Barriers and Facilitators to Implementation of Mental Health Task Sharing in Community-Based Services for Older Adults: A Qualitative Study

Background and Purpose: Older Chinese adults are the fastest-growing population among older immigrants and have a high prevalence of mental health diagnoses. Yet, segregation between the health, mental health, and social care sectors results in discouragement and extended wait times when they seek help for mental health distress. To address this problem, the model of mental health task sharing has been developed in the U.S. and globally to provide a range of care, including screening, psychoeducation, and psychosocial treatment, and improve access. This study aimed to identify barriers and facilitators to effective implementation of mental health task sharing in community-based services mainly serving older Chinese adults.

Methods: This qualitative study was set within social care settings serving older adults in New York City. Semi-structured interviews were conducted with 30 service providers in 17 community-based organizations implementing mental health task sharing, including senior centers, social adult day care (SADC), and Naturally Occurring Retirement Communities (NORCs). Interviews lasted 30 to 90 minutes and were recorded, transcribed, and entered into ATLAS.ti 12 for data analysis. Data was reviewed and analyzed by two coders using rapid qualitative analysis. Two coders established preliminary themes based on major domains of Consolidated Framework for Implementation Research (CFIR) and compiled them into a template to summarize themes. Thematic content analysis was then conducted by two coders to develop a thematic matrix and identify and refine thematic findings to identify barrier and facilitator themes.

Findings: Results demonstrated four themes related to barriers (mental health stigma among older adults, low mental health literacy among social service providers, unclear roles and shortage of staff,) and four themes related to facilitators (culturally tailored engaging strategies, supportive leadership, strong teamwork, and collaboration with professionals). High rates of mental health stigma among older Chinese adults was the most salient barrier. Front-line workers often lacked systematic training in mental health and were unclear of roles when collaborating with mental health providers. A substantial shortage of Chinese-speaking mental health providers led to long waiting lists preventing successful referrals.

To normalize mental health and increase engagement, providers adopted culturally tailored strategies, including integration of mental health into health education, prolonged outreach, and culturally appropriate terminology. Leadership secured resources and supported front-line workers. Working closely as a team and collaboration with mental health professionals facilitated information exchange and created learning opportunities.

Conclusion and implications: This study is the first to explore implementation of mental health task sharing in community-based social services for older Chinese adults. Our findings demonstrated inequity in mental health care such as critical shortage of mental health providers and lack of professional training among social service providers serving the older Chinese community. More systematic integration of mental health was achieved by considering cultural nuances and detection and treatment for mental health illness was improved by culturally acceptable approaches. The results will lay the foundation for the development of implementation strategies to improve mental health task sharing in social service agencies to improve mental health access.