Village Health Volunteers' mental health practice in Thai rural communities: A qualitative study

Introduction: Thailand faces a 7.4% prevalence of mental disorders. The integration of mental health services into the broader healthcare system may lead to substantial accessibility gaps, particularly in rural regions. Village Health Volunteers (VHVs) are the backbone of primary healthcare, providing basic health care and gaining recognition for their diverse community activities. Despite their pivotal role, research on VHVs' mental health practice. and role is limited. While recovery orientation was endorsed in Thai national mental health policy in 2019, its implementation by VHVs remains underexplored. This study had two aims: (a) to describe and increase understanding of the current mental health practice and role of VHVs in communities, (b) to identify the enablers and barriers to implementing recovery-oriented mental health interventions by VHVs.  

Methods: The research employed a qualitative approach, conducting semi-structured interviews with VHVs, individuals with mental illness, caregivers, and healthcare professionals in a rural sub-district in Northern Thailand. Data analysis involved reflexive thematic analysis and document analysis of VHVs job descriptions, training and recruitment policies.

Results: Preliminary findings highlighted a dominant medical orientation in VHVs' care for individuals with mental illness and a lack of clear job descriptions in mental health practices. Healthcare professionals trust VHVs' capabilities, and VHVs themselves express confidence in their skills. However, individuals dealing with mental illness and their caregivers perceive relatively lower levels of support from VHVs, impacting their trust and attitude towards these VHVs. Factors enabling successful implementation included intervention simplicity and healthcare provider support, while barriers encompassed VHV commitments and their attitudes toward those with mental illness.

Conclusion: The study highlights VHVs' limited experience and unclear job descriptions in mental health practices. These findings promise to enhance understanding about how to enhance and support VHVs' mental health practices and inform the development and implementation of recovery-oriented practice interventions in Thai communities.