training evaluations typically assess one or two soft skills, namely trainee confidence to identify, manage, and refer people with mental illness, and their attitudes towards people with mental illness. This research expands on these evaluations by assessing changes in Community Rehabilitation Officers' (CROs) knowledge and self-efficacy to identify, manage, and refer people with mental illness, in addition to their confidence and attitudes. The relationship between changes in CROs' attitudes and changes in their knowledge, confidence, and self-efficacy, and perceptions of CROs' capacity in delivering community mental health care are also explored. Material and methodsIn this mixed-methods study, fifty-seven CROs who participated in mhGAP training in Malawi were assessed on knowledge, confidence, and self-efficacy in delivering mental health care and their attitude towards mental illness. Two programme managers and seven facilitators were interviewed to investigate their perception of CROs' mental health care delivery capacity post-training. ResultsOnly CROs' confidence and self-efficacy scores improved post-training. No relationship was found between changes in attitude scores and knowledge, confidence, and self-efficacy scores. Programme managers and facilitators identified instances where training positively impacted CROs’ delivery of mental health care. However, they questioned its long-term sustainability. ConclusionsmhGAP training was found to enhance CRO confidence and self-efficacy in Malawi. Thus, mhGAP training may help in improving the confidence and self-efficacy of non-specialist health workers in this context. How mhGAP training impacts changes in knowledge and attitudes towards mental health requires further exploration. CROs' sustainable provision of mental health care in resource-constrained contexts needs to be addressed. Findings add to the evidence on the impact of mhGAP training in building health workers’ mental health care delivery capacity.