The question raised in the Lancet Psychiatry editorial is not about whether task-sharing with CHW is an alternative or substitute to psychiatric care, but rather how CHW delivered care can be used effectively in ALL settings as a complement or extension to psychiatric care. Thus, even countries (like the US and EU) which have a thousand fold greater psychiatric resources, half or more of people with mood and anxiety conditions receive no care. The fact that rich countries are now experimenting with CHW delivered care for mental health problems shows that this approach is at the heart of person-centred, community oriented, care as a key component of a stepped care architecture of service. Furthermore, it is absolutely true that mental illnesses are diverse, but the evidence on the use of task-sharing now spans a range of mental health conditions, from mood and anxiety disorders to PTSD to psychoses and autism.
The Pershing Square Professor of Global Health and Wellcome Trust Principal Research Fellow
Department of Global Health and Social Medicine
Harvard Medical School
Professor, Department of Global Health and Population, Harvard TH Chan School of Public Health
Co-Founder and Member of Managing Committee, Sangath
Adjunct Professor, Public Health Foundation of India
HIFA profile: Vikram Patel is a psychiatrist at Harvard Medical School (USA) and Sangath (India). He has a special interest in public health aspects of mental health in developing countries. He is the author of 'Where There Is No Psychiatrist: A mental health care manual'. Vikram_patel AT hms.harvard.edu