BEYOND THE CLINIC: ADDRESSING THE BEHAVIORAL HEALTH WORKFORCE SHORTAGE

Resumo

Objective: To systematically synthesize the scientific evidence on the role of non-clinical facilitators (lay workers, community health workers, peer support workers, low-intensity practitioners, and health coaches) in expanding access to behavioral health care, given the projected shortage of licensed clinical professionals. Data sources: PubMed/MEDLINE, PMC, Cambridge Core, ScienceDirect, Wiley Online Library, SpringerLink, and medRxiv/BioMed Central, plus primary institutional sources (HRSA, WHO, and Brazil's Federal Council of Psychology, CFP), searched between July and August 2026. Eligibility criteria: Studies published mostly between 2013 and 2026, in English or Portuguese, including official workforce projection reports, systematic and scoping reviews, meta-analyses, randomized controlled trials, and large-scale observational studies (n > 1,000, where applicable) on mental health interventions delivered by non-clinical facilitators. Data extraction and synthesis: Single-reviewer extraction using a structured form. Narrative synthesis was used because heterogeneity in designs, populations, and outcomes precluded quantitative meta-analysis. Certainty of evidence was rated using a simplified adaptation of the GRADE domains. Results: Of 82 raw records identified, 37 studies and sources were included in the final synthesis. The evidence indicates a projected shortage of 136,350 psychologists in the United States by 2038 (HRSA); a global treatment gap of approximately 50%, reaching 90% in low-income countries (WHO); and marked territorial inequality in Brazil. Randomized controlled trials show the effectiveness of interpersonal counseling delivered by community health workers for depression in Brazil (n = 86) and Cameroon (n = 400). Psychological Wellbeing Practitioners show consistent effectiveness within the UK stepped-care model. Evidence for health coaching is of low-to-moderate certainty for behavioral outcomes and of low certainty for specific psychiatric outcomes. Limitations: Single reviewer, no prospective protocol registration, no quantitative meta-analysis, and a simplified (non-formal) risk-of-bias assessment. Conclusion: Non-clinical facilitators, integrated into stepped-care models with active clinical supervision, can expand access to behavioral health care without replacing licensed clinicians.