A systematic review of mental health training programmes for community-based volunteers to inform youth volunteers module development

Abstract

Introduction

Mental health disorders are a major problem globally, particularly among vulnerable groups such as youth. In resource-limited settings, community health volunteers (CHVs), including youth volunteers, play a crucial role in mental health promotion, stigma reduction, early identification of distress and referral to formal services. However, evidence on training components and delivery strategies of mental health training programmes for youth CHVs remains limited.

Objective

This systematic review following PRISMA guidelines aims to identify the key components, delivery strategies and reported outcomes of mental health training programmes for youth CHVs, in order to inform future module development to enhance volunteers’ motivation, self-efficacy, knowledge and communication skills.

Methods

English articles published between 2010 and 2024 were searched through PubMed, Scopus and Web of Science databases. Eligibility criteria included mental health training interventions for non-professional community volunteers, including youth volunteers with measurable outcomes. Data were extracted and quality assessment performed using the Mixed Methods Appraisal Tool (MMAT).

Result

Seven studies were included in this review. Training content focusing on mental health literacy, building communication and counselling skills, stigma reduction and mental health promotion demonstrated the most significant improvement in CHV’s knowledge, skills, and self-efficacy. Programs adapting interactive strategies of role-playing, case studies and group discussion, combined with classroom teaching methods were significantly effective as well. Participants expressed greater confidence in handling mental health disorders within their communities.

Conclusion

In conclusion, training programmes that prioritise mental health literacy, stigma reduction, supportive communication, self-care and help-seeking behaviour skill, implemented through interactive delivery methods are the most effective. The findings are essential for the future development of training module for youth CHVs to empower and enhance their capability to deliver effective mental health care within their community.

Trial registration

CRD42024562221 (PROSPERO).

Supplementary Information

The online version contains supplementary material available at https://doi.org/10.1007/s44192-026-00525-1.

Introduction

Mental health disorders are increasingly recognized as major contributors to global disease burden, with conditions such as depression, anxiety, and substance use disorders affecting about one in eight people worldwide [1, 2]. The urgency to address mental health from a young age is crucial as evidence shows that around half of lifetimes cases begin at age 14–15 years old [3] and if left untreated, can lead to long-term adverse outcomes. The World Health Organisation (WHO) highlights that one in seven adolescents experiences a mental disorder, contributing to a significant portion of the disease burden in this age group [2]. Furthermore, suicide ranks as the fourth leading cause of death among individuals aged 15–29, emphasizing the need for targeted mental health support [2]. Therefore, youth, defined variably across contexts but generally encompassing ages 15–30 in Malaysia [4], represent a key demographic for mental health promotion and prevention intervention efforts.

The introduction of community-based interventions through various cadres of community health workers, including community health volunteers (CHVs), has been identified as a critical approach to addressing these health challenges. The WHO defines CHVs as ‘lay health workers that have received training to promote health within their community but are not professionally trained as healthcare professional’ [5]. CHVs may or may not get compensation from government or non-governmental organisation (NGOs) they collaborate with. However, this rarely goes beyond transportation and miscellaneous expenses as an incentive for volunteering. Diverse terminology has been used to identify these unpaid community volunteers across different health systems such as community health workers, village health workers, peer supporters, lay volunteers, or community health influencers [6–8]. In this review, we refer to all as CHVs, distinguishing them from formal professional health workers within a nation’s health system.

In terms of mental health, CHVs play a pivotal role in reducing barriers to seeking mental health care, particularly among youth, where stigma often prevents them from accessing necessary services [9]. Engaging peers in health education and support can significantly reduce self-stigma among young individuals, thus mitigating the youth mental health disorder burden. The WHO Helping Adolescents Thrive guidelines recommend community-based promotive and preventive psychosocial interventions that cover social and emotional learning to promote positive mental health in adolescents [10]. Concurrently, there is other supportive evidence to indicate that community-based and peer-oriented interventions combining problem solving, resilience and coping skills, may significantly contribute to the promotion of mental health among children and young people [11–13]. Youth CHVs, which refers to youth who serve as volunteers in community or institutional settings, play a pivotal role in the promotion of mental health whereby in this review refers to activities that improve mental health literacy, reduce stigma, strengthen supportive communication, encourage early help-seeking behaviour and connect individuals to appropriate services. Youth CHVs are not intended to diagnose or treat mental disorders but rather to enhance preventive and promotional support within the community.

