What did we want to know?
What are the most effective, scalable interventions to address widespread mental health issues that have surfaced during the COVID-19 pandemic?
This entailed conducting a multi-component review to answer the following questions on:
- the nature and extent of mental health issues arising during COVID-19
- the effectiveness of population-level mental health interventions and
- the factors potentially influencing scale-up of mental health interventions
What did we find?
- Rates of depression, anxiety and PTSD are higher than they were before the pandemic.
- Overall, there is review-level evidence that psychological interventions, delivered in schools, occupational settings, and the wider community, can have a positive impact on preventing and treating depression, anxiety, and PTSD.
How to achieve scale-up?
Primary studies provided evidence on scaling up of mental health and psychosocial interventions. The evidence suggest that programmes may be more likely to achieve scale-up if they:
- Increase access to services across time and place by digitising interventions and making them available online
- Expand the workforce by task shifting or task sharing from specialists to non-specialists
- Use technology and online provision to train non specialists and speed up workforce availability
- Enable self-referral and make mental health interventions more open access
Resource related factors
- Secure policy support and government funding for scaling by demonstrating evidence of impact
- Identify when additional resource is needed for scale-up to support greater implementation success
- Match service level to needs by identifying care pathways, signposting, or stepped care
- Integrate mental health services into primary care to make more efficient use of resources
- Employ effective leaders to gain lasting buy-in from stakeholders on scale-up of services
- Include knowledgeable local champions to promote new services at set- up and maintenance
- Gain the buy in of multi-stakeholders, including the implementers of programmes
Programme fidelity (to ensure scale up happens as intended)
- Provide training fidelity and knowledge transfer to provide skills for consistency in provision
- Use guidelines, templates, manuals to provide a common shareable framework for delivery
Monitoring and evaluation
- Use benchmarks and indicators to measure progress against and support future investment
- Include ongoing evaluation of the quality and feasibility of services and track scale-up progress
- Standardise training and adopt recognised accreditation models to disseminate the programme more widely and implement best practice while seeking greater reach
Test the acceptability of an intervention prior to scale-up
- Assess acceptability to implementers to anticipate potential organisational changes needed
- Assess acceptability to service users to ensures services are meeting needs and reach
- Engage with the socio-political context of programme implementation to assess and ensure fit
- Consider cultural factors and adaption needs by integrating local knowledge and practices with evidence-based programmes to contribute to contextually appropriate service delivery
Combine supply side and demand side approaches
- Use resource mapping to identify population needs and service gaps
- Take proactive efforts to raise awareness of the programmes in the target community
- Minimising barriers to service use through campaigns to reduce stigma towards mental ill health
How did we get these results?
This project contained three stages. First, we conducted an overview of systematic reviews on prevalence published between 2021-2022 identified from the IPPO Living Map. Second, we conducted an overview of systematic reviews on population mental health and psychosocial intervention sampling general populations. Third we conducted an analysis of primary studies on scale-up of interventions. Descriptive data on characteristics and findings were extracted and synthesised narratively and in tables.