Chris Underhill, the Social Entrepreneur behind BasicNeeds Intl

September 2014

Share your questions

Sign up as a MHIN member to post your questions to Chris as comments below, or Tweet your questions to @MHInnovation #GMHExpert. Throughout the month of September, Chris will be answering your questions on this Ask an Expert page.

About Chris Underhill

Chris Underhill is a global expert in the delivery of health and rehabilitation systems to very poor people. He is a serial social entrepreneur and his latest organisation, BasicNeeds, concerns the delivery of a holistic model for people living with mental illness and people epilepsy in some of the poorest countries of the world. Chris is a Senior Fellow with the Ashoka Fellowship, a recipient of the Skoll Award for Social Entrepreneurship, and most recently he has been selected as a Schwab Foundation Social Entrepreneur for 2014. The BasicNeeds Model for Mental Health and Development is recognised as a significant innovation in community mental health care delivery combining medical, social, economic and personal aspects into one successful programme. Over 617,000 beneficiaries have been served in the BasicNeeds global programme.  Previous organisations founded by Chris include Action on Disability and Development and Thrive, and in 2000 Chris was made an MBE by her Majesty the Queen for his services to disability and development. 

Join the conversation

Throughout September, you can join a global conversation to learn more about social entrepreneurship and mental health on Twitter #SocEnt4MH.


Question submitted via direct message on twitter:
'If a social entrepreneur is interested in moving into the area of global mental health, what should they do first? Is there any advice you wish you had known in advance?' 

For many years BasicNeeds has been one of the very few international NGO’s with a comprehensive programme in developing countries. If a social entrepreneur wished to move into the developing country, or global mental health, then my first reaction is that they would be welcome. There are far too few organisations in the global mental health space and another person or people trying out their ideas would be enormously helpful. Funding is very scarce in this field and so the social entrepreneur needs to be well equipped financially or be ready for a “long haul” so as to gain the necessary funds. In order to have traction and in particular scale they will need to consider what approach or Model they take very carefully. Similarly, they will need to be thoughtful about whether they wish to help people with mental disorders in the poorest segment of the organisation in a given country or whether they wish to serve others, perhaps slightly better off segments.

Almost inevitably the social entrepreneur will find that they are involved in managing their own scarce resources in the context of task shifting, in other words they will need to train health providers, volunteers, carers and so on to carry out tasks which perhaps in other societies would be considered more of a specialist role. We were immensely lucky when we started BasicNeeds because we had two generous investments which gave us the time to listen carefully to mentally ill people and their families in the poorest segment of their society and to design and test the approach which has now become the BasicNeeds Model for Mental Health and Development. It would be good to hear from anyone who would like to become a social entrepreneur in this field and I would be delighted to assist in whatever way I could as indeed would my colleagues. 

Finally, one of the things that I have achieved is the creation of national organisations in a number of countries whereby our programme has transitioned into an independently managed organisation with its own board. Obviously it would be great if the incoming new social enterprise worked in countries or in parts of countries where we were not present since a collaborative approach would be best. I know that the executive directors of the independent members of the BasicNeeds family will be more than happy to hear from incoming colleagues and I’m sure that effective collaboration would be very appropriate under these circumstances.  

Question submitted by Sameer Shirodker via twitter:

'@Mhinnovation What are the challenges in mental health particularly in developing countries? '

Governments and civil society have to recognize that this is a problem, it’s huge and it’s here. Professionals can only do so much. It is important also that the complex challenges posed by mental disorders are not seen simply as a health challenge but as a development challenge as well. Having a family member with mental illness can be devastating financially, socially, emotionally.  If the situation has to change then it is imperative that mental health initiatives by government and others adopt a whole life approach, and not just focus on solutions to treat symptoms. 

Question submitted via twitter:
#GMHExpert: As a #SocEnt you've started multiple organizations 4 #disability. Why did u decide to pursue #globalmentalhealth? 

There’s a story behind why I got into mental health. When my wife Giselle and I were very young, both 21, we signed up for Voluntary Service Overseas and flew out to Zambia to take up our placements: me as an agriculturalist and her as a teacher. On a break from VSO we visited Malawi, and it was there that Giselle said: I think I am pregnant. We went to the hospital, they confirmed and we were overjoyed. And then we stepped out of the door and saw a cage. In it, mentally ill people were locked up and they were being tortured by children poking sticks at them, making them scream and jump up and down. It was that cage that became the drive for me to move into the field of mental health work.

Before I actually started BasicNeeds I met a lot of experts in many countries, but more importantly I met families with a mentally ill member living in poor communities and listened to what they had to say. It became clear to me that it was important for us to have programmes around the world, not merely for demonstration, but real, fully fledged programmes that would help de-stigmatize the problem and ensure that the affected people get back into society and become a part of everyday community life. With programmes in 12 countries and working with half a million beneficiaries our work became spontaneously global and BasicNeeds became a kind of “natural” member of the global mental health community. 

Question submitted by Nathan Harris via twitter:

'@MHInnovation As a social entrepreneur in global mental health, what are some of the biggest challenges you have faced? #GMHExpert'

Being any entrepreneur is tough; maybe being a social entrepreneur is tougher and perhaps a social entrepreneur in mental health is the toughest!

A challenge in the beginning was where do I start? I decided to start with those who knew most about mental illness – those who had mental illness and their families living in India and other developing countries. Once they started to talk, what needed to be done became clear – their lives had to be transformed. So I developed the Model for Mental Health and Development that takes a whole life approach to mental health care. 

Next came the challenge of setting up an organization in the United Kingdom that implemented the Model outside the UK. So I had to find the right people in several countries. And to do all this of course I needed money - for a theme of work that had few takers. However once we got going we grew so fast that we were constantly running to catch up with ourselves! We now run Mental Health and Development programmes in 12 countries. 

I would say however that a persisting challenge has been to meet the desperate needs of affected families in more and more countries. This is why we launched our Social Franchise this year which allows us to scale up the BasicNeeds Model by tapping into the considerable competence, experience and resources of organizations that chose to become our franchisees. 

How did you first start to build relationships with policy makers when you arrived to work in a new country?

It is a slow process as I am sure you can imagine. However it often starts with one person who is a known contact and then like ripples on a pool of water begins to spread out. Introductions are the best way forwards both from the original known person and from others. If you are in the country yourself this can move quite fast but if you are attempting to get personal contact at long distance it is more complex and just takes longer. The actual psychiatric community is often very small and they are all too often feeling a little overwhelmed so they are easy to locate. However their influence within the wider health community might be quite limited so it is wise to reach beyond so as to be in touch with a variety of influence wielders.