Community Health Worker-led Mental Health Care in India: A 15-year Scoping Review of Nonspecialist Task-sharing Models (2010–2025)

Abstract Background: India faces a severe mental health workforce shortage, with fewer than 0.75 psychiatrists per 100,000 population and an estimated 70%–90% treatment gap, creating an urgent need for scalable service delivery innovations; task-sharing with trained nonspecialist providers is a promising strategy, but India-specific evidence has not been systematically synthesized. Objective: The objective of the study was to map randomized controlled trials (RCTs) of nonspecialist task-sharing interventions for common mental disorders (CMDs) and severe mental disorders (SMDs) in India from 2010 to 2025. Methods: Following PRISMA-ScR guidelines, reviewers screened 1336 records and identified eight eligible RCTs ( n = 7682) across states of India, involving lay counsellors, community health workers (CHWs), peer mothers, school counsellors, community champions, and digitally supported primary healthcare workers. Results: Lay counsellor interventions improved CMD recovery by 22% (MANAS; RR 1.22), reduced depression severity (healthy activity program; Beck Depression Inventory II adjusted mean difference AMD –3.39), and doubled abstinence in harmful drinking (counselling for alcohol problems; 20.7% vs. 9.9%). CHWs reduced schizophrenia symptoms (Community care for People with Schizophrenia in India (COPSI); Positive and Negative Syndrome Scale AMD – 3.75); peer mothers increased perinatal depression remission (Thinking Healthy Programme Peer-delivered; prevalence ratio 1.21); school counsellors improved adolescent psychosocial outcomes (PRemIum for aDolEscents’ (PRIDE) project; Youth Top Problems/Strengths and Difficulties Questionnaire AMD–0.98/–1.23); community champions doubled CMD recovery (Atmiyata; odds ratio OR 2.2); and digitally supported primary care workers lowered Patient Health Questionnaire-9 scores (Maulik; AMD–1.71). Conclusion: Effect sizes ranged from moderate to large (SMD 0.5–1.2; OR/RR 1.2–2.2), showing that non-specialist task-sharing models can substantially improve mental health outcomes across diverse Indian settings, while highlighting persistent gaps in SMD coverage, cost-effectiveness, and implementation scalability, and the need for stronger alignment with the National Mental Health Programme and Ayushman Bharat.