DIS 56
International Development Committee
Evidence submitted by BasicNeeds December 2013
- Executive Summary
This document provides evidence on the following questions:
- The UK’s work with other development agencies and partner governments on disability
- The strength of the evidence base on ‘what works’ in development programmes involving disability
- The role of disabled beneficiaries in planning, managing and monitoring DFID policy and programmes
- Introduction
2.1 BasicNeeds
BasicNeeds is an international development organisation that was founded in 2000 by Chris Underhill MBE with the aim of bringing about lasting change in the lives of people with mental illness and epilepsy, and their family members.
BasicNeeds’ purpose is to enable people with mental illness or epilepsy and their families to live and work successfully in their communities by combining health, socio-economic and community orientated solutions with changes in policy, practice and resource allocation.
By delivering the BasicNeeds Model for Mental Health and Development, BasicNeeds has worked with hundreds of national and international partners and reached more than half a million people with mental illness and epilepsy, and their family members. Based on its community generated experience and knowledge, BasicNeeds has challenged the status quo, leading and affecting change in national and global policy and practice.
BasicNeeds has had a significant impact on policy and systems change on local, regional, national and international levels and has worked closely with the World Health Organisation.
BasicNeeds empowers people with lived experience of mental illness to come together collectively into self-help groups (SHGs) and self-advocate for their needs and their rights. In Ghana, a national association of people with mental illness and their caregivers was founded from SHGs. Together with BasicNeeds, the association played a key role in influencing the passage of a new mental health bill that was finally approved in 2011.
BasicNeeds has also played a critical role in national reform in Kenya, Laos PDR, India, Uganda, Tanzania, Sri Lanka, and Vietnam. At a global level, BasicNeeds has influenced the development of the WHO’s mhGAP Intervention Guide. It lends its expertise to The Lancet Movement for Global Mental Health (which Chris Underhill leads), the PRIME global research coalition in mental health, National Institute of Mental Health the WHO Global Forum of Mental Health, and two WHO steering committees.
BasicNeeds has conducted a number of research studies on both mental health and development policy and practice, and recently co-authored a case study on the implementation of the BasicNeeds model in Nepal that was published in PLoS Medicine, a peer reviewed journal.
2.2 BasicNeeds’ association with DFID
Since BasicNeeds was established in 2000, DFID has provided significant funding through its grants schemes to BasicNeeds programmes in low and middle income countries (LMIC).
In 2013 BasicNeeds established an important relationship with DFID as, via a bilateral aid programme, BasicNeeds Ghana began providing its expertise to the government of Ghana to support the implementation of their 2011 Mental Health Act.
BasicNeeds is also a partner in the DFID funded research on mental health, called the Programme for Improving Mental Health Care (PRIME) led by Cape Town University.
Along with the European Union and Grand Challenges Canada, DFID is one of the few funders making an effort to invest in mental health. Currently the investment tends to be focused on research but notably DFID and the European Union, through supporting BasicNeeds programmes, have supported service delivery. There is a challenge to translate the research into much needed services delivery, see our recent blog for comment on this:
http://www.huffingtonpost.com/basicneeds/results-in-mental-health_b_4254150.html.
2.3 Mental health
Mental illness is seen as both a cause, and a consequence of poverty[1] and ill-health[2]. Globally, an estimated 13% of all disease is attributable to mental health disorders, and neuropsychiatric conditions contribute the most to this overall burden: more than either cardiovascular disease or cancer.[3] As highlighted by the latest Global Burden of Disease Report, mental illness is projected to be the leading burden of disease by 2030. As Alan Lopez, one of the leading contributors to the report noted, “mental health is perhaps one of the most neglected of neglected diseases in global health”.[4]
Almost three quarters of those suffering from mental illness live in low and middle income countries[5], where up to 85% of people with severe mental health conditions do not have access to much needed mental health treatment (the figure for high income countries is 35-50%).
Mental health is extremely under-resourced with the complete absence of mental health budgets in almost a third of countries. In LMIC there is a severe lack of psychiatrists, and the majority of people resort to consulting traditional healers that can result in human rights abuses.
