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BasicNeeds: Helping the Mentally Ill Live Productively

BasicNeeds: Helping the Mentally Ill Live Productively

As a young man, Chris Underhill,
MBE, worked in Zambia with
Voluntary Service Overseas
(VSO), the British version of the Peace
Corps. On a trip to nearby Malawi, he
saw "mentally ill people behind bars
being goaded by a group of people who
found it funny." He was deeply affected
by what he witnessed.

"I have always felt that people who
are ill, maimed . . . need to be supported
in a nonsentimental way and in a way
that gives them some kind of aid
(economic and functional aid), which
would obviously help them make their
way in life," he said in an interview
with Psychiatric Times.

Acting on his beliefs, Underhill has
founded several charitable organizations,
the most recent one being "BasicNeeds",
a program in developing countries that
works with individuals with mental illness
or epilepsy, their families, and their
communities to establish accessible
treatment programs, satisfy basic needs,
and reduce social marginalization and
stigma.

Before creating BasicNeeds, Underhill
had founded "Thrive" (formerly
"Horticultural Therapy"), which uses
gardening to change the lives of disabled
people in the United Kingdom, and
Action on Disability and Development,
which works with physically disabled
persons in Third World countries.

"While I was working in the field
of disability, I kept an eye out for what
was happening to mentally ill people,
and realized that there was nothing
much going on in developing countries.
I had a growing conviction that I should
do something about it," he said.

He did so in 1999 by registering
BasicNeeds as a charitable organization.
The funds to start BasicNeeds
were contributed by Andrews Charitable
Trust (née World in Need) and the Joel
Joffe Charitable Trust. These donations
made it possible for the organization to
develop its overall policy and strategy,
for a sister trust to be registered in India,
and for most of the pilot work to be
done from 1999 to September 2000.

Currently, with an international staff
of 51, BasicNeeds is working in India,
Sri Lanka, Ghana, Uganda, Kenya, and
Tanzania and is establishing a program
in Lao PDR (Laos). From the start of
its operations in September 2000
through December 2005, Underhill
said, the organization has managed a
patient/client volume of 28,411 persons, about 60% of whom have a mental illness
and 40% of whom have epilepsy.
The organization also helps their estimated
142,000 family members.

Financial support for the ongoing
work of BasicNeeds comes from the
British government's Department for
International Development, the British
equivalent of the United States Agency
for International Development; Comic
Relief, a UK charity that funds developmental
projects primarily in the poorest
countries of the world; a range of
trusts and foundations; and some philanthropic
angels.

Goals

BasicNeeds' goals include arranging
for satisfactory and effective community-based care—including treatment,
support, and addressing the issues of
poverty and stigma—for persons with
epilepsy or with schizophrenia, depression,
bipolar disorder, or other debilitating
mental disorders. Achieving
those goals is a challenge because of
the scarcity of trained mental health
professionals, particularly psychiatrists,
and the lack of community-based
facilities, Underhill said. In Tanzania,
for instance, there are 14 psychiatrists
for some 37.7 million persons, and in
Malawi, there is one locally born psychiatrist
for 12.3 million persons.

Community-care facilities have yet
to be developed in nearly half of the
countries in Africa and South Asia where
BasicNeeds works. Consequently, mental
health care in many countries involves
placing individuals in institutions, where
in some instances they are physically
chained and abused, according to information
on BasicNeeds' Web site.1

Several countries in Africa have just
1 hospital for the mentally ill, Underhill
reported. Apart from the treatment concerns
of persons with mental illness
staying in institutions for many years,
he explained, it is almost impossible
for families to transport the person with
mental illness to the hospital if it is
located a significant distance away. If
a traumatic event occurs and the family
decides to take the person with mental
illness to the hospital, they may have
to calm him or her with a tranquilizer,
tie him up, and take him by bus, frequently
in 40°C (104°F) heat.

"So you have a human rights problem
right there," Underhill said. There
are human rights violations in the
community as well, he added. Because
most families do not understand what
is wrong with the family members who are mentally ill or epileptic, they may
chain or tie them up and beat them.

Community mental health model

Valuing human rights, promoting inclusion,
obtaining psychiatric treatment
in the community, and creating partnerships
with government departments
and community groups are all part of
BasicNeeds' comprehensive approach—an approach that is regarded by many
as both innovative and sustainable.

For example, in a project visit report
to the UK's Department for International
Development, Triple Line
Consulting Ltd, which assessed the
work of BasicNeeds and 3 other organizations
working in Sri Lanka or
India, said "BasicNeeds' project in Sri
Lanka, which combined a medical
model of mental health treatment with
community development approaches,
was the most innovative of the 4 projects
reviewed." The report also noted
that the changes that BasicNeeds has
fostered in the country "show good potential for sustainability."2

BasicNeeds avoids the traditional
model in which charities or church-based
bodies look after persons with mental
illness. Instead, it uses a community
mental health and development model,
which Underhill said enables the organization
"to reach out and touch so many
people in a meaningful way." Underhill
devised the model, and between January
and September 2000, D. M. Naidu, a
disability activist for some 25 years,
field-tested it in southern India.

The model has 5 interlinking components:
capacity building, community
mental health, sustainable
livelihoods, research, and management
and administration.

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