In Malaysia, CHVs have been used in community-based health promotion activities, including screening and prevention efforts for non-communicable diseases, including mental health. To facilitate their work, adequate training is important to give CHVs more confidence and credibility to carry out the task in the community [14–16]. However, despite their important role in health promotion and disease prevention, mental health-specific training for community volunteers remains insufficiently structured and lacks a clear synthesis of the content, delivery method and outcomes that are most relevant for CHVs roles. This hampers the ability of CHVs to effectively perform their roles and sustain community-based health programs.

Even though youth-oriented and peer-related approaches have been increasingly discussed, there is still a lack of clarity regarding which training components are suitable for youth CHVs who may assist in mental health promotion in community settings. Mental health literacy, stigma reduction, early recognition and facilitation of referral should be emphasized rather than therapeutic or clinical intervention. There is a clear need for a structured, evidence-based training module that addresses the specific needs of youth CHVs working in mental health, particularly focusing on enhancing their self-motivation, knowledge, communication skills and self-efficacy.

This systematic review aimed to identify the effective training components and delivery strategies of mental health training programmes for youth CHVs, as well as the reported outcomes of such programmes. The findings of this review are intended to guide the future development of a contextually appropriate training module for youth-oriented promotive and preventive mental health roles that will contribute to improvements in their self-motivation, knowledge, communication skills and self-efficacy as community health volunteers.

Materials and methods

The systematic review followed the PRISMA guidelines (Preferred Reporting Items for Systematic reviews and Meta-Analyses) [17]. The systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on June 5th, 2024 (registration number CRD42024562221).

Search strategy

Searches were performed on three databases: PubMed, Scopus and Web of Science. The searches were conducted on October 9th, 2024. Selected subject headings, keywords and related synonyms were used together with Boolean operators (OR, AND) to search for relevant articles. The search strategies used for related articles are provided in Table S1. Results were de-duplicated using SR-accelerator, a systematic review platform. The reference lists of all included articles were searched to identify additional references that might have been missed.

Study eligibility criteria

All articles resulting from the search that were published in English over the last 14 years (2010 to 9th October 2024) were assessed. Publications in English were included as the review sought to synthesise evidence from peer-reviewed literature available to the research team in English. However, the findings could later be translated and culturally adapted in Malay language. The year 2010 was selected as the starting point as it corresponds to the publication of the WHO mhGAP Intervention Guide version 1.0 [18], a technical resource to support delivery of community-based mental health care, reflecting an increasing global focus on task-sharing to reduce mental health treatment gap. Articles were included if they met the following eligibility criteria:

1. P – Population All or part of the study population are youth volunteers aged 15–30 years old that operate within community or institutional organisations; and

2. I – Intervention/Exposure Mental health training, workshop or program provided to the community health volunteers; and

3. O – Outcomes Changes in self-motivation, knowledge, communication skills or self-efficacy; and

4. Study Design Studies published in a peer-reviewed journal as a randomised control trial (RCT), quasi-experimental study, pre-post intervention study, or qualitative study.

Study selection

Titles and abstracts of all eligible studies were screened independently by two researchers. Full papers were assessed for inclusion independently by two researchers and any discrepancies were resolved through discussion.

Data extraction

Extracted data from the included studies were presented in Microsoft Excel. Data extracted includes the title, authors, publication year, country of study, study design, training participants, training aim or objectives, training content, training duration, training delivery strategies, comparator (if any), study outcome(s), outcome measurement method, and key findings. Data extraction was performed by one researcher. Intervention teaching methods were classified as didactic (if exclusively made up of lectures), interactive (if active participation by the trainees were included) and mixed if both were used [19].

