Impact statement
Professional competency frameworks play an important role in the education, training and continuous professional development of the diverse – multi-disciplinary and multi-professional – global mental health workforce. To reflect this diversity, a novel, multi-sectoral global mental health competency framework was developed from a job market analysis and a stakeholder consultation. This framework encompasses a range of job families such as advocacy, policy, service delivery, programme management, capacity development and research and teaching. Far from being a definitive list, the framework highlights the immense variety of interpersonal, technical, cognitive and knowledge-based competencies demanded from employers across sectors and roles. Alongside the well-recognised, core competencies such as collaboration, cultural sensitivity, integrity and intervention delivery, educators, trainers, managers and other leaders should develop trainees’ and professionals’ resilience and adaptability; creativity and curiosity; and entrepreneurial and reflective skills. The framework can foster inter-professional mobility and curriculum design, and inspire lifelong learning.
Introduction
Global mental health (GMH) is a professionally diverse field of practice spanning multiple sectors and roles (Collins, Reference Collins2020). It is practised across humanitarian, development and peace settings (World Health Organization, 2013, 2021). Because GMH is characterised by a diversity of disciplines, epistemologies, cultural perspectives and stakeholders, it defies easy categorisation (White et al., Reference White, Orr, Read, Jain, White, Jain, Orr and Read2017; Rajabzadeh et al., Reference Rajabzadeh, Burn, Sajun, Suzuki, Bird and Priebe2021). It opposes an essentialist view of mental disorders and well-being, and instead centres on context, collaboration, empowerment, humility and power-shifting in its pursuit to sustainably alleviate mental distress and promote the right to health worldwide. This expansive and ambitious remit poses challenges to designing comprehensive training that caters to the wide range of GMH roles (Ng et al., Reference Ng, Magidson, Hock, Joska, Fekadu, Hanlon, Galler, Safren, Borba, Fricchione and Henderson2016; Buzza et al., Reference Buzza, Fiskin, Campbell, Guo, Izenberg, Kamholz, Hung and Acharya2018; Acharya et al., Reference Acharya, Buzza, Guo, Basnet, Hung, Van Dyke, Acharya and Becker2024).
The case for a multi-sectoral, multi-professional GMH competency framework
The intersectoral nature of GMH calls for competency frameworks and training programmes that embody diversity and multiprofessionalism (Di Ruggiero, Reference Di Ruggiero2022). Rather than narrowly viewed as a healthcare issue, GMH has also been construed as a human rights and a development issue (White et al., Reference White, Imperiale and Perera2016). GMH is practised across contexts, with a significant presence within humanitarian and emergency settings. Roles often embrace the composite approach of mental health and psychosocial support (MHPSS), which is underpinned by inter- and multidisciplinary theoretical and conceptual frameworks and guidelines (Inter-Agency Standing Committee, 2007). This requires strong, diversified and transferable professional skills.
Accordingly, recommendations have been made to enhance GMH professional training via ‘[…] inter-professional and trans-professional education that breaks down professional silos and enhances collaboration […]’ (Fricchione et al., Reference Fricchione, Borba, Alem, Shibr, Carney and Henderson2012, p. 53). Such training is instrumental to developing an agile, internationally and interprofessionally mobile, and collaborative workforce (Trowbridge et al., Reference Trowbridge, Tan, Hussain, Osman and Di Ruggiero2022). The ultimate goal, as Fricchione et al. (Reference Fricchione, Borba, Alem, Shibr, Carney and Henderson2012, p. 53) argue, should be to instil the skills, confidence and flexibility for professionals to access and scrutinise ‘global knowledge and experience’ and apply them in solving ‘local challenges’.
Relatedly, Fernando (Reference Fernando2017) highlights that decolonising the GMH curricula should be prioritised. Decolonisation refers to recognising and dismantling unjust and discriminatory power structures and practices maintained by dominant (e.g., Western) groups and cultures (Lewis et al., Reference Lewis, Hartwell and Myhra2018). It seeks to legitimise and amplify the voices and experiences of historically oppressed groups. Decolonisation may be especially important for students from medical backgrounds, since it has been recognised that how mental health and mental ill health are taught within curricula has been heavily shaped by Eurocentric paradigms (Bracken et al., Reference Bracken, Fernando, Alsaraf, Creed, Double, Gilberthorpe and Timimi2021). Cultural humility, structural competency and self-awareness are arguably vital in this process (Ng et al., Reference Ng, Magidson, Hock, Joska, Fekadu, Hanlon, Galler, Safren, Borba, Fricchione and Henderson2016; Lewis et al., Reference Lewis, Hartwell and Myhra2018; see Perkins et al., Reference Perkins, Nishimura, Olatunde and Kalbarczyk2023, for a scoping review).
