On the road to recovery — Deng, BasicNeeds Lao PDR participant

Building on Innovation, Building on Scale

Having gone for scale once, BasicNeeds is scaling again

Mental health is an indispensable component of health and the World Health Organisation (WHO) recognizes that ‘there is no health without mental health’. Mental health problems today account for nearly 13% of the world’s total disease burden, affecting up to 450 million people worldwide at any one time. The World Economic Forum estimates that the cost of mental illness to the world economy is US$2.5 trillion per year in reduced economic productivity and physical ill health. According to a recent report, mental health problems cause more disability than any other health problem as well as early deaths. They also impose a tremendous strain on economic and social costs to the society which hinders development, and people with mental health problems are subject to some of the world’s worst human rights abuses.

In spite of the burden it imposes, mental health is given far too low a priority — often neglected altogether — in both national and international policies. Also the amount invested in treating mental health problems is very small — less than 2% of health spending in most low and lower-middle income countries.

Lack of awareness, high levels of stigma and inadequate political attention have led to a serious lack of investment in mental health care. What better time than now to scale up services to address this growing concern!

At BasicNeeds, we believe that in order for people with mental illness and epilepsy to lead better lives, we must take into account not only their need to access affordable treatment and health care but also take into consideration their social and economic needs. With that in mind, BasicNeeds introduced a community-based system that tackles access to diagnosis and treatment as well as supports the livelihood efforts of mentally ill people and their families making a direct contribution to the local economy. Known as the BasicNeeds Model for Mental Health and Development, this community-based system has proven to work in a variety of resource poor settings from urban environments in India to rural and nomadic communities in Kenya.

Fifty year old Deng from Lao PDR suffering from schizophrenia used to wander around in rags or sometimes without clothes. She came into contact with BasicNeeds Lao PDR through a community consultation meeting. Through the programme she was registered with the district hospital and is currently under treatment and is visited by the district mental health team trained by BasicNeeds Lao PDR on a regular basis. With the support of the BasicNeeds team, Deng was able to get back into income generation. She picks flowers and gets paid 10,000 KIP (US$ 1.24) for 1 kilo of flowers at the local shop. The flowers are offered by worshippers at the Buddhist temple. In addition, Deng also works in local gardens to clear weeds and earns up to 50,000 KIP (US$ 6.18) on some days. She is very pleased with her recovery and is happy to be earning an income.

Over 631,000 people with mental illness and epilepsy, their carers and families have now been through our programmes in 12 countries in Africa and Asia since we began our work in 2000.

The impact of the work includes, gains made by individuals, strengthening of the policy environment and health facilities, and mobilising community support. Yet, there are millions more who can benefit from access to the BasicNeeds Model and hence we are scaling up our efforts further to meet the growing need.

Replicating the BasicNeeds Model
BasicNeeds has created a core model that is clearly defined and which can be easily adopted by NGOs all over the world with populations to whom providing mental health services would be beneficial. Since the launch of our social franchise in 2014, we have four new franchisees on board. Our first franchisee GASS in India is currently implementing our Model in the rural areas of Karnataka state and has already transformed the lives of over 3,500 participants over the last eight months. With the support of Grand Challenges Canada, organisations Caritas Nyeri in Kenya, Voice in Ghana and HelPIN in Nigeria have also signed up as franchisees and are currently undergoing training on implementing the Model. We were also recently awarded a grant by Charities Aid Foundation at the suggestion of the Robert Wood Johnson Foundation to conduct a feasibility study for replicating the BasicNeeds Model in the United States.

Building ecosystems to empower scale
After a period of global expansion, innovation and scaling, it is clear that our next phase of growth will come from significant national deepening of our programmes. Using a ‘hub and spoke’ framework, BasicNeeds is now strengthening its existing country programmes as regional or country ‘hubs’ of excellence and enterprise. As hubs they will demonstrate high quality delivery of the BasicNeeds Model while recruiting and mentoring new local independent organisations as social franchisees or ‘spokes’. Since 2002, the BasicNeeds Ghana programme for example, has reached over 123,000 people with mental illness and/or epilepsy, their carers and families. It has co-created a new Government Mental Health Act and now works nationally supporting the Ghanaian government to build a national mental health care system; delivering large scale mental health and development programmes; and in 2014, with the Government support, identified 2 new social franchisees in Ghana and Nigeria, which it will now mentor to deliver the BasicNeeds Model.

Creating an International Association
BasicNeeds will gradually move towards an Association model that includes key global players, local governments and NGOs. Members of the Association will benefit from sharing best practices and cost effective solutions with peers and will be involved in influencing the global health agenda through advocacy.

BasicNeeds was the first agency to introduce a community-based system with related evidence that showed how community based development approaches can really work. Having directly helped more than half a million with mental illness or epilepsy and their families, BasicNeeds is thus in a position to work with an additional 1 million people by 2018.

Chris Underhill is one of the speakers at the Global Health and Innovation Conference, March 28–29th 2015, Yale University, New Haven CT.