Risk of bias (quality) assessment

The methodological quality was assessed by two independent researchers using tools appropriate to the study design of included studies. Discrepancies between reviewers were resolved through discussion and a third reviewer adjudicated when consensus was not reached. The Mixed Methods Appraisal Tools (MMAT) was used for quality assessment [20]. This tool can be used to evaluate the methodological quality of five different types of studies, namely mixed method studies, randomised controlled trials, non-randomised studies, quantitative descriptive studies, and qualitative studies. For each study design, MMAT evaluates five criteria related to study’s quality. Examples include appropriateness of sampling strategy, representativeness or relevance of participants, completeness of outcome data, appropriateness of measurements, control of confounding, coherence between data sources and interpretation, and integration of qualitative and quantitative components. The detailed criteria applied to each included study are presented in Table S2. Each item was assigned with equal weight and the final score was the sum of the five individual items. Notably, it is generally not recommended to display the ratings’ overall score as the information on problematic aspects will be lost with the presentation of the overall score of the ratings [20, 21]. However, in this review, the MMAT scores for the included studies will be reported in range from 0 (none of the criteria are met) to 100% (all criteria are met) for clarity and interpretation.

Results

The search yielded a total of 1448 records from the three databases. 68 duplicate records were removed, leaving 1380 records for title and abstract screening. Then 1361 articles were removed, leaving a total of 19 for full text reading. After full text reading, a final total of seven articles were included in the present review. The PRISMA flow chart is presented in Fig. 1.

Fig. 1.

PRISMA flow chart

Study characteristics

Of the studies included, four were mixed method [22–25], two pre-post-test design [26, 27] and one qualitative study [28]. Studies were conducted in different regions with two in India, one in Canada, one in Rwanda, one in Bangladesh, one in Indonesia and one in Myanmar. Across the studies, different terms were used to describe the participants being trained, including community health workers, peer support workers, peer responders, and lay mental health workers (Table 1). For consistency in this review, all of these participants were grouped under the term community health volunteers (CHVs), since they were all non-professional, community-based members involved in providing mental health support. The included studies reported participants’ age ranged between 18 to 59 years and mostly were not limited to youth-specific populations. Therefore, the results are most directly applicable to non-professional community mental health support roles rather than exclusively to youth volunteers. A summary of included studies is provided in Table 1.

Table 1.