Several recent attempts have been made to systematise GMH competencies by either modifying related competency frameworks from adjacent disciplines (such as psychology and global health), or by creating bespoke frameworks or lists (e.g., Khoury, Reference Khoury and De Castro Pecanha2023). Notably, most of these have been focused on psychological service delivery (Institute of Medicine, 2013; International Association of Applied Psychology and International Union of Psychological Science, 2016; Buzza et al., Reference Buzza, Fiskin, Campbell, Guo, Izenberg, Kamholz, Hung and Acharya2018; World Health Organization and UNICEF, 2022), and (early-career) researchers (Thornicroft et al., Reference Thornicroft, Cooper, Bortel, Kakuma and Lund2012; Collins and Pringle, Reference Collins and Pringle2016; Ng et al., Reference Ng, Magidson, Hock, Joska, Fekadu, Hanlon, Galler, Safren, Borba, Fricchione and Henderson2016; Merritt et al., Reference Merritt, Jack, Mangezi, Chibanda and Abas2019), and on specific interventions and settings such as humanitarian contexts (e.g., IFRC, 2016). To our knowledge, no unifying multi-sectoral GMH competency framework exists to date.
Understanding employer needs
Concerns have been raised that competency lists developed by experts from curriculum reviews and other methods may not fully reflect contemporary professional practice (von Treuer and Reynolds, Reference von Treuer and Reynolds2017). In contrast to traditional methodologies such as expert consultations and curricular reviews, job market analysis arguably offers a more objective, up-to-date and comprehensive overview of in-demand competencies (Brown et al., Reference Brown, Mulherin, Ferrara, Humphrey, Vera and Hall2018; Keralis et al., Reference Keralis, Riggin-Pathak, Majeski, Pathak, Foggia, Cullinen, Rajagopal and West2018). It has been successfully used in fields such as global health to gauge employer expectations and boost students’ sector awareness (Brown et al., Reference Brown, Mulherin, Ferrara, Humphrey, Vera and Hall2018; Keralis et al., Reference Keralis, Riggin-Pathak, Majeski, Pathak, Foggia, Cullinen, Rajagopal and West2018).
Research context, aim and methods
The increased internationalisation of higher education, including the growing student diversity and mobility, and use of online distance learning, calls for effective, up-to-date and equitable approaches to supporting students’ professional development (Tran et al., Reference Tran, Jung, Unangst and Marshall2023). In the context of a competitive global labour market, educators have a responsibility to maximise graduates’ employability, as well as help them acquire ‘[…] values, knowledge, attitudes and skills, dispositions and democratic principles […] to make a critically informed, responsible contribution to society’ (Robson and Wihlborg, Reference Robson and Wihlborg2019, p. 128). To help fulfil this responsibility, as part of a learning and teaching development project in a UK postgraduate taught GMH Master’s Degree programme, this study sought to identify a comprehensive set of in-demand GMH-related professional skills and competencies as indicated in relevant job descriptions and person specifications, across sectors and professional roles. A scoping job market analysis was carried out between September 2022 and January 2023.
Qualitative content analysis (QCA) was applied to extract competencies from the job advertisements. QCA is a systematic and transparent method for parsing textual data into distinct entities and generating concise informative summaries in the form of conceptual categories, systems or maps (Elo and Kyngäs, Reference Elo and Kyngäs2008, p. 108). We adopted an inclusive definition of competencies as encompassing ‘an interplay of knowledge, capacities and skills, motives and affective dispositions’ (Rieckmann, Reference Rieckmann2012, p. 129). Consistent with the World Health Organization (2017, p. ix), we recognise competencies are not fixed but ‘dynamic and contextual’.
Data collection
We used purposive sampling techniques, which aim to maximise the sample’s richness, diversity and informativeness, while not claiming statistical generalisability (Suri, Reference Suri2011). Job listings with rich descriptions of roles and candidate profiles were given preference, together with those reflecting common and feasible career paths for graduates (intensity sampling; Suri, Reference Suri2011). Job listings for a wide range of GMH-related roles and sectors were selected (maximum variation; Suri, Reference Suri2011). A pragmatic mix of generic (e.g., www.linkedin.com; https://uk.indeed.com/), sector-specific (e.g., https://unjobs.org; https://www.charityjob.co.uk; (https://www.jobs.nhs.uk/); https://www.jobs.ac.uk; https://cbm-global.org/) and country- and region-specific (e.g., https://ngojobsinafrica.com; https://www.ghanacurrentjobs.com) job sites was searched. To maximise retrieval, broad subject-, sector- and post-related search terms were used (e.g., ‘GMH’, ‘psychology’, ‘clinical’, ‘policy’, ‘MHPSS’, ‘counsellor’, ‘capacity’ and ‘research’). Initially, 250 advertisements were screened for relevance; from these, 50 were selected using the criteria above and sorted into job families. Another 120 advertisements were then screened in search of advertisements from underrepresented job families. This resulted in another 20 advertisements being added to the final sample.
