Community Health Workers are playing an increasingly vital role in mental health care, particularly in communities that have long been underserved by traditional systems. Working outside the bounds of formal clinical structures, they provide support grounded in shared experience, cultural understanding, and deep community trust.
A new review published in Harvard Review of Psychiatry examines the growing recognition of this workforce and calls for stronger investment in its future. The authors find that Community Health Workers are not only expanding access to care but helping to redefine what effective, equitable mental health support looks like. Their findings suggest that lasting improvements in mental health outcomes will depend not just on scaling services, but on shifting who is seen as a provider of care and a source of knowledge.
The article, Community Health Workers Research: Where Are We Now? A Narrative Review of an Expanding Workforce for Mental Health traces the evolution of CHWs and explores how this workforce can be better supported and integrated into mental health systems. Drawing on decades of research across six key domains (training, retention, integration, cost-effectiveness, impact measurement, and scalability), the authors present the case that CHWs are already transforming care, but long-term investment is needed to sustain their role.
“Though CHWs were largely consulted during the pandemic for general health care support in low- and middle-income countries, there is now recognition of the need to better partner with CHWs and realize their potential as a workforce contributing to mental health care,” the authors write.
Efforts to build more equitable mental health systems have increasingly focused on expanding roles for peer workers and community-based providers. Yet past research has highlighted deep tensions in how these roles are defined and supported. While peer specialists were originally envisioned as agents of mutual aid and advocacy, they are often tasked with enforcing clinical norms rather than challenging them. Others have documented how well-intentioned efforts at “inclusion” may reproduce marginalization when peer expertise is decontextualized, co-opted, or narrowly measured through biomedical outcomes.
At the same time, initiatives grounded in human rights and social determinants of health have shown the value of embedding care in local contexts and training lay workers in non-coercive, psychosocial approaches that reduce reliance on medication. These findings suggest that truly transformative care requires shifting not only who delivers mental health support, but also how systems recognize and share power with those closest to the communities they serve.
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