BasicNeeds Mental Health and Development Model

Innovation summary

Mental illness represents a cause and a consequence of poverty and poor physical health. Yet few programs take into consideration both the lives and livelihoods of their service users when developing mental health interventions for LMIC.

The aim of the BasicNeeds “Mental Health and Development Model” is to empower people with mental health problems living in poverty through community-oriented treatment and self-help support. The model comprises five inter-linking modules designed to address service users’ medical, social, and economic needs:

Capacity building
Community mental health
Livelihoods
Research
Collaboration

Interventions are designed around these themes, taking into account the local needs and context.

Impact summary

To date, BasicNeeds has reached over 650,000 people with mental health problems, their carers and family members¹
Access to treatment by service users with mental health problems increased by 84%, and 75% reported a reduction in symptoms²
The cost per person is US $9.67, per month

"I finally knew what was wrong with my daughter. At least I had some answers and I got advice on how to help her get better. Hope for me was alive again."

- Mother of a BasicNeeds service user, Lao PDR

Innovation details

BasicNeeds currently has programmes in 12 countries– five in Africa (Kenya, Uganda, Ghana, Tanzania, South Sudan) and seven in Asia (India, Nepal, Sri Lanka, Pakistan, Vietnam, Lao PDR, China). The BasicNeeds “Mental Health and Development Model" comprises five inter-linking modules, as described further below:

Capacity building

Identifying, mobilizing, sensitizing and training mental health and development stakeholders

Community mental health

Enabling effective and affordable community oriented mental health treatment services

Livelihoods

Facilitating opportunities for affected individuals to gain or regain ability to work, earn and contribute to family and community life

Research

Generating evidence from the practice of mental health and development

Collaboration

Forging partnerships with stakeholders who are involved in implementing the model on the ground and/or are responsible for policy and practice decisions to improve mental health provision.

Key drivers

Operational model
The Mental Health and Development Model is wide in scope and inclusive of affected persons, carers & family, community, government and other key stakeholders

Using local resources
Clinical services and opportunities for work/income generation are facilitated through government and other local facilities and resources

Empowerment
Self-advocacy is promoted by organizing and building capacities of affected persons

Challenges

Limited resources
Keeping pace with the demand and acute needs of affected individuals and families while working through government and other existing local resources is a challenging but important approach for long-term sustainability

Discrimination by health providers
The mind set of psychiatric and health personnel is a challenge; however, in many countries this has not been as tough as we had thought it might be

Supply chains
Availability of psychotropic medicines in the health systems especially cannot always meet the increased demand generated from the community

Funding
Sufficient and consistent allocation of funds and other required resources from government sources are challenges

Continuation

The BasicNeeds Mental Health and Development model has already been implemented in 12 countries. In an average year BasicNeeds works with 35-40 thousand affected individuals.² BasicNeeds has evolved from demonstrating early scale of its model in selected geographies into an organization with significant geographic presence, supporting innovation, local leadership, driving policy changes and building national systems in mental health.

BasicNeeds is currently testing its social franchise approach of scaling to reach more people in need of assistance. An investment from Grand Challenges Canada will enable three organisations in Ghana, Kenya and Nigeria to deliver the BasicNeeds Model under a social franchise agreement. This project will be carried out over a three year period and is expected to reach 10,000 people.⁴

Partners

BasicNeeds partners number 90 who operate from the grassroots to national levels, ranging from farmers’ cooperatives to Ministries of Health who work with BasicNeeds to deliver the BasicNeeds model locally.

To deliver treatment services through the local health facilities in every operational country BasicNeeds works in close partnership with the government ministry of health and its district level arms.

Funders

BasicNeeds raises income from a range of funders, including:

Institutional donors, e.g.

Trusts and foundations, e.g.

Skoll Foundation

Individual supporters

Evaluation methods

BasicNeeds uses its own global Monitoring-Quality Assurance-Impact Assessment system building off of routine data collection carried out as part of everyday work.

BasicNeeds is currently evaluating its Grand Challenges Canada Transition to Scale Programme in Kenya, Nigeria and Ghana, jointly with the London School of Hygiene and Tropical Medicine. This evaluation will focus on whether, how and why the BasicNeeds Model as delivered under a social franchise business model is effective in delivering the programme’s outcome.

Cost of implementation

In 2012 the cost of implementing the BasicNeeds’ model in 11 countries was £1,947,129. Based on direct field level costs on the ground in 2012 the approximate cost per affected individual was £20 and cost per beneficiary (affected person + primary carer + family members) was £4.⁵

Impact details

As of December 2015, BasicNeeds has reached 653,300 people through the delivery of the BasicNeeds Model, of which 127,349 are people living with mental illness and epilepsy, 101,879 are carers and 424,072 are family members.

Impact was achieved at different levels, some key headlines:

Affected individuals

Overall there was improvement against baseline in the number of affected individuals who:

Gained access to treatment (80% of participants from 58% at baseline)
Reported reduction to their symptoms (0% to 78%)
Participated in community groups (4% to 39%)
Able to work (52% to 80%)

Practice

The impact of the BasicNeeds Model in current operational countries has penetrated into the delivery of government mental health services through integration into primary health care. Key areas of BasicNeeds’ impact:

Increased delivery of services

During 2015, 293 outreach clinics and camps were conducted by BasicNeeds’ partners. 72 treatment services including psychiatric consultations, diagnosis and medication prescriptions were facilitated and 124 treatment services provided in government-run primary health facilities.

Increased availability of medicines

Under BasicNeeds programmes, medicines are either free or subsidised, thereby bringing down the cost of treatment per month for affected persons from an average of US$71 (£51) before joining the programme to US$32 (£23). The cost of treatment primarily comprises expenses on travel and food to reach the treatment point.

Leveraging of other resources

BasicNeeds partners leveraged support from their governments in the form of human resources for mental health camps, premises for running outreach clinics, training or self-help group meetings.

Increased community involvement

479 self-help groups were set up in 2015 which had a membership of 25,806 affected people and carers.

The community based evidence generated by programmes and partners has enabled BasicNeeds to challenge existing systems, advocate for improvements and lead change nationally and globally.