Characteristics of training interventions

Author (year) Country	Study design	Training participants	Number of participants in study	Training objective / aim	Training content	Training duration	Training delivery strategy
Armstrong et al. (2011) [26] India	Pre-post-test design	CHWa in Bangalore rural district India (mean age 37, range 21–59 years)	70	To increase recognition of mental disorders, enhance appropriate response and referral, support people with mental disorders and their families; and improve mental health promotion in communities	1. Introduction to mental health and mental disorders (risk factors, symptoms, and common disorders) 2. Mental health first aid 3. Practice-based skills (Counselling and problem-solving techniques, referring and understanding drug treatments) 4. Mental health promotion (stigma and discrimination, poverty and mental health, gender and mental health)	4 day course	Mixedb (didacticc lessons, discussion and role-play)
Marastuti et al. [22] Indonesia	Mixed method	CHW in two different districts in Indonesia (age range 26–56 years)	65	To improve the CHWs' knowledge about mental health disorders and encourage another health care task	Integrative training model of 9 sessions: 1. Introduction and self-exploration 2. Mental health and mental disorder 3. Psychotic illness 4. Non-psychotic illness 5. Understanding CHW's role in the health system 6. Intervention 7. Basic counselling 8. Field trip 9. Developing plan of action	4 days of classroom-based and 1 day field trip to mental health hospital	Mixed (didactic lessons, discussion, games, case study, role-play and movies)
Willems et al. [23] Rwanda	Mixed method	CHWs from 30 districts in Rwanda age range 20–50 years	51,858	Supporting CHWs to recognise signs of mental disorder and to provide first aid and referral advice for further professional care	Eight modules: 1. Introduction to common mental disorders 2. Mental disorders I (symptoms and risk factors) 3. Mental disorders II (basic first aid) 4. PTSDd I (symptoms and signs) 5. PTSD II (first aid and referral) 6. Depression 7. Drug use 8. Epilepsy	Two modules per week over 4 weeks	Using Interactive Voice Response (IVR) technology to deliver audio-based modules through phone to the CHWs
Bourdon et al. [24] Canada	Mixed method	Volunteered youth with interest in becoming peer support workers (PSWs) and paid PSWs age range 16 to 45 years	5	To train employees and youth interested in peer support work on key elements in supporting youth with mental health disorders	Peer Support Fundamentals (PSF) training: 1. Definitions and benefits of peer support 2. Roles, values, and principles of peer support 3. Mental health, mental disorders, risks factors and stigma 4. Towards recovery and treatment 5. Boundaries in peer support, supporting versus rescuing 6. Communication skills 7. Self-care and wellness map 8. Safety and security, trauma-informed support, suicide, and self-harm	One theme per weekly session (2 h each), for total of 16 h	Mixed online training (group format) using PowerPoint slides, as well as discussion and role-plays
Gyee et al. [27] Myanmar	Pre-post-test design	CHWs aged 18 years and above	76	To train CHWs to raise awareness, identify and screen for mental disorder and make decisions on referral to GPe	Training module based WHO mhGAPf Intervention guide: 1. Psychotic disorder 2. Depression 3. Epilepsy 4. Conducting awareness and psychoeducational activities	One-and-a-half-day session	Didactic
Pallikkuth et al. [25] India	Mixed method	Lay mental health workers with volunteering experience of 1 year (mean age 42.6, range 22–56 years)	13	The training program aims to develop lay mental health workers knowledge, skills and attitude	Mental Health Action Trust (MHAT) training program: 1. Mental disorders 2. Common factors in psychological interventions 3. Family psycho-education 4. Activity scheduling 5. Social skills training 6. Assertiveness training 7. Relapse prevention training 8. Communication training 9. Problem solving training	6 h / week over 2 months	Mixed (didactic, interactive discussions, small group discussion, simulation games, role plays, video presentation and feedback)
Koly et al. [28] Bangladesh	Qualitative	Volunteered peer responders with age range of 20 –38 years old	18	The training program aims to promote community-based, inclusive mental health services for people with disabilities in Bangladesh	Peer-responder training (PRT) programme 1. Module 1: Understanding basic mental health 2. Module 2: Community based mental health services (psychosocial support and its techniques, management of mental health conditions) 3. Module 3: Mental health and social context (community-level stigma, mental health, and gender-based violence, mental health during crises, mental health and disability, self-care)	5 days	Mixed (didactic, discussion, roleplay)

^aCHW = Community Health Worker; ^bMixed = Interactive and didactic; ^cDidactic = lectures; ^dPTSD = Post-traumatic Stress Disorder; ^eGP = General Practitioner; ^fmhGAP = Mental Health Gap Action Programme

Quality assessment

According to the MMAT evaluation criteria, the quality assessment scores ranged from 60 (three criteria met) to 100% (all criteria met). The quality assessment for each study is presented in Table S2. The overall methodological quality of the included studies varied. All studies met the MMAT screening criteria with well-defined research questions and generally relevant data. The qualitative study satisfied all five criteria, whereas mixed methods studies frequently demonstrated good integration but occasionally lacked clear explanation, thorough interpretation of integrated findings, or evidence of rigor in each component. The primary drawbacks of non-randomised studies were inadequate confounding control and ambiguous participant representativeness. Overall, the evidence was moderate to high in quality, but these limitations should be taken into account when interpreting the findings.

Characteristics of training interventions

All seven training interventions aimed to improve knowledge and awareness of mental health. Further elaboration of the training objectives is summarised in Table 1. Five (71%) out of seven training interventions were taught by local mental health professionals, mainly psychiatrists, psychologists and mental health nurses [22, 25–28]. One intervention was taught as an online course [23] and one intervention was delivered through collaboration with national mental health association [24]. The interventions varied in structure and mode of delivery with some programmes adapted to participant roles and local context, such as including peer-support content for youth settings, community-based mental health service content, field-based learning or using remote audio-based delivery for geographically dispersed volunteers [22–24, 28].

