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The United States is facing a mental health crisis. Suicides and opioid misuse are on the rise, and millions of Americans experience mental illness, including such common conditions as depression and anxiety, each year. Yet a large proportion of those who need mental health or substance use treatment never get it. Social and economic inequalities drive disparities not only in the prevalence of mental illness but also in access to effective prevention and high-quality treatment. In some regions, people must travel hundreds of miles to reach the nearest psychiatrist. Mental health care can also be very expensive: Many providers do not take insurance and require that patients pay out of pocket.

Implementing a "task-sharing" model — where some mental health "tasks" (such as screening, active/supportive listening, and even some elements of treatment) are shared with workers not traditionally considered part of the mental health workforce — can be part of the solution. This arrangement allows more-traditional mental health workers, including psychologists and psychiatrists, to devote more of their time to more-complicated or specialized tasks, such as diagnostic assessments, prescribing psychiatric medication, and providing therapies.

This guide, which is based on the management and evaluation of New York City's Connections to Care (C2C) program, describes practical steps for implementing mental health task sharing in community-based organizations. In addition to actual examples from the C2C program, the guide presents step-by-step guidance and worksheets to help practitioners and funders better plan, implement, evaluate, improve, and sustain task-sharing programs.

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The research described in this report was funded by the Mayor's Fund to Advance New York City and conducted by RAND Health Care.

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