Barriers and Facilitators to Implementation of Mental Health Task Sharing Among Older Chinese Adults: A Qualitative Study.

Abstract

Mental health task sharing, which involves delegating select mental health tasks to non-licensed providers in social service settings, has been used globally and in the U.S. to improve access to and uptake of mental health care. This study aimed to identify barriers and facilitators to effective implementation of mental health task sharing in community-based organizations mainly serving older Chinese adults, a fast-growing older immigrant population with a high prevalence of unmet mental health needs. Semi-structured interviews were conducted in 2023 with 30 service providers from 17 community-based social service organizations in New York City that had implemented mental health task-sharing initiatives since 2016. Interview data were analyzed by two coders using the framework method, a systematic approach for managing and interpreting qualitative data through coding, charting, and thematic analysis, with codes reflecting key domains in the Consolidated Framework for Implementation Research (CFIR). Codes were further analyzed for the factors' positive or negative influence on implementation. Key barriers to the implementation of mental health task sharing included limited mental health resources, varying levels of staff mental health competencies, and insufficient financial incentives for social service organizations to provide mental health care. Facilitators to mental health task sharing implementation included supportive leadership, training, cross-system collaborations between mental health specialists and social service providers, and close teamwork between administrators and frontline providers in social service organizations. Study findings highlight the importance of more systematically integrating mental health and social care and of using culturally tailored strategies to engage different populations in care.