In terms of training duration, one intervention lasted for a short period of one and a half days [27], whereas three interventions lasted for four days to five days [22, 26, 28]. Another three interventions were given in regular sessions (e.g., six hours per week over two months, two modules per week over four weeks, two hours per week over eight weeks) [23–25]. One intervention specifically included a one-day field trip to mental health hospital at the end of classroom-based teaching [22]. None of the included studies used a comparator group.

Training delivery strategy

Five (71%) of seven interventions used mixed training strategies in which a combination of didactic and classroom-based interactive strategies were used [22, 24–26, 28]. The interactive strategies included group discussions, role-play, case studies, and simulation games. One intervention used didactic strategy as the sole method [27] and one intervention for volunteer workers in a remote location used an interactive voice response technology to deliver audio-based modules through phone application [23].

Training content

The training content varied across the studies included. Five interventions covered general topics in psychiatry, including risk factors, signs and symptoms of common mental disorders. Out of these, four interventions taught communication and counselling skills, two emphasised trainers’ roles and mental health promotion, including stigma, and one intervention taught additional mental health first aid. Two interventions focused more on specific topics of mental health, in which one was more focused on post-traumatic stress disorder (PTSD) and another followed a well-structured WHO mental health training intervention guide for non-specialist workers [29] focusing on psychotic disorders, depression and epilepsy. The description of training content is summarised in Table 1.

Outcome measurement method

Six out of seven training interventions used a pre-intervention and post-intervention design in evaluation of outcomes [22–27] (Table 2). Out of these, four courses collected additional evaluation data at later follow-up times post-intervention to assess for outcome changes and one course collected written feedback from participants at the end of each training session while the course was ongoing. One intervention was designed to collect evaluation outcomes at post-intervention [28].

Table 2.

Outcomes and key findings of included studies

Author (year)	Outcome measures	Outcome type	Outcome method	Outcome assessment	Significance	Key findings
Armstrong et al. [26] India	Knowledge, stigmatising attitude	Quantitative	Vignette and questionnaire	pre-intervention, post-intervention and at 3 months follow up	Significant improvement	Improvement in knowledge (22.7% at baseline to 43.9% at 3 months, p = 0.022), and minor reduction in stigmatising attitudes towards depression (84.8% at baseline to 62.1% at 3 months, p = 0.009)
Marastuti et al. [22] Indonesia	Knowledge and personal experience	Mixed	Questionnaire, daily journal record	pre-intervention, post-intervention and at 4 months follow up	Significant improvement	Statistical testing was reported for knowledge only, whereas qualitative analysis of daily journal record for personal experience. Mean knowledge score increased (11.9 at baseline to 15.3 at 4 months, p < 0.001). Overall, participants recorded positive experiences after undergoing training and training improved their knowledge gain, self-affirmation, empathetic feelings toward patients with mental disorder and willingness to take action and provide help
Willems et al. [23] Rwanda	Knowledge, confidence, acceptability of training	Mixed	Questionnaire, post-training focus group	pre-intervention and post-intervention	Improvement in knowledge and confidence	Training improved knowledge with 41.7% of CHWs had improvement in total knowledge score at endline compared to baseline. At endline, 86–93% of CHWs reported confidence across different tasks including referring patients with mental disorder to hospital and providing community/family education on mental health topics. Training content was considered interesting, easy to understand, and helpful to intervene appropriately to refer patients with signs of mental disorder to hospital and to provide community and family education at community level
Bourdon et al. [24] Canada	Level of implementation fidelity of the training and perceived level of understanding	Mixed	Questionnaire, written feedback (collected within 24-48 h post-intervention and at one month)	Pre-intervention, within 24 h to 48 h post-intervention and one month follow up	Not stated	The perceived level of understanding for various components of training were similar and high at all time points (mean score of 3.96/5 or greater). Qualitatively, five main themes emerged for training impact, which were (1) feeling better prepared to provide peer support, (2) importance of self-care, (3) importance of setting boundaries, (4) active listening, and (5) anxiety relief
Gyee et al. (2022) [27] Myanmar	Knowledge, attitude and practice (KAP)	Quantitative	Questionnaire	Pre-intervention, post-intervention and 6 months follow up	Significant improvement	Training improved knowledge, attitude and practice by 7.4% between pre- and post-training, which was mainly driven by knowledge (+ 10.5%, p = 0.001). Significant increase in KAP score by 24.0% (p < 0.0001) from post-training to 6 months follow up, driven by attitudes (+ 8.9%, p = 0.01) and practices (+ 73.2%, p < 0.0001)
Pallikkuth et al. [25] India	Knowledge, perceived behavioural and attitude changes post-training	Mixed	Questionnaire, written feedback and self-reflection report collected during training	Pre-intervention, post-intervention and at the end of each day of training for self-reflection report	Significant improvement	Training increased knowledge on psychosocial interventions for severe mental disorder (t = -7.28, p < 0.001). Self-reflection reports showed improvement in personal attitudes (including optimism about the efficacy of treatment, reduced stigma, empathy) and positive interpersonal behaviour changes (including interpersonal problem-solving skills, emotional regulation, active listening, and distress tolerance)
Koly et al. [28] Bangladesh	Feasibility of the training programme	Qualitative	Focus group discussion	Post-intervention	Not stated	Three major themes identified, namely (1) Acceptability and programme relevance; (2) Perceived programme benefits; and (3) Challenges and barriers Overall, the training programme was feasible with potential benefits including increased mental health literacy, eradicating stigma and improving the well-being of trained person. The programme also motivated participation when participants were provided with mental health literacy, capacity-building opportunity and sense of empowerment

