Scaling mental health care globally for the WHO

Setting the scene

EQUIP, short for Ensuring Quality in Psychosocial and Mental Health Care, began life as a paper-based tool designed to assess how safe and effective carers were in providing mental health support. Created by George Washington University and War Child in collaboration with WHO, it showed promising results in small pilots, helping carers build confidence and provide safer care. WHO was keen to test EQUIP at scale, to then share more widely with NGOs, universities and hospitals across the world.

The challenge

A Human Centered Design discovery process began within a controlled trial with eight NGOs working in very different parts of the world. The tool had to deliver consistent, reliable results across languages, cultures and training environments, including remote training settings with poor internet access. For it to succeed, the platform had to be easy to adopt, intuitive to use, and flexible enough to support a range of training needs and interventions.

A screenshot of a desktop view of a web-based data dashboard from the World Health Organization and UNICEF. The page is titled "GroupACT: Group Facilitation Skills(A) Results" and the "Summary" tab is active. The top half of the screen displays a line chart labeled "Group progress." It tracks the number of trainees at four different skill levels over five assessments, showing a general trend of improvement as trainees move to higher levels. The bottom half features a table titled "Total number of scores," which provides a numerical breakdown of how many trainees achieved each of the four levels in "Assessment 1," "Assessment 2," and "Assessment 3." — Team status: A data visualisation of the EQUIP assessment status and journey of each team member.

The solution

We started with people, not technology, studying how the paper version was used in practice, we listened to carers and trainers about what worked and what slowed them down. From there we created digital prototypes and took them directly into the field. In Uganda, Ethiopia, Nepal and Peru, NGO staff used interactive prototypes of EQUIP for real assessments of carers. We reviewed what worked and what did not, and made changes on the spot. This constant cycle of feedback and quick iteration meant the platform quickly became something NGOs felt was designed with them, not just for them.

Above: Socios en Salud, in Peru, demonstrating their use of the EQUIP tool.

Adoption spread quickly. NGO staff who once struggled with lengthy paper assessments found the digital platform straightforward and effective. They began asking for more features, more translations and new ways to use it. For training mental health carers, EQUIP improved both safety and effectiveness. For monitoring officers, it was transformative: instead of wading through stacks of data by hand, they now had automated reports and clear visualisations, cutting their workload in half.

A collage of screenshots from a website with a blue, green, and white color scheme, titled "UNICEF" and "EQUIP." The top row shows three different pages: On the left, a landing page with the title "Improve helping skills reduce harm" and an image of people in a classroom setting, one wearing a face mask. In the middle, a page with "ENACT Foundational Helping Skills Adult" at the top, displaying a form with various checkboxes and skill levels (LEVEL 1 to LEVEL 4). On the right, a page showing a progress report for "ENACT Foundational Helping Skills Adult," with a series of horizontal bars indicating different assessment levels. The bottom row displays three sections of what appears to be an informational or "how it works" page: On the left, a section titled "How it works" describing the EQUIP program, with bullet points and a small image of a laptop. In the middle, a section detailing "Train and supervise your helpers" with a numbered point "1" and an image of people interacting in a classroom or workshop. On the right, a section titled "See visual results" with a numbered point "3" and a graph showing data, accompanied by a concluding statement: "Register today to learn more about how to use EQUIP to train and rate helpers, staff and students. It's free to use."

In 2022 EQUIP was launched publicly. What began as a paper form in small pilots had become a global platform, used not only in low-resource NGO training programmes but also in hospitals, universities and supervisory settings.

EQUIP enables trainers to really zero on what our trainees need. We understand what areas we need to focus on during training and tailor our sessions accordingly.

Rozane El Masri

War Child Lebanon

A collage of three mobile phone screens showcasing the user interface of the "ENACT: Foundational Helping Skills" assessment application. The first screen (left) is the main assessment page for an individual named "Grace James." It lists five assessments. Assessments 1 and 2 are marked as "Draft," while assessments 3, 4, and 5 have "Start" buttons. The second screen (middle) shows a list of competencies to be assessed. "Verbal communication" is checked off, and "Non-verbal communication" is highlighted. The header indicates that 1 of 15 competencies has been completed. The third screen (right) is the assessment form itself, where an evaluator can score performance. It includes radio buttons to select skill levels (Level 2, 3, or 4) and checkboxes for specific basic and advanced helping skills, such as "Uses open-ended questions" and "Encourages client to continue explaining." — Mobile devices: Portability was crucial, so EQUIP is designed to be simple and clear on mobile and tablet devices, commonly used in on location assessments.

The outcomes

Today, EQUIP is available in 15 languages and used in more than 30 countries, with over a thousand people engaging with it every week. Its impact has been so clear that WHO and USAID have made it the mandatory platform for assessing foundational mental health helping skills. Its influence has been recognised far beyond the humanitarian sector, with The Lancet, Scientific American and Cambridge University Press all publishing on the dramatic improvements it has brought to mental health training.

We have been impressed how SystemSeed translated the concept into the reality of the digital EQUIP platform, which War Child is already using and benefiting from.

Mark Jordan

War Child Holland