BasicNeeds: Successful Mental Health Programs With Scarce Resources

Rejected by his family, Ahmed Abdullai often wandered aimlessly and slept in a graveyard in Tamale, northern Ghana. Now, with the help of BasicNeeds--an international development charity working to end the suffering of mentally ill persons in Africa, Asia, and soon, Latin America--Abdullai takes medications to stabilize his mental illness, learns gardening skills at the Tin Laayisi horticulture project, lives at home, contributes to the family farm, and feels like a "human being once again."

He is one of more than 28,000 persons who, along with their families, are being helped by BasicNeeds and its partner organizations in Ghana, Uganda, Kenya, Tanzania, India, and Sri Lanka.

Chris Underhill, MBE, BasicNeeds' founder/director, will be speaking in New Orleans on Thursday afternoon, November 16, on "One Psychiatrist Per Million People: Developing a Mental Health Program for the Poorest Countries in the World" at the 19th annual US Psychiatric & Mental Health Congress. His organization will also exhibit there.

"There are several important realities that need to be brought to the attention of mental health providers," Underhill told Psychiatric Times.

Mental illness, he explained, accounts for about 12.3% of the global burden of disease, and by the year 2020 this will rise to 15%. In addition, more than a billion people live in countries that spend less than 1% of their total health care budget on mental health, compared with the 6% spent annually in the United States.

Currently, "96.5% of people in low-income countries have access to, at most, 1 psychiatrist per 100,000 people," Underhill said. Yet, when it is understood that psychiatrists, many of whom are in private practice, congregate in capital cities like most other professionals and are not available to poor, rural populations, then the real ratio in most areas is 1 psychiatrist per million population.

To address that reality, BasicNeeds has formulated a model for mental health and development that optimizes the use of professional mental health resources and focuses on the ability of the community and mentally ill persons themselves to manage the processes inherent in a program of mental health and development. Sixty percent of BasicNeeds' client base is mentally ill, and the other 40% suffer from epilepsy.

One of the statistics that the organization is most proud of is that 22% of its clients have resumed earning a living (in jobs such as agricultural day labor, administration, and teaching), Underhill said. An even larger proportion, he added, has returned to some sort of productive work, including contributing to the home or a home-based industry, such as farming.

BasicNeeds also is developing new programs in Laos and Colombia. The program in Colombia is a mental health and development program, being managed by the husband-wife team of psychiatrist Carlos Gomez-Restrepo, MD, and Andrea Padilla, a human rights lawyer.

Other projects for BasicNeeds include launching an e-roundtable on mental health and development issues and assisting communities in Sri Lanka and Southeast Asia affected by the 2004 tsunami disaster.

The e-roundtable is open to individuals and organizations throughout the world that have an interest in mental health and development. Anyone interested should contact James Duggan (James.Duggan@basicneeds.org.uk) for more details.

In addition, BasicNeeds is conducting "Training of Trainers" programs to pass on its experiences and best practices--the BasicNeeds development-oriented, psychosocial care model--to other community development organizations. Two training programs have been held to date with community and nongovernmental organization lead-ers from Indonesia, Thailand, India, and Sri Lanka attending. Pakistani leaders were also in attendance and wanted to use the same techniques for those affected by the earthquake in Pakistan.

The program has 2 components: a 10-day residential "Training of Trainers" program and a 12-month follow-up program in which participants receive on-the-job training and additional skills development and educational guidance.

Although the continued involvement of BasicNeeds in major international disasters and emergencies represents a departure from the organization's original focus, Underhill said, the organization hopes to fill in a much-needed gap in the provision of disaster relief.

BasicNeeds is structuring a model aimed at individuals who experience abnormal responses to a disaster or emergency over the long term and at those who already have a mental illness and experience a disaster-related deterioration of their condition, the onset of comorbid psychiatric disorders, and/or gaps in their treatment and medication supply.

US psychiatrists, Underhill added, can assist BasicNeeds in its many programs by contributing financially (see www.basicneeds.org.uk), by volunteering their services to help with mental health training courses, and by assisting in the development of a "genuine, well-motivated support structure" for BasicNeeds in the United States.