The majority of training interventions (57%) collected mixed data, while two interventions (29%) collected quantitative data alone and one (14%) collected qualitative data only. Most training interventions used questionnaire or vignettes. Vignettes refers to concise case descriptions used to evaluate participants’ ability to recognise mental health disorders, determine appropriate responses and indicate referral actions. Three training interventions used trainees’ written feedback or daily journals to collect additional evaluation data. Furthermore, focus groups were also used to establish the outcome of training interventions.

Outcome evaluation

The outcome evaluation of the included studies is summarised in Table 2. Six out of seven studies (86%) measured changes in knowledge on mental health following training intervention. Five studies assessed knowledge by using before-and-after questionnaires or vignettes that tested participants’ understanding of mental health content, such as recognition of mental disorders, symptoms and risk factors, psychosocial intervention concepts, and appropriate first aid or referral responses, and all reported improvement in knowledge scores [22, 23, 25–27]. One study had a post-intervention focus group discussion on training intervention feasibility in which the participants reported improvement in mental health literacy [28]. The remaining study that did not measure knowledge changes did measure level of understanding through written feedback post-intervention and reported improvement in perceived level of understanding [24].

Two studies measured changes in attitude using pre- and post-intervention questionnaire [26, 27], including one study that explored perceived attitude change post-intervention through written feedback and self-reflection [25]. The attitudes explored mainly related to people living with mental disorders and the mental disorders themselves, including stigmatising beliefs, empathy, optimism regarding treatment effectiveness and willingness to offer supports. All three studies showed significant improvement in attitudes. In terms of self-efficacy, we regarded the study by Willems [23] that measured confidence level of trainees as measuring self-efficacy. The study measured trainee confidence level through pre- and post-questionnaires in which at endline, 86–93% of CHWs reported confidence in referring individuals with mental disorders and in providing education on mental health topics in their community [23].

One study measured trainee practice using questionnaires before and after intervention, and at six months follow-up [27]. Practice improvement referred to the self-reported performance of CHVs in community mental health tasks, encompassing activities such as raising awareness, identification or screening for mental disorders, and referral decision-making. The study reported significant improvement in overall practice scores at both time points post-intervention [27]. Three studies measured feasibility, acceptability, and implementation fidelity of training interventions [23, 24, 28], all of which received positive feedback from trainees.