At 70 advertisements, saturation was reached – analysing additional advertisements did not yield substantially new competencies (Morse, Reference Morse2015).
To track and ensure a multi-sectoral scope, the researchers categorised the 70 advertisements into several job families: advocacy (7; 10%); capacity development (8; 11%); policy (7; 10%); programme implementation, management and evaluation (12; 17%); research (15; 21%); clinical, psychological and psychosocial service delivery (17; 24%) and teaching (4; 6%). The jobs were based in the United Kingdom (34); the African continent (17, including Ethiopia, Nigeria, Tanzania, Zanzibar, South Sudan, Senegal, Kenya, Rwanda, Uganda, Kuwait, Ghana and Mali); multiple countries (4); other European countries (3); the Americas (3); New Zealand (2) and remote or other (7). A wide range of employers and sectors were represented, including humanitarian aid organisations, charities and other non-profit organisations, government agencies, higher education institutions, international NGOs and the private sector. The sample featured a mix of positions suitable for graduates and early-career professionals, mid-career professionals and highly specialised and/or senior roles. The aim was to include both foundational, entry-level competencies and more advanced and aspirational ones.
Data analysis
The advertisements were exported into the qualitative data analysis software programme, NVivo 12 (https://support.qsrinternational.com/s/), where the person specifications, main responsibilities, required qualifications and employer information were manually analysed using QCA by the first and third authors. The purposive sampling and QCA aimed to map the range of relevant competencies; therefore, frequencies were not calculated. First, the advertisements were read and re-read line-by-line, following which codes corresponding to individual competencies were ascribed to short phrases or sentences (Elo and Kyngäs, Reference Elo and Kyngäs2008). Then, the long list of initial codes was re-examined, and codes were grouped into sub-categories based on similarities. The sub-categories were then clustered into a smaller number of higher-level, more abstract meaning units called categories (see Table 1, for an example of the coding process). The third author conducted the initial coding of all advertisements, after which the first author reviewed this initial analysis for logical consistency and carried out further analysis, as required. The two authors met frequently to discuss coding decisions and resolve any discrepancies. The third author is a health researcher and recent MSc GMH graduate, who had received training in qualitative data analysis. The first author is a researcher with expertise in public health, GMH and qualitative methodologies.
Table 1. Example of the qualitative content analysis coding process
The final stage of the QCA entailed the creation of a model or a conceptual map (Elo and Kyngäs, Reference Elo and Kyngäs2008; Elo et al., Reference Elo, Kääriäinen, Kanste, Pölkki, Utriainen and Kyngäs2014) – an accessible four-dimensional competency framework. To increase trustworthiness, the first iteration of the framework was sent to 17 potential users of the framework, including seven experts from Ukraine, Sierra Leone, Uganda, Nigeria, Egypt and the United Kingdom, and 10 recent MSc GMH graduates. They were asked to advise whether the framework and language used were clear, understandable and usable (Elo et al., Reference Elo, Kääriäinen, Kanste, Pölkki, Utriainen and Kyngäs2014). Their feedback helped identify and remove jargon and ambiguity, enhancing its international applicability.
Results
Approximately 200 distinct skills and competencies were derived from the 70 job advertisements (see Supplementary Material for the full list). Four meta-level categories were found to reasonably accommodate the QCA codes and sub-categories (Figure 1):
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• ‘Self’ – enduring personal characteristics, abilities and aptitudes;
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• ‘Skills’ – transferable skills required across a wide range of professional settings, including technical and interpersonal skills;
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• ‘Sector’ – skills, competencies and experience required in specific roles and sectors;
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• ‘Subject’ – working knowledge of theories, concepts, frameworks and principles relevant to GMH research and practice.
Figure 1. The ‘4S’ Multi-Sectoral GMH Competency Framework.
Note: The list of competencies is not exhaustive. CAMHS - child and adolescent mental health services; GMH - global mental health; MHPSS - mental health and psychosocial support.
Self: Intellectual abilities, personal resources and values
This category encompasses three sub-categories: intellectual abilities, personal resources and values. Intellectual abilities are highly prevalent within job descriptions, and refer to cognitive abilities pertaining to analysing, synthesising and interpreting information and generating ideas and solutions. In addition to the quintessential skills of analytical and critical thinking, and problem-solving, employers placed a strong emphasis on creativity, idea generation and innovation. These were especially common in capacity development, service delivery and research roles. These attributes were often described as being open to change and ‘thriving’ in solving problems:
Should thrive in solving problems and producing pragmatic solutions (Regional Scaling Coordinator, War Child Holland).
Research never goes exactly according to plan, and the Research Officer must approach the problems that will inevitably arise with patience and creativity […] Creativity and an ability to think outside the box to conceptualize projects and implementation strategies (Research Officer – South Sudan, Forcier Consulting).
