1. 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

2. 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

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

4. 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

5. 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

6. 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

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

8. Project intervention

9. Pilot intervention: Mental health support group
Participants
(n=68)
People with severe mental illness
Intervention
01 commune
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

10. Intervention materials
Presentation title
28th February 2011

11. Wall painting with 8 topics
28th February 2011

12. Wall painting with 8 topics
Presentation title
28th February 2011

13. Wall painting with 8 topics
Presentation title
28th February 2011

14. 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%)

15. Presentation title
28th February 2011

16. Effectiveness on health outcomes
Components
Baseline
(N=68)
Endline
P-value
Social functioning
Interpersonal relationship
9.34 ( )
11.13 ( )
0.18
Social acceptability
20.11 ( )
21.28 ( )
0.13
Community living skills
Activities
11.65 ( )
14.66 ( )
0.19
Work skills
5.67 (3.89 – 7.46)
6.39 ( )
0.55
Specific Levels of Functioning Scale – 30 items

17. 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.

18. 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

19. 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