Nurse‐led task‐shifting strategies to substitute for mental health specialists in primary care: A systematic review.

Aim: The study aimed to synthesize evidence comparing task‐shifting interventions led by general practice nurses and mental health specialists in improving mental health outcomes of adults in primary care. Design This study used a systematic review of randomized controlled trials. Data Sources: Articles from the databases CINAHL, MEDLINE, APA PsycInfo, PubMed, EMBASE, Cochrane EBM Reviews, Web of Science Core Collection, and ProQuest Dissertation and Thesis published between 2000 and 2020 were included. Review Methods: The review was arranged based on the Cochrane Collaboration guidelines and reported using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA). Results: Twelve articles met the eligibility criteria. Eight studies revealed that nurse‐led intervention was significantly superior to its comparator. The review identified three major themes: training and supervision, single and collaborative care and psychosocial treatments. Conclusion: Nurses could be temporarily employed to provide mental health services in the absence of mental health specialists as long as appropriate training and supervision was provided. This finding should be interpreted with caution due to the high risk of bias in the studies reviewed and the limited generalisability of their findings. Summary statement: What is already known about this topic? The shortage of psychiatrists and other mental health professionals has been causing treatment gaps in mental health care, not only in developing countries but also in developed countries.Task‐shifting or task‐sharing is one of the most promising strategies in addressing the treatment gap, but the involvement of nurses in this strategy is barely studied. What this paper adds? This paper explores the effect of task‐shifting and task‐sharing interventions led by general practice nurses for adults with mental disorders in primary care and found that nurses could deliver psychosocial interventions normally delivered by mental health specialists with at least the same quality provided they received proper training and supervision.This paper presented a theoretical framework of task‐shifting. The implications of this paper: In the absence of mental health services in primary care, general practice nurses could be temporarily employed to fill the vacancies.However, appropriate training and supervision are required before the programme is started to make sure that the nurses are adequately prepared to undertake the new roles in practice.The implementation of task‐shifting and task‐sharing requires a well‐planned and gradual implementation strategy to avoid burnout and workplace‐related distress in the target health workers. [ABSTRACT FROM AUTHOR]