Table 1. Lay counsellor characteristics, systematic review of mental health interventions by lay counsellors in low- and middle-income countries, 2000–2019.
| Study | Lay counsellor selection | Lay counsellor training |
|---|---|---|
| Ali et al. (2003)47 | (i) Women from the community were recruited by word of mouth and distribution of leaflets; and (ii) 12 women were selected on the basis of their communication skills, motivation, literacy in Urdu and freedom to move about | Eleven 3-hour training sessions on a cognitive behavioural therapy-based intervention over 4 weeks |
| Neuner et al. (2008)35 | (i) Nine refugees (five women and four men; mean age: 27 years) from the community were trained as counsellors. Skills required to be accepted for the training included literacy in English and literacy in their mother tongue, as well as the ability to empathize with their clients and a strong motivation to carry out this work; and (ii) their educational level varied from primary school to university education | 6 weeks of education in counselling for alcohol problems, a psychoeducational and social skills intervention, and in general counselling skills |
| Tol et al. (2008)40 | (i) An unspecified number of lay counsellors, or interventionists, who had to be older than 17 years and have at least a high school education, were selected from local target communities based on a selection procedure assessing social skills through role plays; (ii) they were generally people with no formal mental health training but had some experience as volunteers in humanitarian programmes; and (iii) a study author stated in email correspondence that “the interventionists were newly hired community members, not currently employed as community health workers, etc.” | Once selected, interventionists received a 2-week training programme that involved cognitive behavioural therapy-based interventions |
| Jordans et al. (2010)32 | (i) A gender-balanced group of interventionists was selected based on previous experience and affinity to work with children – they were selected from the targeted communities; and (ii) the number was not specified | (i) 15-day cognitive behavioural therapy-based skills-oriented training; and (ii) regular supervision by an experienced counsellor |
| Patel et al. (2010)a43 | (i) 24 lay health counsellors were locally recruited and had no previous health-care background; (ii) they performed case management duties and delivered all non-drug treatments; (iii) 12 counsellors were assigned to public health-care facilities and 12 to private health-care facilities; and (iv) each health-care facility had one lay counsellor | (i) 2 months of training in an interpersonal therapy intervention; and (ii) support by a psychiatrist during the trial |
| Yeomans et al. (2010)41 | (i) All of the workshops were led by Burundian lay counsellors chosen by the nonprofit organization for their extensive experience with trauma workshop facilitation and for having demographics comparable to the participants: rural, poor, many without substantial formal education, and balanced in gender and ethnicity; and (ii) a study author stated in email correspondence that the facilitators were “simply lay people in the community working as lay facilitators of workshops, either employed or not employed.” | All lay counsellors had a full day of training dedicated to the modification of the standard workshop (in which they had been previously trained) |
| Connolly & Sakai (2011)30 | Twenty-eight adult women and one man from the community chosen by the community leader of a volunteer Protestant religious group | (i) 2 full days of thought field therapy training; and (ii) supervision by study authors during interventions |
| Ertl et al. (2011)31 | Fourteen adults (seven women and seven men) who were community-based lay therapists without a mental health or medical background | Intensively trained local lay counsellors underwent narrative exposure therapy training for an unspecified length of time |
| Tol et al. (2012)39 | (i) An unspecified number of lay counsellors, or interventionists, who had to be older than 17 years and have at least a high school education, were selected from local target communities based on a selection procedure assessing social skills through role plays; (ii) they were generally people with no formal mental health training but had some experience as volunteers in humanitarian programmes; and (iii) a study author stated in email correspondence that the interventionists “were newly hired community members, not currently employed as community health workers, etc.” | Counsellors were trained in a cognitive behavioural therapy-based intervention and supervised in implementing the intervention for 1 year before the study |
| Connolly et al. (2013)29 | Thirty-six adult men and women from the community chosen by a Catholic priest or community leader on the basis of their subjective level of respect in the community | (i) 2 full days of thought field therapy training; and (ii) supervision by study authors during interventions |
| Meffert et al. (2014)33 | Five members of the Sudanese community without prior mental health training were trained to deliver interpersonal therapy | (i) 1 week of training in an interpersonal therapy intervention; and (ii) group supervision once a week |
| O'Callaghan et al. (2014)36 | (i) “Three male and three female local lay facilitators (total of six) living in Dungu and working for SAIPED, a Dungu-based humanitarian NGO, delivered the intervention”; and (ii) although SAIPED was referred to as an NGO, a study author stated in email correspondence that the facilitators in the Dungu pilot psychosocial study involved workers (volunteers) in a local community-based organization who had no previous mental health training | 3 hours of training in a family-focused psychosocial support intervention in each of eight modules (24 hours total) |
| Tol et al. (2014)38 | (i) Lay counsellors comprised an unspecified number of locally identified non-specialized facilitators trained and supervised in implementing the intervention for 1 year before the study. Facilitators had at least a high school diploma and were selected for their affinity and capacity to work with children as demonstrated in role plays and interviews; and (ii) a study author stated in email correspondence that the lay counsellors “were newly hired community members, not currently employed as community health workers, etc.” | Counsellors were trained in a cognitive behavioural therapy-based intervention and supervised in implementing the intervention for 1 year before the study |
| Murray et al. (2015)34 | Twenty-three adult counsellors (11 from study sites and 12 external); their backgrounds varied but all counsellors had at least a high school education and basic communication skills | (i) 10 days of trauma-focused cognitive behavioural therapy training; and (ii) subsequent weekly meetings with supervisors and meetings with trauma-focused cognitive behavioural therapy experts |
| Nadkarni et al. (2015)45 | (i) At the end of the internship, 12 lay counsellors (10 female), who achieved competence as assessed by standardized role plays, were selected for the pilot randomized control trial; and (ii) on average, lay counsellors were 25.9 years of age with 15 years of education | 3 weeks of training by professional therapists in counselling for alcohol problems, a psychosocial intervention, following an internship |
| Robson et al. (2016)37 | (i) The Catholic diocese selected 36 catechists who were volunteer religious education teachers or assistants to the clergy; and (ii) the catechists were well educated and respected as leaders within their communities | (i) 2 full days of training in thought field therapy; and (ii) supervision by study authors during treatments |
| Nadkarni et al. (2017)46 | (i) Counsellors were adults with no prior professional training or qualification in the field of mental health, they had completed at least secondary school education, and were fluent in the vernacular language used in the study setting; (ii) 11 counsellors participated in the trial; and (iii) a study author stated in email correspondence that “The lay counsellors were not employed when we recruited them for our programme” | (i) 2 weeks of classroom training in counselling for alcohol problems, a psychosocial intervention, with a 6-month internship; and (ii) weekly peer supervision during the trial |
| Patel et al. (2017)44 | (i) Eleven lay health counsellors who were members of the local community and were 18 years or older were selected to participate in the trial after an extensive training and selection process; (ii) they had completed a minimum of a high school education and did not have previous mental health training; and (iii) they were originally recruited by newspaper advertisements and through word of mouth | (i) 3 weeks of participatory training in a healthy activity programme, which involved psychosocial and psychoeducational interventions; and (ii) subsequent weekly peer-led supervision for 6 months |
| Dias et al. (2019)42 | Four lay counsellors (two men and two women) were recruited via advertisements and word of mouth; all were over 30 years of age and had a bachelor’s degree in a non-health-related field and no previous training in mental health | 1-week training course in depression-in-later-life therapy followed by intensive role playing |
NGO: nongovernmental organization.
a The study by Patel et al. in 2010 reported on two trials.43