Suggests creative improvements and better ways of working (Research Coordinator, The MHPSS Collaborative).
Creative and proactive problem solver (Social Worker – Ghana, International Justice Mission).
The second sub-category, personal resources, is a highly heterogeneous cluster of traits and competencies that promote coping, resilience and thriving in the workplace (Kasler et al., Reference Kasler, Zysberg and Harel2017; See Figure 1). The most frequent ones across sectors and roles were: (a) flexibility, adaptability and openness to change; (b) resilience and grit and (c) ambition, drive and determination. Specifically, there was a strong focus on working effectively amidst changing, challenging and unclear circumstances. Notably, these were not reserved for humanitarian emergency jobs but were also required in service delivery roles in peace settings:
Strong self-starter, able to take initiative and adapt to changing circumstances and priorities (Psychological Counsellor – Ethiopia, Save the Children).
Shifts tasks, roles and priorities to perform effectively under changing or unclear conditions (Research Coordinator, The MHPSS Collaborative).
Managing self: Displays grit, courage, resilience […] (Senior Policy Advisor, Mental Health and Wellbeing Commission).
Less commonly mentioned but noteworthy were self-discipline, curiosity, accountability, composure, courage, entrepreneurialism, among others – for example: ‘entrepreneurial mindset’ (Healthcare Partnerships & Service Integration – Kenya, Zipline); ‘start-up mentality’ (Lead Clinical Psychologist – Nigeria, Reliance Health); ‘stand up and challenge decisions’ (Advocacy Worker, Think Care Careers); ‘we are courageous and speak up about what is important to people’ (Senior Policy Advisor – New Zealand, Te Hiringa Mahara).
Finally, values are a sub-category that is distinct from intellectual abilities or traits and attributes promoting coping amidst change and adversity. This sub-category was derived from coding both the personal specifications and the employer information sections, and was prevalent across job families, including service delivery, advocacy and policy. A wide range of values were expected – including respect for diversity; integrity and professionalism; social justice commitment and fairness and inclusion:
Knowledge and commitment to anti-racist and inclusive practices. […] Demonstrable commitment to upholding the rights of people who face disadvantage or discrimination (Independent Advocate, Gaddum Advocacy).
Act in a way that acknowledges and recognizes people’s expressed beliefs, preferences and choices (Assistant Psychologist, NHS Wales).
Skills: Interpersonal skills, research skills and organisational skills
This category accommodates the vast range of transferable skills – including interpersonal skills, organisational skills and research skills – that were the backbone of virtually all advertisements (see Figure 1). In addition to quintessential employability skills such as teamwork, time management, initiative and leadership, the analysis highlighted several more advanced and GMH-specific competencies, particularly intercultural communication and collaboration; influencing skills; negotiation skills and networking and relationship-building within and across sectors:
Excellent relationship building and influencing skills (Senior Policy Officer – London, NHS).
The role involves lobbying and developing understanding of the interventions and tools, organize and participate in adaption and contextualizing workshops and conducting online or face-to-face training with stakeholders and partners based in different countries across the region (Regional Scaling Coordinator, War Child Holland).
Work closely with the Psychological Intervention Specialist to conduct consultations with multi-sector stakeholders, community-based organizations, international NGOs (Psychological Intervention Researcher, UNICEF).
Respectfully engage with partners and fellow staff members from different cultural backgrounds (Research Officer – South Sudan, Forcier).
Next, research skills represent a highly varied cluster comprising technical (e.g., data collection and analysis, information literacy); scientific communication (e.g., report writing, grant proposals and translating research into practical recommendations) and interpersonal (e.g., ethical awareness, political sensitivity) skills. Importantly, research skills were found across job families, including service delivery, policy, capacity development and intervention evaluation.
Furthermore, several of the advertisements expected candidates to engage in various knowledge dissemination and exchange activities such as policy briefs, stakeholder dialogues, training materials and locally adapted guidelines:
Preparation of accessible high quality reports on complex issues – for example policy positions, national consultations and member briefings (Senior Policy Officer – London, NHS).
Assist in the creation of training material and reports (Intern – Peru, Innovations for Poverty Action).
Adapt existing training packages to the current context and different needs (MHPSS Technical Advisor, Red Cross).
Sector: Sector- and country-specific competencies and experience
The sector category houses competencies that are highly specific to the included job families – for instance, carrying out psychological assessments, cross-sectoral liaison, client advocacy, capacity and needs assessment, programme scale-up and policy analysis and development (see Figure 1):
Outstanding capacity to understand the country context, portfolio, and overall programmatic needs (Mental Health Technical Advisor, International Rescue Committee).
To work alongside and ensure active service user participation in all aspects of work, including design, implementation and monitoring of activities (Mental Health Worker (Dual Diagnosis), Richmond Borough Mind).
