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BasicNeeds  -­‐  Vietnam        

Program  Background    

BasicNeeds (BN) has operated a pilot mental health program in the Thua Thien Hue (TTH) province in Vietnam since 2011. Vietnam has 93 million people and 58 provinces. TTH has a population of 1.1 million. The BN Vietnam program was funded with a $1.5m grant from Atlantic Philanthropies, which was intended to launch the program and take it through its first 4 years of operations (2011 – 2015). The program is now nearing the end of its life cycle. Atlantic Philanthropies will not be a future supporter of BasicNeeds for reasons unrelated to their performance  BasicNeeds  Vietnam  Program  Overview  

BN has worked in 3 districts in TTH, and within those it reached 15 “communes” (aka communities). Each commune has approximately 15 villages and 10,000 people. The total population of the communes reached by BN was thus 166,000 (approx. 0.17% of Vietnam’s population). The objective of the program is to enable people with mental illness and/or epilepsy to integrate and work within the community. As in many developing countries, there is a stigma associated with mental illness in Vietnam, which contributes to limited support for mental health patients BN has various community-building and advocacy programs that help to eliminate this stigma and connect patients and their caregivers with necessary services. Prior to BN’s involvement, the only mental health conditions eligible for treatment by the National Health Service were epilepsy and schizophrenia, and the treatment was limited to medication of the patient, with no counseling or other services made available. Through BN’s work, Generalized Anxiety Disorder (“GAD”) was added to the list of mental illnesses eligible for treatment through the national health program. GAD generally includes most depression related mental health illnesses. The model employed in Vietnam is customized for the unique features of the country, but generally follows the general BN model used in other countries (a combination of psychopathic medicine and community “livelihood” / intervention programs).

                     

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The intervention programs are conducted in partnership with the Women’s Union and includes things like community events, capacity building training events for patients, purchasing startup equipment for a small business, and helping the patient to secure bank financing or micro-financing for a small enterprise. In many countries epilepsy is widely misunderstood and believed to be a form of mental illness, even though it is often readily treatable through a medication regime. For this reason, BasicNeeds includes epilepsy among the conditions addressed by its programs.  Vietnam  Program  Achievements  

Overall, the goals of the program as established at the outset were exceeded, the government has expanded significantly the number of mental health patients that are treated through the national health care system, the condition of GAD is now recognized as a mental health illness, the communes where BN operates are now materially better equipped to deal with mentally ill patients and helping them re-integrate into the workforce and participate in ordinary life. Key metrics on the program’s impact follow:

• 2,273 patients were reached through the program v. an initial goal of 1,700 (757 schizophrenia, 506 anxiety, 315 epilepsy, 695 other)

• More than 80% of patients completed treatment, and around 85% show a great improvement in their symptoms

• More than 50% of patients have had their condition “stabilized”

• More than 10% of patients are now participating in “livelihood” activities, meaning they are engaged in an economically productive activity and able to contribute towards the support of their family (normally making a food or handicraft for sale at the market, etc.)

• In addition, 5 new self help groups were established where 98 members meet monthly to discuss patient care and how to assist patients in reintegrating (there was an initial target of 7 groups)

Perhaps most noteworthy, thanks to the strong integration of the Women’s Union into BN’s mental health programs, the livelihood components appear to be on a stable and sustainable footing and will continue without future assistance from BN. It does appear the BN model, through this pilot program, has proven to be a successful model that can be replicated in other communes in Vietnam.  Diligence  Trip  Overview        

Two Focusing Philanthropy staff members spent two days in Hue with the BasicNeeds team. Day 1 consisted of a field trip to see patients, caretakers, and Women’s Union volunteers. Day 2 was an event celebrating the conclusion of the four year BN program where patients, donors, health ministry officials, and program volunteers gathered to acknowledge the achievements of all those involved and to raise further awareness for mental health problems. We met with multiple BN staff members including Nguyen Thanh Tam (“Tam”), the program manager for BasicNeeds Vietnam based in Hanoi, Vietnam, and Chris Underhill, Basic Needs founder and President, based in the UK.  Day  1

We joined a film crew for a state run television program that was visiting a number of BN patients and program participants, investigating and reporting on the effectiveness of the BN program (pictured to the right). There is still a large social stigma associated with mental illness in Vietnam, but that is slowly changing thanks in part to a more open and progressive regime that is working to educate the public about mental health problems and slowly eroding the historical stigma. BN, and specifically Tam and her local staff, seems to understand very well the importance of forming strong relationships with the government, respecting existing power structures, and helping the Vietnamese leadership report on the results and achievements of the BN program.      

