Prof. Davey Jones Caulfield Campus 28th February 2011 School of Public Health and Preventive Medicine Improving health literacy of people with severe mental illness: An informal community-based mental health care model in Vietnam Trang Nguyen*, Tuan Tran, Jane Fisher Jean Hailes Research Unit, Monash University, Australia Research and Training Center for Community Development (RCCD) Prof. Davey Jones Caulfield Campus 28th February 2011

WHO Pyramid for an Optimal Mix of Services for MH High Low COSTS FREQUENCY OF NEED In order to respond to the mental health burden, World Health Organization (WHO) and World Organization of Family Doctors (WONCA) have confirmed the role of community-based approach in LMICs by developing an evidence-based model “pyramid for an optimal mix of services for mental health”. The model was expected to provide adequate mental health services to address those challenges in LIMIC countries(4). Purposes of the model are to ensure population in need to receive adequate treatment at affordable and cost-effective manners, to protect human right and to alleviate stigma and discrimination against people with mental disorder. This model would fit well context of LMICs which is toward community-based mental health care. The model focuses on informal system including community care and self care. It can be seen that there was a change from formal services to informal services. Low High Source: WHO, 2008

WHO Pyramid for an Optimal Mix of Services for MH Formal services Informal

Task-shifting Specialised Health workers Non-specialist Kulhara, et al, 2009 Chatterjee, et al, 2014 Cohen, et al, 2014 Abbo, 2014 Chatterjee, et al, 2009 Task-shifting Specialised Health workers Non-specialist health or other workers In other words, there is a task-shifting process from professional staff to non-professional workers such as traditional healers, teachers, non-government organizations, user and family associations, lay people. Task-shifting was initiated to tackle workforce shortage in mental health area. Although there are still discussion of the acceptability and feasibility of this approach, it cannot be denied that non-specialist interventions contribute remarkably to prevention, treatment of common mental disorders and severe mental illness in LMICs. A process whereby specific tasks are moved, where appropriate, to health workers with shorter training and fewer qualification Source: WHO, 2008

Mental health system in Vietnam INFORMAL CARE Provided by non-professional health workers Non-government organizations Community care Family care Self-care FORMAL CARE Provided by professional health workers © RTCCD, 2012

Project question and theory Can quality of informal care for metally ill patients be improved sustainably by mobilisation of community resource and experience exchange? Project theory Women Union Positive Deviance Improved Quality of Mental Health Informal Care It can be seen that, most of main caregivers are women. Therefore, the project theory focused on supporting Women’s Union staff to apply positive deviance approach to improve the quality of informal mental health care

Objectives Develop intervention materials to improve informal care in the community Assess its effectiveness, acceptability, feasibility

Project intervention

Pilot intervention: Mental health support group Participants (n=68) People with severe mental illness Intervention 01 commune 2013-2014 Baseline survey Endline survey Before & after design 12 months Quality of life Outcome Mental health support group Fortnight meetings Talent show Consultation &referral Loudspeaker communication

Intervention materials Presentation title 28th February 2011

Wall painting with 8 topics 28th February 2011

Wall painting with 8 topics Presentation title 28th February 2011

Wall painting with 8 topics Presentation title 28th February 2011

Background characteristics Age: 40 (5 – 75) Gender: Men (n=40, 58.8%) Marital status: Married (n=27, 49.7%) Education: Not completed primary school (n = 35, 51.5%)

Presentation title 28th February 2011

Effectiveness on health outcomes Components Baseline (N=68) Endline P-value Social functioning Interpersonal relationship 9.34 (7.32-11.36) 11.13 (9.37-12.89) 0.18 Social acceptability 20.11 (19.02-21.21) 21.28 (20.19-22.36) 0.13 Community living skills Activities 11.65 (8.52-14.79) 14.66 (11.29-18.03) 0.19 Work skills 5.67 (3.89 – 7.46) 6.39 (4.81-7.97) 0.55 Specific Levels of Functioning Scale – 30 items

Acceptability, feasibility Positive deviance approach by sharing positive examples in the community  can be applied in rural areas in Vietnam Women’s Union staff can facilitate the mental health support groups with trainings. The model and information were well accepted by caregivers due to its practical information The project also contributed to reduce stigma against people with severe mental illness “Since the mental health support groups were established, I knew how to help my son to prevent crisis . Now he can work to earn money for his family”. A mother of a schizophrenia patient, Thuong village, Tien Ngoai commune, Hanam Province.

Conclusion The intervention was promised to be effective to improve health literacy of people with severe mental illness in resource- constrained settings The project did not show a significant results  There is a need of scaling up for a proper scientific evidence Minor modification will be applied for culture adaptation to implement in other settings

Acknowledgement Supervisors: Professor Jane Fisher, Doctor Arthur Hsueh Research and Training Community Development (RTCCD) Jean Hailes Research Unit staff and students Monash University for scholarships (MIPRS & MGS & Travel Grant) Grand Challenges Canada I would like to thank my supervisors for their enormous support and great guidance, to all staff and students at JHRU and the Review committees of SPHPM for very helpful comments, to Monash Uni and Graduate Women Victoria for financial support, to all heads of schools and directs of selected centres and adolescents, and to my family members without whom this project is impossible. 19 19