Knowledge, confidence, and practices of clinical associates in the management of mental illness

BACKGROUND: Additional human resources are needed to provide mental health services in underserved areas in South Africa (SA). Clinical associates, the mid-level medical worker cadre in SA, could potentially be used to deliver these services. AIM: The study explored the self-reported knowledge, confidence, and current practices of clinical associates related to mental health assessment and management. SETTING: South Africa. METHODS: A cross-sectional study was conducted. The link to the electronic questionnaire was distributed to clinical associates via databases and social media. Data were analysed with Stata v17. RESULTS: Of the 209 participants, 205 (98.1%) indicated they had training on management of patients with mental illness during their undergraduate degree and 192 (91.9%) had a mental health rotation. Few (10.7%) had any additional mental health training. Most participants rated their knowledge of priority mental disorders as ‘good’ or ‘excellent’. Only 43.2% of the participants felt quite or very confident to perform a mental health examination. Participants who felt quite or very confident to manage patients presenting with suicide risk, aggression, and confusion were 44.9%, 46.9% and 53.1%, respectively. Factors associated with a confidence score of 75% and higher were male gendered, working in Gauteng or Northern Cape provinces, and in a rural area. The majority of participants were already involved in mental health assessment and management in their current work. CONCLUSION: Clinical associates have a contribution to make in mental health service provision, but this may need to be supplemented by additional practical training. CONTRIBUTION: Potential gaps in training have been identified.