                     

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A BasicNeeds epilepsy patient prepares materials for the upcoming event the following day.

He suffered from severe depression when he entered the

program and is now fully normalized and integrated into the community. The following day he will give a speech at the

event.            

 

A BasicNeeds patient diagnosed with General Anxiety Disorder (yellow shirt) could not sleep and was not a contributing member to society when she entered the

BasicNeeds program.

She now has a successful business creating dragon masks for cultural festivals.

A schizophrenia patient has seen a dramatic improvement in

his condition since entering the BasicNeeds program and now is capable of supporting his family by making food products

for sale by street vendors.

BasicNeeds patients gather at a community building to make cakes for sale at the local market

     

                     

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Day  2  

On our second day in Hue we attended a workshop event along with around 100 patients and 100 other people involved in the BN program in some way. This included doctors, ministers from the health department, religious leaders, and volunteers for the BN livelihood program (Women’s Union), etc. The event was a celebration of the accomplishments of the patients and a demonstration of the success of the program as it nears its completion. It was also designed to raise awareness in the community for mental health and demonstrate the capabilities of the patients, many of whom were selling products in the courtyard, performing a dancing routine, and participating in a flower arrangement contest, all of which showed the mental health patients acting as normal and productive elements of the community.

Pictured below to the left: The event is hosted at a community center near the central part of Hue. Pictured below to the right: are BNs patients dancing and celebrating, demonstrating they are normal, capable, and functional elements of society

despite their mental illness.

Pictured below to the left: BNs patients sell vegetables in front of the event, demonstrating their ability to earn income and support their families. Pictured below to the right: BNs schizophrenia patient was formerly dysfunctional and now makes

and sells brooms.

Pictured to the right: Patients play games, which show the sense of community that has been developed within the BN program. Patients socializing with and helping other patients is a key to BN’s success (counseling is prohibitively expensive and medication alone is not effective).

                     

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Chris Underhill, BN’s founder, was also present. By all measures the event appeared to be a success and the accomplishments of the program participants were appropriately recognized. Tam’s ability to organize such an event and bring such a high-powered list of attendees was a further demonstration of her leadership capabilities and the competency of her local staff. The BasicNeeds program in Vietnam is now nearing its successful completion. Tam is starting a new organization to deepen the BN programs already begun in TTH province and replicate the BN model in new communes, first in TTH, and possibly other provinces further into the future. The organization will be called the Center for Community Based Mental Health and Community Development. Her goals were loosely communicated to us verbally, with a promise that more information will be coming soon:

• Ensuring the continuity of BN programs in the existing 15 communes already served • Extending the BN model into new communes in the TTH province (an easier proposition than extending to new

provinces) • Formalizing the “livelihoods” component of the BN program (setting standards, creating manuals, etc.) so that it can

be more easily replicated in other communes • Creating standards for the medical treatment of patients and communicating to other hospitals • Raising awareness for mental health and advocacy

It is clear that Tam will have some access to funding from local donors. It’s also clear she will be able to achieve government support through its health program. We’ve asked her for more details. Funding is in short supply for the new initiative, but Chris has committed his full support for Tam through Basic Needs. The new program will thus continue in partnership with BN, although the specific form of this partnership is still to be determined.

Tam addresses the audience at the start of the event. Chris Underhill, BN’s founder, and a representative from Atlantic Philanthropies are in the front row.

Chris Underhill makes an emotional and powerful speech, congratulating the patients and the BN participants on their successes to date.

                     

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BasicNeeds’ staff, state officials, donors, program participants, and state media mingle at a celebratory lunch. Tam’s ability (far right) to bring together these various groups over the past four years is a distinguishing feature of her capabilities and critical to her success in Vietnam. Focusing Philanthropy team member, Jason Windebank, pictured to the right in blue shirt.