Expanding the Non-Clinical Mental Health Workforce: Protocol for a Randomized Controlled Trial of a Psychological...

In 2022, half a million residents of New York City reported being unable to access mental health services. One solution to combat this service gap is community-initiated care (CIC), in which staff, who are not mental health specialists, at community-based organizations (CBOs) identify clients experiencing distress and then deliver a brief psychological intervention. CIC is intended to reduce barriers to accessing care, lessen costs, and prevent stigma. In this protocol, we describe a trial designed to evaluate implementation of CIC in New York City using a psychological intervention that has been successful globally for rapid deployment by people who are not licensed mental health clinicians.

This protocol describes a cluster randomized controlled trial that will compare CBOs where non-clinical staff are trained to deliver the World Health Organization's Problem Management Plus (PM+) intervention versus CBOs providing care as usual. Forty-two CBO sites, the unit of clustering, will be randomized 1:1 to either condition. Approximately 1000 CBO clients (26-28 per site) will be recruited. Approximately 45 CBO staff (2-3 per site) in the intervention arm will be trained to deliver PM+. The primary outcome is distress at 20 weeks post-baseline, assessed with a personalized measure of psychological distress (the Psychological Outcome Profiles Questionnaire). Cost-effectiveness will be evaluated. Ethical approval: August 3, 2022.

The study described in this protocol will yield evidence on effectiveness of CIC delivered by non-clinical staff. Findings will help policymakers determine how to invest in and support non-clinicians in the United States and globally.