Mental Health Support Programs

With funding from AP, VVAF executes a community-based mental health project in partnership with Da Nang and Khanh Hoa Departments of Health and the Da Nang and Khanh Hoa Psychiatric Hospitals. The project receives technical assistance provided by a team from the U.S. National Institute of Health (Fogarty International Center), Vanderbilt University, and Rand Corporation. In this project VVAF aims to provide treatment services for depression in primary care practices (at the commune level) where there are no mental health specialists or psychiatrists. The patients receive both medication and psychotherapy treatment in a collaborative manner provided by a team of commune health station’s general practitioner, nurses, village health workers under supervision of mobile psychiatrists. In this collaborative stepped care model, we help to build capacity.

Specifically, this program provides a mobile team of psychiatrists to support community health stations, training of community health stations' general practitioners and nurses to provide guideline treatment, screening, basic psycho-education, and follow-ups provided by village health workers, social support from local authorities, mass organizations, and families, and use of culturally appropriate models of healing that incorporate family orientation, spiritual beliefs and practices, and community connectedness.

VVAF's mental health support programs look to integrate the community into the approach on mental health, while using experts at the hospital level for support. VVAF work currently strives to improve the mental health status of populations in Da Nang and Khanh Hoa provinces.

VVAF’s work on this issue has focused on the introduction of the collaborative stepped care model. This model stresses the integration of mental health care into general health services which allows the mobilization of a large number of para-professionals at the grassroots level to manage the common mental health problems.

This program aims to increase mental health resources and to improve community mental health care services for management of common mental health disorders (CMD). The project is currently in its third phase after successfully mapping the inadequacies of mental health policy in these regions in the Formative Phase (which ended at the beginning of 2010) and conducting a successful Pilot Phase in these two provinces (which ran from January 2010 to December 2010).

The Pilot Phase included construction projects in Da Nang and Khanh Hoa designed to improve the mental health infrastructure in the two provinces, researching and testing the programs methods on a smaller scale before engaging in more widespread implementation, supervising and training staff in various commune health systems (CHSs). The Pilot Phase allowed for all research measures to be finalized. Some construction projects have continued into the Implementation Phase, including the M-Block of Khanh Hoa Psychiatric Hospital.

In 2011, VVAF entered the intervention phase by rolling out the model to eight (8) commune health stations. These are three communes in Khanh Hoa (Phuoc Tan/Nha Trang City, Dien Son/Dien Khanh Dist, Vinh Ngoc/Nha Trang City) and five communes in Da Nang (Hoa Cuong Nam/Hai Chau Dist, Hoa Phong/Hoa Vang Dist, Man Thai/Son Tra Dist, Tam Thuan/Thanh Khe Dist, and Hoa Minh/Lien Chieu Dist). An important component of this intervention phase is the research program which will be conducted at four communes (out of the eight communes of intervention).

VVAF has been able to accomplish many things through this program, including the development of a feasible model for implementation; the development engaging psychoeducation training (which VVAF has begun to provide to health collaborators, CHS, and nurse trainees at the hospital); gains in experience doing systematic screening, identifying, and treating of depression at hospitals; high levels of interest and engagement in this program, as reported by service providers; and positive evaluations of the program by patients, which have found the program to be beneficial.

VVAF also faces significant challenges, including a continued stigma about mental health issues, questions about how to improve patient engagement in therapy, low mental health service utilization, a lack of trust in community providers and CHS, a continued burden on staff, a lack of comfort with the therapeutic process by service providers, an over-reliance on medication, and the continued need for regular supervision and ongoing consultation.

During the project implementation, we have actively engaged the officials from the Ministry of Health and the National Mental Health Hospital No 1 (who is responsible for the implementation of the National Mental Health Program). Site visits by those officials took place. Training workshops to share VVAF’s community-based mental heath program with the government officials at central and provincial levels took place regularly. As a result, there’s a substantial level of interest from the central government to follow up on the research study of VVAF’s program to evaluate its effectiveness and sustainability.

Also, as part of the implementation phase, VVAF compiled a mid-term review report on the project in August and September 2011. Also, staff members attended a one-month training in Melbourne, Australia, forging ties with Melbourne Uni, another grantee of Atlantic Philanthropies, regarding the continuation of the mental health program.