Discussion

Our systematic review identified seven studies that examined the aspects contributing to the effectiveness of mental health training for community-based non-professional volunteers with reported outcomes related mainly to knowledge, attitudes, practice, confidence, acceptability and feasibility. Overall, the findings indicate that training programmes with well-defined content, hands-on skill development, and interactive methods of delivery were linked to better learning outcomes among volunteers. Some studies also emphasised the value of tailoring both the content and delivery of programmes to suit the local context and the specific needs of participants. Such programs improved volunteers' knowledge, attitudes, practice and confidence levels, empowering them to effectively support individuals dealing with mental health disorders, especially in resource-limited settings. However, the included studies were not limited to youth-only populations as majority of the studies involved participants of broader age groups ranging from 21 to 59 years. Therefore, the findings are most directly applicable to non-professional community volunteers in a broader sense, while providing indirect guidance for the future development of youth-oriented training modules.

The methodological quality of findings also offer important context for interpreting these results. The clearly stated research questions and data collection methods that aligned with the study objectives were strengths of the included studies. The qualitative study showed strong methodological coherence, and several mixed methods studies demonstrated effective integration of quantitative and qualitative components. However, the MMAT assessment also identified recurring limitations. In the non-randomised studies, participant representativeness was either limited or ambiguous, and confounding factors were not consistently accounted for, hence reducing confidence that the training alone resulted in observed improvements. The findings indicate that while the current literature supports the potential value of mental health training for community-based volunteers, the strength of the conclusions is still limited by weaknesses in study design and reporting.

The review highlights the importance of thorough mental health training programs that focus on literacy and practical skill-building. Training programs that focus on mental health literacy, including recognizing symptoms and risk factors, significantly improved CHVs' knowledge and confidence [22, 26, 27].

Communication and counseling skills, including active listening, empathy, and interpersonal problem-solving, were frequently included as training features. However, these skills were not routinely measured as separate outcomes [25, 26, 28]. Additionally, training programs that included strategies to reduce stigma and build trainees’ resilience created a more supportive environment for CHVs [22, 24]. Training modules that included self-care and emotional regulation were also found to improve CHVs' overall well-being, which is crucial for maintaining motivation and performing effectively in challenging situations [24, 25].

Although the studies used different training program interventions, the content of the training programs, based on five studies that showed significant results [22, 23, 25–27], can be categorised into six components. The most common component is basic mental health knowledge which focuses on the understanding of mental health disorders, their symptoms and risk factors, as well as basic understanding of stigma and discrimination. The second common component is the specialised intervention which is used in disease-focused programs and involves training on specific mental disorders such as depression or PTSD. The training included relapse prevention, activity scheduling and psychoeducational techniques. The practical skills component comes third and includes counselling and communication skills building, problem-solving skills and referral strategies. Next is the mental health promotion component which aims to increase mental health awareness within the community as well as addressing sociocultural factors such as gender-based violence, poverty and disability. The mental health first aid component trained volunteers to recognise early symptoms and learn skills to assist an individual until help arrives such as in the case of self-harm or suicide. One of the studies included a self-care component which provided strategies for personal wellness and building resilience for the volunteers. These training content components are illustrated in the Fig. 2.

Fig. 2.

Components of training content used for training program intervention across significant studies

In terms of program delivery methods, effective training programs often used a mixed-method delivery, which combined traditional teaching with hands-on experiences. The review identified interactive strategies, like role-playing, group discussions, and case studies, as important for strengthening knowledge application and increase self-efficacy of CHVs [22, 24, 25]. These strategies allowed CHVs to learn through experience, helping them internalize knowledge and apply it confidently. Additionally, blended learning, which includes both digital platforms and in-person sessions, has been particularly helpful in reaching CHVs in remote areas [23, 24]. For instance, using audio-based modules through interactive voice response technology has made training more accessible and facilitated remote learning [23].