Programme development, implementation and evaluation skills, in particular, encompass collecting data on programme outcomes, contextualising and adapting materials, supporting the scaling-up of evidence-based interventions, training stakeholders, involving service-users and others (see Supplementary Material).
Commonly required across sectors and roles was the ability to work with a wide range of stakeholders, including governmental and non-governmental agencies, professional groups, service-users, communities and donors. Examples of specific professional activities and skills were stakeholder consultation, coordination, motivation and persuasion, in addition to partnership-building. Those often entailed demonstrable knowledge and understanding of key stakeholders at global and regional levels.
Relatedly, knowledge of relevant systems, legislation and policies was also commonly expected, including global frameworks and in-country policies:
Knowledge of international policies, laws and mandates as pertaining to pesticides and suicides (WHO Consultant).
Finally, several jobs, mostly in capacity development, required experience of working in a low- or middle-income country (LMIC), in war-affected regions, or in a country different from one’s own.
Subject: Core GMH knowledge and knowledge of related disciplines
Finally, this category represents the knowledge-based competencies that were either essential or desirable candidate characteristics (see Figure 1). The analysis distinguishes between core GMH knowledge (e.g., knowledge of scaling-up approaches and of cultural adaptation of interventions) and broader knowledge of mental health and psychosocial interventions and theories.
Partly due to the inclusive, multi-sectoral scope of the framework, employers commonly expected up-to-date knowledge of, or expertise in, related disciplines such as human rights, international development, social work, public health, anthropology and epidemiology.
Discussion
This study aimed to scope the international GMH job market and extract and synthesise in-demand competencies from relevant job advertisements in order to develop a novel, multi-sectoral GMH competency framework. The framework showcases the diversity of sectors, disciplines and transferable skills relevant to contemporary GMH practice, and highlights areas for workforce development (Fricchione et al., Reference Fricchione, Borba, Alem, Shibr, Carney and Henderson2012; Ng et al., Reference Ng, Magidson, Hock, Joska, Fekadu, Hanlon, Galler, Safren, Borba, Fricchione and Henderson2016).
Research skills
A noteworthy finding of the job market analysis was the presence of research skills in non-research positions such as policy, programme management and psychological service delivery. Research skills training is essential to building capacity for GMH, particularly in LMICs (Wainberg et al., Reference Wainberg, Scorza, Shultz, Helpman, Mootz, Johnson, Neria, Bradford, Oquendo and Arbuckle2017; Okewole et al., Reference Okewole, Merritt, Mangezi, Mutiso, Jack, Eley and Abas2020). Adoption of research competencies has been shown to boost personal and professional growth (Okewole et al., Reference Okewole, Merritt, Mangezi, Mutiso, Jack, Eley and Abas2020), as well as increasing capacity for implementing evidence-based care (Thornicroft et al., Reference Thornicroft, Cooper, Bortel, Kakuma and Lund2012; Wainberg et al., Reference Wainberg, Scorza, Shultz, Helpman, Mootz, Johnson, Neria, Bradford, Oquendo and Arbuckle2017; Merritt et al., Reference Merritt, Jack, Mangezi, Chibanda and Abas2019). As Abu-Zaid (Reference Abu-Zaid2014) shows, few medical students show interest in undergraduate research engagement as well as research-based careers mainly due to factors such as insufficient exposure to scientific research early in education, unwillingness to prolong medical training, personal preference and failure to understand the importance of having research skills in general practice. Thus, building a positive attitude towards research remains a priority (Merritt et al., Reference Merritt, Jack, Mangezi, Chibanda and Abas2019). Merritt et al. (Reference Merritt, Jack, Mangezi, Chibanda and Abas2019) highlight the value of improving research skills in those working in the GMH field in LMICs countries to help rebalance historical underinvestment. The current job market analysis also underscores the need to scale up access to professional development programmes for GMH professionals focusing on knowledge-to-practice translation (Wainberg et al., Reference Wainberg, Scorza, Shultz, Helpman, Mootz, Johnson, Neria, Bradford, Oquendo and Arbuckle2017).
Communication and political skills
While an array of communication skills have invariably featured in existing competency frameworks (Buzza et al., Reference Buzza, Fiskin, Campbell, Guo, Izenberg, Kamholz, Hung and Acharya2018; Merritt et al., Reference Merritt, Jack, Mangezi, Chibanda and Abas2019), the current job market analysis shines a light on a broader spectrum of communication and political skills, including some less commonly emphasised skills such as conflict resolution and influencing skills, together with policy and political knowledge and sensitivity. Multi-stakeholder collaboration, negotiation and consensus-building are indispensable in many GMH-related roles, particularly in the policy, advocacy, capacity-building and healthcare management sectors (Ng et al., Reference Ng, Magidson, Hock, Joska, Fekadu, Hanlon, Galler, Safren, Borba, Fricchione and Henderson2016; Iemmi, Reference Iemmi2022). Negotiation, specifically, has been highlighted as an emotionally demanding skill; hence, its close links to leadership, emotional intelligence and resilience (Higazee and Gab Allah, Reference Higazee and Gab Allah2022). This signals the need to embed such training in GMH programmes – for instance, in the form of simulation and role-play activities (Higazee and Gab Allah, Reference Higazee and Gab Allah2022).
