Improving access to mental health care at community-based level: the role of rehabilitation care workers

Aim Between 2012 and 2014, the Klipfontein/Mitchells Plain sub-structure in Cape Town piloted an initiative to train community health workers through a one-year Higher Certificate in Disability Practice, creating a new cadre of mid-level health workers referred to as rehabilitation care workers. These workers were trained to provide basic rehabilitation and disability-inclusion services for people with mental, neurological and substance use disorders across the lifespan. This paper explores the role of rehabilitation care workers in advancing disability-inclusive development and community-based rehabilitation to support universal health coverage in primary-level mental health services. Method Rehabilitation therapists developed and supervised home- and community-based recovery-orientated care programmes for rehabilitation care workers, using a task-sharing model. Based on the pilot’s success, local health service management adopted a health systems strengthening approach, adjusting human resource policies to support community-based rehabilitation services including psychosocial care. This pilot was a collaborative effort between the Western Cape Department of Health and Wellness and local universities to develop the curriculum and train an initial cohort of 33 community health workers. Outcomes Supervised rehabilitation care worker teams improved access to intersectoral health services in line with community-based rehabilitation principles. The initiative disrupted the ‘revolving door’ phenomenon through individual case management, group interventions, and population-level mental health promotion and prevention efforts. Conclusion Rehabilitation care workers play a critical role in bridging the mental healthcare gap and strengthening the care continuum between primary and community-based services. The Klipfontein/Mitchells Plain sub-structure pilot demonstrates how adaptive human resource and service planning can support disability inclusion and reinforce district health systems. The ongoing creation of rehabilitation care worker and rehabilitation therapist posts focusing on mental, neurological and substance use disorders is gradually expanding to other sub-structures in the region.