III Case Studies of Innovative Practice and Policy
BasicNeeds: Scaling Up Mental Health and Development
Chris Underhill, Shoba Raja, and Sebastian Farquhar
Responding to the Global Mental Health Challenge
Mental health problems are increasingly recognised as a significant and growing contributor to the global burden of disease (Murray et al. 2012). The majority of people with mental health problems live in low- and middle- income countries (LMICs) and receive little or no evidence-based treatment, a situation often described as the ‘treatment gap’ (Lopez et al. 2006). This means that citizens of LMICs bear a disproportionate share of the burden of global mental illness (Whiteford et al 2013).
Moreover, the close links between mental health and development (MHD) are critically underemphasised. Conditions of deprivation or social exclusion increase the risk of mental illness (Lund et al. 2010) and reduce access to treatment and its affordability (Knapp et al. 2006). At the same time, mental illness exacerbates inequalities in wealth and income (Kessler 2008). Where social supports are inadequate, households are vulnerable to the income shocks created by mental ill health (Lund et al. 2011). Mental disorders reduce the ability of affected individuals and their carers to engage in productive activity
C. Underhill (*) • S. Raja BasicNeeds, Leamington Spa, UK
Global Priorities Project, Oxford, UK © The Author(s) 2017
R.G. White et al. (eds.), The Palgrave Handbook of Sociocultural Perspectives on Global Mental Health, DOI 10.1057/978-1-137-39510-8_21
as well as wage earning. This effect is especially large where stigma and social exclusion reduce the ability of affected individuals to engage in formal and informal labour markets (Sartorius 2007). The risk of stigma also reduces demand for treatment (Saxena et al. 2007).
In response to this situation, BasicNeeds was set up in 2000 as an international not-for-profit mental health organisation. The organisation delivers the MHD model in developing countries and has, to date, reached 631,441 beneficiaries through field operations in 12 countries in Africa, South Asia and South East Asia. Field programmes are operated either directly by BasicNeeds or through franchisee, that is, independent organisations licensed by BasicNeeds through a Social Franchise agreement to operate the BasicNeeds model (BasicNeeds 20l4d, 20l4e). BasicNeeds was founded by Chris Underhill who previously founded ‘Thrive’ and Action on Disability and Development’. Both organisations worked with vulnerable people affected by physical or mental disabilities. Lessons learned were applied designing the BasicNeeds model.
The BasicNeeds model of MHD, described in detail further in this chapter, comprises five modules: capacity building, community mental health, livelihoods, research, and collaboration (Raja et al. 2012). Taking a whole life approach, the BasicNeeds model addresses the health, social and economic needs of people with mental illness and their families. The model emphasises the importance of supporting the development of local institutions and community capabilities, participatory methods in all aspects of programme development, and grounding programmes in research on effectiveness (BasicNeeds 2008)
Operating in challenging contexts where as many as 85% of mentally ill people in LMICs are unable to access treatment or work opportunities (WHO 2004a), the BasicNeeds model has gained global attention for its innovative interlinking of mental health care, poverty alleviation and good practice (WISH 2013; Skoll Foundation 2013; Ashoka 2012; World Economic Forum 2014).
Working with colleagues in India, Chris conceived of the BasicNeeds model by listening to persons with mental disorders in rural and urban areas through a series of community meetings held in 2000—2001. Once the model was fully designed, BasicNeeds’ first field programmes were implemented in India (BasicNeeds 2004). From 2002 onwards, MHD programmes were rapidly expanded to other countries in Asia and Africa. BasicNeeds works with communities and supports the health systems of LMIC to address the many challenges of Global Mental Health (GMH) in an integrated and holistic way (Lund et al. 2013).
The BasicNeeds model for MHD has emerged over more than 14 years. Within the framework of the MHD model, the finer details of implementation could differ from location to location depending on the needs of communities and the capacities of local systems. Because it is inclusive, it also depends on the conditions with which individuals present. In some regions, care is focused heavily on individuals with epilepsy, for example, while in others epilepsy is rarely treated.
This chapter introduces the BasicNeeds MHD model and describes its operations using examples from field programmes to demonstrate how each component of the MHD model aligns to the needs of the problem context. In the subsection on the ‘Research’ module, the authors elaborate on the method used to monitor BasicNeeds’ impact on an annual basis. In addition, the chapter draws from papers and a recent independent review in India to illustrate key outcomes, discussing also some of the limitations. Finally, cognizant of the GMH community’s consistent advocacy for scaling up, the chapter explains BasicNeeds experience and strategies in making the MHD model scalable.