Emphasis on higher-order competencies
A distinctive finding of the current analysis – over and above existing frameworks – is the strong emphasis on dispositional and motivational characteristics and complex intellectual skills such as creativity, strategic thinking, perseverance and curiosity. This tendency was also observed in Keralis et al.’s (Reference Keralis, Riggin-Pathak, Majeski, Pathak, Foggia, Cullinen, Rajagopal and West2018) market analysis of global health jobs. As Jardim (Reference Jardim2021, p. 1) argues, ‘[c]ognitive and technical skills are not sufficient to face the professional challenges of the current digital and global world […]’. Some of these competencies (e.g., resilience, entrepreneurial mindset, courage, curiosity, perseverance, passion and adaptability) may be difficult to measure or evaluate, and have therefore remained under-investigated in the professional skills development literature (Jogerst et al., Reference Jogerst, Callender, Adams, Evert, Fields, Hall, Olsen, Rowthorn, Rudy, Shen, Simon, Torres, Velji and Wilson2015; von Treuer and Reynolds, Reference von Treuer and Reynolds2017). We nevertheless propose they remain important, and often integral, to effective professional activity in the GMH field.
Resilience and adaptability
The inclusion of resilience and adaptability in the current framework is not surprising given the challenging, resource-constraint contexts of much of GMH practice, together with the often-stigmatised, underfunded and neglected issues professionals in this field seek to redress. GMH professionals operate in ideologically and professionally contested and politically and economically unstable settings, and are therefore required to be adaptable, resilient and persevering; they are required to be pathfinders (White et al., Reference White, Orr, Read, Jain, White, Jain, Orr and Read2017; Dean et al., Reference Dean, Cooper, Wurie, Kollie, Raven, Tolhurst, MacGregor, Hawkins, Theobald and Mansaray2020). Most recently, the COVID-19 pandemic has demonstrated, and reinvigorated interest in, the importance of fostering resilience in healthcare and aid workers (Dean et al., Reference Dean, Cooper, Wurie, Kollie, Raven, Tolhurst, MacGregor, Hawkins, Theobald and Mansaray2020; Young et al., Reference Young, Pakenham, Chapman and Edwards2022). The capacities for resilience and adaptability have been identified as core to sustainable development (Rieckmann, Reference Rieckmann2012; Brundiers et al., Reference Brundiers, Barth, Cebrián, Cohen, Diaz, Doucette-Remington, Dripps, Habron, Harré, Jarchow, Losch, Michel, Mochizuki, Rieckmann, Parnell, Walker and Zint2021). There is a strong case, therefore, that such practices should be embedded in GMH curricula.
As Matheson et al. (Reference Matheson, Robertson, Elliott, Iversen and Murchie2016) note, it would be fruitful to explore the practices and characteristics of resilient professionals, and assess the extent to which those could be trained and taught. Among the resilience-promoting workplace interventions and behaviours suggested by Matheson et al.’s (Reference Matheson, Robertson, Elliott, Iversen and Murchie2016) participants are exposure to challenging situations, peer learning and mindfulness. All of these could be adapted to the classroom. Learners and trainees should also be provided with opportunities for experiential learning through internships, mentorship, site visits and engagement with communities of practice.
Importantly, traits and skills such as resilience and adaptability can be viewed as characteristics of organisational culture and structures and team dynamics, in the context of broader external forces, not merely as individual attributes (Dean et al., Reference Dean, Cooper, Wurie, Kollie, Raven, Tolhurst, MacGregor, Hawkins, Theobald and Mansaray2020; Masten and Motti-Stefanidi, Reference Masten and Motti-Stefanidi2020). This is echoed by Eichbaum’s (Reference Eichbaum2015) concern that an individualistic view of global health competencies promotes an individualistic approach to learning and assessment, which may be at odds with the interactional, dynamic way such competencies are acquired and distributed within low-resource settings. We therefore encourage readers to critically examine the applicability of the Multi-Sectoral GMH Competency Framework at the organisational, sector, team and community levels.
