Implementation of school-based risk management protocol in task-shifted mental healthcare

Background: Adolescent mental health problems are prevalent in low- and middle-income countries like Kenya, where access to care remains severely limited. Task-shifted, school-based interventions offer solutions but often lack structured protocols for managing risk such as suicidality or abuse.

Methods: A mixed-methods implementation study was conducted across 149 public high schools in Kenya. The Shamiri Risk Management Protocol (Shamiri-RMP) was evaluated through a review of 222 student cases.

Results: Of 76,855 students enrolled in the broader Shamiri program, 977 (1.27%) were referred for risk assessment, and 222 (0.28%) were enrolled in the Shamiri-RMP. Risk reductions occurred in 60.47% of high-risk cases, 56.34% of moderate-risk cases and 51.76% of low-risk cases. Implementation facilitators included supervisory support (50.88%) and protocol clarity (80.70%), while barriers included referral gaps (5.26%) and confidentiality concerns (54.39%).

Conclusion: Findings support the feasibility and scalability of the Shamiri-RMP in low-resource school settings.