The duration and structure of a training program can also play a role in their success. Short, intensive training sessions are good for teaching basic knowledge, while longer, recurring sessions help reinforce and retain more complex skills [22, 25]. In terms of structure, training programs need to be customized to align with the cultural norms and specific needs of the participants. Programs that are built by accommodating the needs of participants in mind have been shown to increase engagement and sustainability [22, 24, 27].

Implications for practice

The review demonstrates that it is important to provide CHVs with training that is relevant to their context to empower them. In Malaysia, where mental health literacy remains limited and stigma surrounding mental disorders persists [30], it is crucial to offer training that is tailored to the local culture. A future training module intended for youth mental health promotion should focus on competencies that are appropriate for non-professional roles, such as enhancing mental health literacy, reducing stigma, enhancing supportive peer communication, recognising early signs of psychological distress, maintaining personal well-being and promoting appropriate help-seeking behaviour. Using digital tools like mobile learning platforms can make training more accessible and cost-effective. Equipping CHVs with skills to prioritize their well-being and resilience can prevent burnout and motivate them to continue supporting others effectively.

Limitations and future directions

Despite the intended downstream applicability of the findings to youth-oriented module development, a key limitation of this review is that the included studies were not exclusively conducted among youth volunteers. Therefore, the results should be interpreted as evidence for non-professional community mental health training with only indirect relevance to youth-specific volunteer training programs. Another limitation is that none of the studies measured motivation as the outcome of training program. Communication skills were also more frequently included as training feature rather than measured as an outcome. This limits our evidence-based findings on the training content that can improve motivation and communication skills of volunteers. In addition, data extraction was performed by one researcher and was not independently validated by another reviewer, which may increase the possibility of extraction error. Most studies have only assessed the immediate post-training performance of CHVs, without considering the long-term impact. Future research should focus on youth-specific, long-term studies to see how training affects CHVs' performance and mental health outcomes in the communities they work in. Additionally, the efficacy of digital learning in training CHVs and reaching a broader audience in need of support warrants further investigation.

Conclusion

In conclusion, this study provides valuable insights into the effective components and delivery methods for mental health training modules designed for CHVs. The most promising training approaches are those that prioritise mental health literacy, stigma reduction, supportive communication, self-care and help-seeking behaviour skills, particularly when implemented through interactive and context-sensitive methods. The findings have the potential to influence the future development of a training module tailored to youth CHVs in community settings. By incorporating evidence-based strategies, we can empower CHVs to deliver more effective care, ultimately leading to better community health outcomes.

Supplementary Information

Below is the link to the electronic supplementary material.

Abbreviation

CHV

Community health volunteer

CHW

Community health worker

GP

General practitioner

MHGAP

Mental health gap action programme

MMAT

Mixed method appraisal tool

MOH

Ministry of health

NMRR

National medical research register

PRISMA

Preferred reporting items for systematic reviews and meta-analyses

PSW

Peer support worker

PTSD

Post-traumatic stress disorder

WHO

World health organisation

Author contributions

Siti Norain Sallahuddin conceptualized the study, developed the research protocol, and conducted the systematic review, including literature search, screening, data extraction, and synthesis. She drafted the manuscript and revised it critically for intellectual content. Nur Atiqah Mohd Ahwan contributed to the screening of articles and data extraction processes. Rosnah Sutan, as supervisor, provided guidance on methodology, and interpretation of findings, and contributed to the critical revision of the manuscript. All authors reviewed and approved the final version of the manuscript for submission.

Funding

No funding was received for conducting this study.

Data availability

The authors confirm that the data supporting the findings of this review are available within the paper and its supplementary materials.

Declarations

Ethics approval

The review protocol was registered under PROSPERO in July 2024 with registration number of CRD42024562221. The study was also approved by the National Medical Research Register (NMRR) of the Ministry of Health Malaysia (MOH) on July 2024 (NMRR ID: 24-02189-KHQ).

Conflict of interest

The authors declared no potential conflict of interest with respect to the research, authorship, and/or publication of this paper.