skill-mix rather than a staff -mix approach to increase
human resources for mental health.16 Training programmes
will need to be accompanied by eff ective supervision to
maintain skills, and ongoing career development opportunities
will be vital to minimise attrition.
Involvement of a broad set of workforce categories is
likely to facilitate scaling-up of mental health care in lowincome
and middle-income countries. The specifi c
composition of the mental health workforce should vary
across settings, to be aligned with existing delivery
system and resource structures.
Future directions
Global eff orts to address widespread shortages in the
health workforce have entailed development of a technical
framework to assist governments and health managers to