Entrepreneurialism and GMH
Entrepreneurial skills and aptitudes (such as a start-up mentality, strategic thinking, perseverance, persuasion, optimism, generativity, drive and flexibility) also emerged as important. However, these have remained overlooked in existing competency frameworks. Acute global crises such as COVID-19, together with rapid technological advancements such as the rise of digital healthcare and artificial intelligence, have provided fertile ground for global entrepreneurship, including in LMICs (Mishra and Pandey, Reference Mishra and Pandey2023). We hereby argue that an entrepreneurial lens offers an opportunity to reinvigorate GMH training by increasing the focus on developing trainees’ creative, enterprising and leadership capabilities (Kidd et al., Reference Kidd, Kerman, Cole, Madan, Muskat, Raja, Rallabandi and McKenzie2015; Tang et al., Reference Tang, Byrge, Zhou, Turcan and Fraser2018). We urge educators, trainers, managers and other leaders to explore ways to cultivate entrepreneurial skills in the GMH workforce – for example, by leveraging international partnerships, internships, mentorship and alumni engagement (Colombelli et al., Reference Colombelli, Loccisano, Panelli, Pennisi and Serraino2022).
Suggested applications of the framework
By design, the framework incorporates a considerable number of competencies across sectors, job titles and career stages. Consequently, students, trainees and professionals are not expected to be proficient at all of them. Rather, the framework can be used to identify training needs, articulate already-acquired skills, aid career planning and mobility and promote self-awareness and reflection, as well as lifelong learning (Jogerst et al., Reference Jogerst, Callender, Adams, Evert, Fields, Hall, Olsen, Rowthorn, Rudy, Shen, Simon, Torres, Velji and Wilson2015; Okewole et al., Reference Okewole, Merritt, Mangezi, Mutiso, Jack, Eley and Abas2020). To both prospective students and employers, it can demonstrate the breadth and transferability of skills acquired in GMH programmes and training (Acharya et al., Reference Acharya, Buzza, Guo, Basnet, Hung, Van Dyke, Acharya and Becker2024). Relatedly, it can be used in programme advertisement and candidate selection so that candidates are aware of the scope and remit of job opportunities post-qualification. The framework can also aid educators in designing programmes aligned with the job market, including collaborative, interprofessional training programmes (Rowthorn and Olsen, Reference Rowthorn and Olsen2014; Okewole et al., Reference Okewole, Merritt, Mangezi, Mutiso, Jack, Eley and Abas2020; Acharya et al., Reference Acharya, Buzza, Guo, Basnet, Hung, Van Dyke, Acharya and Becker2024).
A key challenge for educators and trainers is how to foster and assess these competencies (Schleiff et al., Reference Schleiff, Hansoti, Akridge, Dolive, Hausner, Kalbarczyk, Pariyo, Quinn, Rudy and Bennett2020). As Vikram Patel, Chair of the Department of Global Health and Social Medicine at Harvard Medical School, aptly notes, adopting a competency-based approach to education and training goes hand in hand with introducing novel forms of assessment and teaching that resemble the specifics and challenges of doing GMH in the field (Institute of Medicine, 2013). Many of the competencies identified in the framework can directly inform creative authentic assessments and training opportunities, and equip trainees to undertake the decolonisation process. Techniques such as scenario-based learning, peer feedback and situational judgement tests have shown promise in this area (Wroe et al., Reference Wroe, McBain, Michaelis, Dunbar, Hirschhorn and Cancedda2017; Aylott et al., Reference Aylott, Finn and Tiffin2023). Many of the identified attitudinal and technical competencies are likely best developed in the field (Eichbaum, Reference Eichbaum2017). To allow for students’ and trainees’ exposure to authentic professional and cultural settings, multi-country partnerships, particularly between high-income and LMICs, should be established (Marienfeld et al., Reference Marienfeld, Hu, Yang, Liu, Lasswell, Rohrbaugh, Acharya and Becker2024). Assessment – particularly of the more situational and relational competencies such as intercultural communication, humility, influencing skills, conflict resolution and social justice awareness – should include more naturalistic, contextual and reflexive approaches such as role plays, observation and reflective field reports, and ideally involve co-assessors from diverse socio-cultural backgrounds (Eichbaum, Reference Eichbaum2015, Reference Eichbaum2017).
