The Effectiveness of Peer-Delivered Services in the Management of Mental Health Conditions: a Meta-Analysis of Studies f
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The Effectiveness of Peer-Delivered Services in the Management of Mental Health Conditions: a Meta-Analysis of Studies from Low- and Middle-Income Countries Zahir Vally 1 & Lameze Abrahams 2
Published online: 12 October 2016 # Springer Science+Business Media New York 2016
Abstract It has been suggested that peers, or lay persons, should be more readily utilized in the provision of some mental health services, particularly in poor contexts where limited resources invariably result in many clients not receiving suitable and timely services. A systematic review and meta-analysis was conducted of all studies where peers were trained to implement some form of mental health service delivery to individuals resident in low- and middle-income countries (LMICS). The analyses of 14 eligible studies (n = 18,411 participants) revealed that depression and post-traumatic stress (PTS) were the most frequently assessed outcome measures. Overall effect sizes of small and medium magnitude were yielded for depression and PTS, respectively, suggesting that services delivered by peers may be efficacious in LMICS. While these results are encouraging, they are preliminary, and recommendations are made relating to the selection, training, and supervision of peers. Keywords Peer . Mentor . Consumer . Meta-analysis . Mental health . Poor . Low-and-middleincome countries
Introduction Mental healthcare in low- and middle-income countries (LMICS) has undergone a number of changes in recent years, both with regard to the conceptualization of mental illness, but also in relation to the envisaged design and modes of service delivery. Specifically, the advent of the * Zahir Vally [email protected]
1
Department of Psychology and Counseling, United Arab Emirates University, Al Ain, Abu Dhabi, United Arab Emirates
2
Department of Psychiatry & Mental Health, University of Cape Town, and Lentegeur Psychiatric Hospital, Cape Town, South Africa
Int J Adv Counselling (2016) 38:330–344
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recovery movement has spurred a growing interest in psychosocial rehabilitation and prompted clinicians to redefine their understanding of treatment from one that sets as its primary goal symptom reduction to a much broader conceptualization (Kramers-Olen 2014). This revised conceptualization includes an acknowledgement of individuals’ strengths, values, and attitudes towards themselves and their illnesses. This renewed vision of recovery seeks the establishment of a life that is fulfilled, satisfying, and meaningful, despite the limitations imposed by a debilitating illness (Parker 2012). The changes indicated have occurred often within the context of amendments to legislature that have sought to directly impact upon the delivery of mental health services. In South Africa (SA), for example, one of the first changes to healthcare policy following the fall of apartheid was the introduction of the White Paper for the Transformation of the Health System (Department of Health 1997a) as well as the accompanying National Health Policy Guidelines for improved Menta
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