Mental health interventions, which neglect the context of poverty, risk ineffective delivery. This is partly because mental illness and the stigma surrounding it can be a causal factor behind a family’s poverty. Many people with mental illness are unable to maintain paid employment, and illnesses can get in the way of other productive work (Razzano et al. 2005). In addition, the stigma of mental illness can reduce individuals’ prospects indirectly by making it harder to acquire education. For example, Fatuma Mohamed, who participated in BasicNeeds Tanzania programme commented: ‘I wish to go to school like my fellow pupils, but I’m afraid of being called awful names’ (BasicNeeds 2006a). Depending on location, this stigma can take multiple forms. In India, a fear that mental illness will harm marriage prospects can lead to it being hidden, and this is felt more strongly by women than by men (Thara et al. 2003). Thornicroft et al. (2009) found degrees of anticipated and experienced discrimination are consistently high among people with schizophrenia through a study across 27 countries (see chapter 13 by White, Ramachandran and Kumar in this volume for further details about mental health related stigma and discrimination).
Equally, having an occupation can help in sustaining recovery from mental illness (Bush 2009). Where individuals are able to engage in wage earning or other productive work, it can offer a renewed sense of purpose and feeling of meeting the responsibilities one has towards one’s family. Participants of BasicNeeds’ programmes have reported feeling satisfied that they no longer feel like a burden on their families, and are proud to be able to contribute. Regaining a sense of purpose can be part of managing mental illness. Nguyen Thi Mui, a 43-year-old woman from Vietnam, diagnosed with schizophrenia, told BasicNeeds:
I have learnt how to make a broom and now I can sell it at the local market. It is very wonderful. Every day, I can earn 10,000 to 15,000 VND ($0.47-$0.72) so that I can buy some food for myself. My parents are very happy because I can overcome my illness.
BasicNeeds provides, alongside its community-oriented mental health treatment, interventions designed to enable affected individuals to engage in paid employment or other productive work. This first involves an assessment of the opportunities available to the individual, which includes the skills of the individual, the skills shortages locally and locally available institutions that can provide support. In addition to this assessment, BasicNeeds and its partner organisations visit affected individuals to offer support, mentoring and information about opportunities such as micro-finance initiatives. While some independent micro-finance organisations have been hesitant to offer loans to individuals with mental illness due to stigma, BasicNeeds has offered a subsidy in the form of a loan guarantee in some regions. This support can be accompanied by communities organising self-help groups as part of the animation process or communities supporting the affected individuals by identifying valuable activities they could work towards:
Before he became ill, Venkatesh worked for thirty years in the weaving industry.
He gave it up and concentrated on overcoming his illness with the support of his family. Following treatment and ongoing assistance from one of BasicNeeds’ partners in India, Grameena Abyudaya Seva Samsthe (GASS), Venkatesh decided to set up a small business—supplying snacks to travelers using the bus shelter in his village. Trade has been good and he turns over about R.300 [$7.50] a day, a modest sum but comparable to the incomes of many people in the area. Most importantly, Venkatesh describes himself as having a completely new beginning. He is confident and contented, enjoying the relative freedom of the work he does now. Notably, the local panchayat (local elected body) has been instrumental in allowing Venkatesh to use the bus shelter, which is a favourable location for his business. (BasicNeeds 2006b)