Above all, competency frameworks developed in high-income, Western settings by mostly Western researchers such as the current framework should be adapted to local settings critically, ethically and equitably (Schleiff et al., Reference Schleiff, Mburugu, Cape, Mwenesi, Sirili, Tackett, Urassa, Hansoti and Mashalla2021). The ‘blind’ imposition of Western values and concepts without prioritising context-specific training needs, learning preferences, cultural norms and worldviews exemplifies colonial practice and amounts to social injustice (Pritchard et al., Reference Pritchard, Alavian, Soogoor, Bartels and Hall2023). Individuals working in the field of GMH have a responsibility to be familiar with and continuously challenge the normalisation of embedded colonial assumptions and processes. Understanding how these histories shape current practice provides opportunities for practitioners to apply their own values and knowledge to help redress power imbalances and progress the decolonisation process across practice (Pritchard et al., Reference Pritchard, Alavian, Soogoor, Bartels and Hall2023; Sridhar et al., Reference Sridhar, Alizadeh, Ratner, Russ, Sun, Sundberg and Rosman2023). The inclusion of values (including respect for diversity, social justice commitment and fairness) as a competency meta-dimension underscores their centrality to effective, equitable and sustainable GMH practice (Kohrt et al., Reference Kohrt, Marienfeld, Panter-Brick, Tsai and Wainberg2016). Guided (self-)reflection, exposure to different cultural perspectives and experiences and knowledge of how power, inequality and oppression have operated historically to marginalise communities in LMICs remain vital (Sridhar et al., Reference Sridhar, Alizadeh, Ratner, Russ, Sun, Sundberg and Rosman2023). Self-awareness, humility, resilience, curiosity and courage – all distilled in the current framework – are fundamental personal attributes in undertaking this work (Ventres, Reference Ventres2019).
Limitations and future directions
The framework discussed in this article is limited in several ways. First, it is only one of several possible conceptual representations of the competencies extracted from the advertisements. The boundaries between the dimensions and sub-dimensions are only tentative, however, and do not determine the order or priority in which these competencies should be acquired. Second, the sample is relatively small, and many regions and job roles have remained underrepresented; in particular, advertisements that do not use traditional mental health job titles but are within the GMH scope, for example, child protection and occupational therapy roles. Third, the framework was initially designed to boost the employability of English-speaking GMH graduates in the UK, and due to its reliance on job advertisements as the data sources, one could argue that it represents an employability framework more so than a competency framework. The adopted definition of competencies was purposefully broad, and we acknowledge alternative definitions exist (von Treuer and Reynolds, Reference von Treuer and Reynolds2017). Finally, and fundamentally, although effort was made to include advertisements from different countries, the framework largely reflects a Eurocentric perspective. Global North jobs and employers, who may unintentionally prioritise Western values and epistemologies, were oversampled – creating bias in the current study.
Priority areas for follow-up research include validating the framework across LMICs and diverse communities of practice (e.g., see Zwanikken et al., Reference Zwanikken, Alexander, Huong, Qian, Valladares, Mohamed, Ying, Gonzalez-Robledo, Linh le, Wadidi, Tahir, Neupane and Scherpbier2014); mapping competency gaps among trainees and professionals in low-resource settings, and redressing structural barriers to the acquisition of required competencies among these groups (Hansoti et al., Reference Hansoti, Hahn, Dolive, Akridge, Atwell, Mishra and Schleiff2021; Schleiff et al., Reference Schleiff, Mburugu, Cape, Mwenesi, Sirili, Tackett, Urassa, Hansoti and Mashalla2021). Further work is also warranted into translating the framework into training guides that can be adapted for different sectors, professional groups and cultural settings, as well as into feasible curriculum learning objectives that can be adequately assessed using creative and contextualised assessment techniques (Schleiff et al., Reference Schleiff, Hansoti, Akridge, Dolive, Hausner, Kalbarczyk, Pariyo, Quinn, Rudy and Bennett2020; Brundiers et al., Reference Brundiers, Barth, Cebrián, Cohen, Diaz, Doucette-Remington, Dripps, Habron, Harré, Jarchow, Losch, Michel, Mochizuki, Rieckmann, Parnell, Walker and Zint2021). Notwithstanding the aforementioned limitations, the current study has strong potential for advancing and democratising professional development in the field.
Open peer review
To view the open peer review materials for this article, please visit http://doi.org/10.1017/gmh.2024.26.
Supplementary material
The supplementary material for this article can be found at https://doi.org/10.1017/gmh.2024.26.
Data availability statement
The data that support the findings of this study (i.e., copies from the job advertisements that informed the analysis) are available from the corresponding author, D.K., upon request.
Acknowledgements
The authors would like to sincerely thank the MSc Global Mental Health alumni and the professionals who offered feedback on the competency framework, and Ian Hutchison, for the graphic design of the framework. The authors would also like to thank Ms. Mia Wilson and Ms. Fiona Stubbs (University of Glasgow), for their continued support with this project.
Author contribution
Conceptualisation: D.K.; Data curation: G.H.; Formal analysis: D.K., G.H.; Funding acquisition: D.K., L.S., J.L.M.; Methodology: D.K., G.H., L.S.; Project administration: G.H.; Software: G.H.; Validation: J.L., R.G.W., A.J.; Visualisation: D.K., L.S., J.L.M.; Writing – original draft: D.K., J.L., G.H., A.J.; Writing – review and editing: D.K., J.L., R.G.W., L.S., A.J., J.L.M.
Financial support
The work reported in this article was funded by the University of Glasgow’s Learning & Teaching Development Fund.
Competing interest
The authors declare no conflict of interest.
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