Poverty brings with it heightened stress, social exclusion, malnutrition, violence and trauma, all of which contribute to mental illness. It is a vicious circle, as those with mental illness experience widespread stigma and discrimination, suffer violence and abuse, they find it harder to get work, get an education or contribute to family and community. They are more prone to other forms of illness and disease, and find it harder to access health care.
Impaired mental health can lead to disability or premature death. A mental health condition is therefore considered a disability if it has a long-term effect on normal day-to-day activity.
- Evidence
3.1 The strength of the evidence base on ‘what works’ in development programmes involving disability
BasicNeeds has learnt that to be effective, programmes must start with people living with mental illness or epilepsy; and address illness, poverty and social exclusion of affected people and their families in a sustainable, holistic way.
BasicNeeds has over the past thirteen years developed a unique Model which does just that, this Model is described below:
By putting people living with mental illness and epilepsy at the centre of the development process, BasicNeeds has demonstrated with robust evidence ‘what works’: 80% of affected people involved in BasicNeeds programmes [6]:
- have better access to effective community based mental health services;
- are equipped with the skills and ability to make choices and contribute to a community’s economic and social activity;
- are empowered to transform those choices into positive changes in their lives;
- feel included and valued in their community expressing their strengths and needs, with their rights properly recognised.
3.3 The role of disabled beneficiaries in planning, managing and monitoring DFID
policy and programmes
BasicNeeds believes to ensure sustainable outcomes people affected by mental illness or epilepsy, particularly those who are most marginalised and living in poverty, must participate in and lead solutions that will transform their lives. The design and delivery of all BasicNeeds programmes funded by DFID are underpinned by this belief .
BasicNeeds has a rich experience of supporting the development of SHGs of people with mental illness and epilepsy and their carers. These are sustainable independent registered structures and are empowered to self-advocate. As previously described a national users association has developed in Ghana as a result of the SHG movement and the voices and advocacy that this association brings to the delivery of the DFID bilateral project mentioned is notable. This development was supported through funding from Comic Relief.
As well as supporting the development of the government capacity to provide mental health services the bilateral project supports all the elements of the implementation of the BasicNeeds Model. This includes the development of a further 1237 community based SHGs and 175 district service users/care-givers associations in Ghana that will significantly strengthen the Users movement, contributing to ensuring services meet their needs and that change is sustainable .
We recommend that DFID consult disabled people’s organisations (including associations of people with mental illness) on new policy. Meaningful consultation with these civil society groups should take place using appropriate methodology. Through our work we have notably developed participatory methodologies that ensure the inclusion of people with mental illness and epilepsy such as Participatory Data Analysis; these are described in the references below. Consultations can be facilitated when required by NGOs with experience as in the case of BasicNeeds or initiatives such as participate (http://www.participate2015.org) . This should be properly resourced and time built into the process for this to happen.
Example references:
Raja S, Underhill C, Shrestha P, Sunder U, Mannarath S, Wood S, Patel V. (2012) Integrating mental health and development: A case study of the BasicNeeds model in Nepal. PLOS Medicine. 9(7): e1001261. http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001261
Shoba Raja, Sarah Kippen Wood, Jordan Pfau, Chris Underhill, ‘Participatory Data Analysis: Inclusive Research in Mental Health and Development’, Disability and International Development, 2012. Issue-2; 17-23. http://www.zbdw.de/projekt01/media/pdf/2012_2_BiE.pdf
3.4 The UK’s work with other development agencies and partner governments on disability
Below are some key references of policy documents that endorse BasicNeeds’ view that innovation in mental health should not be limited to delivering medical treatment but needs to be a multi -sector, comprehensive set of interventions that take into account the mental illness and poverty of affected persons and their families.
This principle can apply locally, nationally and globally as the UK works with other agencies on disability.
This view is also illustrated in our recent blog http://skollworldforum.org/2013/06/27/from-darkness-to-light-the-first-ever-global-mental-health-action-plan/)
Example references:
World Health Organisation, Mental Health Action Plan, 2013
http://www.who.int/mental_health/publications/action_plan/en/index.html.
World Innovation Summit of Health, Report on Mental Health; Transforming Lives, Enhancing Communities: Innovations in Mental Health, Vikram Patel and Shekhar Saxena, with Mary De Silva and Chiara Samele, 2013. http://www.wish-qatar.org/app/media/381.
BasicNeeds UK Reg. Charity No. 1079599