Op-Ed: The Developing World Deserves Mental Health Access Too

BasicNeeds founder Chris Underhill talks about the silent scourge of mental illness in the developing world.

A mentally ill woman, who wardens identify as Sandy, stands naked in a squalid cell, in Juba's Central Prison, in South Sudan, Oct 22, 2012. There are no dedicated mental health facilities in Africa's newest country, so families often dump sick relatives at the nearest jail, where staff have little training or medication with which to treat them. (Photo: Getty Images) 

Chris Underhill, MBE is the Founder Director of BasicNeeds.

BasicNeeds firmly believes that mental health is a basic right and not a privilege. However, for the millions of people living in poverty, mental illness is a world of isolation, fear, abuse and neglect. Suffering from schizophrenia, Bernard Mapunda from Tanzania was called a “crazy fellow” by people in his village as he fought with children and adults and quarrelled with people wherever he went. He used to walk aimlessly around the village and would be found sleeping atop trees.

During one of my visits to Africa, I was shocked to see how mentally ill people were treated within their communities and how little was being done for their welfare. According to the World Health Organisation, there are 450 million people like Bernard in the world suffering from mental disorders of which three quarters live in low and middle income countries, where 75 to 85 percent of people with severe mental health conditions do not have access to much-needed mental health treatment. Also, depressive diseases are among the leading causes of disability worldwide.

I visited various government-run mental health programmes in Africa and Asia and found that the few services that existed for mental healthcare are limited to institutional care in outdated patient wards where serious cases of neglect and abuse have been documented. Also, in rural areas of Africa and Asia, it is common to chain people in shackles and put them in cages to ensure their control. It was therefore clear to me that mental health is a hugely neglected area. It was in response to this situation of mentally ill people that I founded BasicNeeds in 2000, an international development organisation which works with people who are affected by mental illnesses and epilepsy. Since the lives of people with mental disorders are affected by the attitudes of their family and community, BasicNeeds works not only with people with mental illness but also their carers, families and the wider community as well.

I believe that it is only when people are empowered with the ability to feed themselves, have a roof over their heads and are able to integrate themselves within the community that they will recover from their illness. In addition to this, mentally ill people must be able to access good treatment; after all, this is their basic right and not a privilege. With a vision that “the basic needs of all people with mental disorders throughout the world are satisfied and their basic rights are respected,” BasicNeeds established the model for Mental Health and Development in 2000. The model places people with mental illnesses and epilepsy at its centre and mental health firmly within an economic and social development context. It is a holistic approach as it creates an environment in which people with mental disorders are able to address not only their illness, but also their economic and social situation. The model constitutes five interdependent operational modules:

Capacity building: We empower people with mental disorders, their carers and families, mobilise key stakeholders to influence mental health practice and policy.

Community mental health: We work with doctors, nurses and community volunteers to deliver community health services in primary health clinics.

Sustainable livelihoods: Through self-help groups we provide opportunities for income generation or participation in productive work.

Research: We conduct ongoing research on programme outcomes, which is then used to influence government policy and practice.

Management: Attentive management of our partnerships and programmes lies at the heart of all our activities.

In order to carry out our work in the various countries that we operate in, we partner with local NGOs, local and national government health services to bring people affected by mental illness into the mainstream, creating livelihood opportunities and forming self-help groups that can access local and government resources. By building the capacity of existing services in a country and simultaneously nurturing self-help groups, the model has been refined, sustainably implemented across different countries in urban and rural settings as well as in contexts of peace and instability.

Since the 13 years of our inception we have cumulatively reached 558,272 beneficiaries including mentally ill people, their carers and family members across 12 countries. Though we have reached significant numbers, this is not enough as there are so many more people like Bernard who are in desperate need of assistance. In order to do that, we believe that not only scale up but also replication of our work will enable us to reach at least a million more people in the next five years.

Therefore as part of our strategy, we aim to build upon our existing programmes as well as implementing new programmes. Some of the existing programmes will make a transition to independent, national organisations in-country under their own trustee boards. This has already occurred in Uganda, Ghana and India. To achieve large-scale growth we are also in the process of preparing to promote the model for Mental Health and Development as a product via a social franchise to agents like NGOs, Ministries of Health, hospitals, universities, corporates and social entrepreneurs who can cost-effectively implement it in their countries or regions.

Coming back to Bernard’s story, worried by her son’s behaviour, his mother took him to a BasicNeeds field consultation and Bernard began treatment. As often happens within three months of starting his treatment, he began showing signs of improvement and increasingly he began to lead a more normal life. With the help of BasicNeeds, he established a small business selling food and other related things with his mother and in due time will expand to a full grocery store selling rice, flour, groundnuts, sugar, salt, cooking oil, beans, eggs and other items. It is not difficult to understand that Bernard will feel much more complete as he returns not just to normal life but to a productive life. This is what I seek to achieve in the development of our work worldwide.


Editor’s Note: This article was published as part of a series leading up to the 2013 Skoll World Forum on Social Entrepreneurship, to be live-streamed April 10-12 from Oxford, U.K.

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