South Asian Hub for Advocacy, Research and Education on Mental Health

The rates of perinatal depression in South Asian women are reported to be amongst the highest in the world, ranging from 18%-30% in urban areas and 28% to 36% in rural areas. As a result, maternal depression has been identified as a priority area for intervention to improve maternal and child health outcomes. Systematic reviews in high-income countries provide robust evidence that perinatal depression can be effectively managed with psychological treatments and there is increasing global evidence that non-specialist health workers, such as community health workers (CHWs) can effectively deliver such interventions. The largest reported effects have been achieved by the Thinking Health Program (THP), developed and evaluated by Rahman and colleagues in Pakistan, in what was the largest randomized controlled trial for perinatal depression in the world which halved the rates of depression of compared to Enhanced Routine Care and led to significant improvements in women’s functioning and disability, reduced diarrhoeal rates and increased immunization rates among the infants of the treated mothers. SHARE has the goal to facilitate evidence based mental health policy and program implementation in South Asia. The above mentioned institutions have collaborated to develop an innovative, effective and sustainable approach for the delivery of an established psychological treatment that reduces the burden of depression in mothers in South Asia.

SHARE Programme will adapt the original Thinking Healthy Programme, which was delivered by Community Based Agents (Lady Health Workers), for delivery by Peers. Thus SHARE-Thinking Healthy Programme by Peer delivery (THPP), aims to address a key barrier to the scaling up of mental health interventions in LMIC (Low and middle income countries), the lack of trained human resources, by adapting an existing evidence-based intervention so that it can be delivered by Peer Support Workers (PSWs) – experienced women living in the same community – in partnership with established Lady health workers (LHWs). The SHARE-THPP intervention will be developed through extensive formative research and piloting the intervention with PSWs to evaluate the feasibility and acceptability of the implementation of the intervention. The main objectives of the study are to adapt the existing cognitive behavioural therapy-based THP intervention; to evaluate the impact of adapted THP intervention package, called Thinking Healthy Program – Peer delivery,(THPP) on maternal mental health , disability and on child health outcomes, and to monitor and evaluate all aspects of the intervention, its delivery process and implementation.

The effectiveness of the resulting intervention will then be evaluated through randomised controlled trials in three diverse settings in South Asia: community based rural populations of Rawalpindi, Pakistan; populations displaced by disaster and/or conflict in Swat, and facility based urban populations in Goa, India. It will be delivered in partnership with CHWs in all these settings.

SHARE has the potential to advance our knowledge of the extent to which task-shifting can be implemented through lay persons, offering a potential opportunity to access a vast untapped human resource for mental health care and addressing a major barrier – the lack of human resources in the formal health sector – to scaling up mental health services in low resourced settings.