Mental health promotion by local governments: a consensus study on community mental health workers

Mental illness is a leading cause of disability worldwide and requires responses that extend strictly clinical care. Community health workers are increasingly recognized for their potential, yet no clear guidelines exist regarding their roles and training in mental health. This study aimed to establish expert consensus on a framework for implementing a Community Mental Health Worker Program within local governments, focusing on training requirements, strategic priorities, service delivery approaches and potential forms of funding.

A three-round Delphi study was conducted with thirty experts. Participants rated fifty-seven items, ranked two sets of options, and answered three open-ended questions. Consensus was defined as 70% agreement (rated as "strongly agree" or "agree") or disagreement (rated as "strongly disagree" or "disagree") on a five-point Likert scale.

Fifty-one items reached consensus. The ranking questions achieved moderate to strong agreement by round three. The open-ended responses generated 226 segments, grouped into twenty categories. Experts agreed that community mental health workers play a vital role in community-based mental health promotion, working collaboratively and intersectionally with various stakeholders. However, appropriate training is lacking and is considered crucial for ensuring their public recognition. Providing adequate funding is considered the primary incentive for implementing such programs.

This study made it possible to gather consensus on the critical role of community mental health workers and the urgent need for structured training programs at the local level. It also identified key elements and strategic strategic approaches essential for implementing a successful Community Mental Health Worker Program.