Innovation summary

The burden of common mental health problems, Vietnam’s socio-economic context and the shortage of mental health specialists has created a critical gap in support for people living with mental health problems in Vietnam. Currently, psychosocial interventions for common mental disorders in both adults and children are almost entirely unavailable.

This ‘frugal innovation’ will seek to address this gap by providing low-cost, evidence-based psychosocial interventions to adults and children.

To address depression in adults, a Supported Self-Management intervention will be applied. This is where patients receive coaching from a care provider. The use of a skills-orientated workbook based on the principles of Cognitive Behavioral Therapy (CBT) will also be tested.

For children’s behavioral disorders, a family-based education intervention called Strongest Families will be piloted and tested. This involves parents receiving coaching by telephone.

Impact summary

  • 8 provinces and 32 Commune Health Stations (CHS) will be involved
  • 240 families will receive coaching from 3 trained coaches, using the Strongest Families intervention 
  • Cost: $2,000,000 USD 

Innovation details

The proposed ‘frugal innovation’ will fill a critical gap in service provision for common mental health disorders in Vietnam. It will involve the provision of low-cost and accessible evidence- based psychosocial interventions to address depression and anxiety disorders in adults and behavioral disorders in children.

Strongest Families (SF)

This component involves:

  • extensive training for coaches to deliver an evidence-based program of support to parents of children with behavioral disorders
  • teaching parents management skills via weekly 45-minute telephone sessions from the coaches
  • providing resources including a skills handbook, written at a Grade 5 level for ease of use, and short videos

240 families will be recruited for the study. The families will receive the intervention for around four months, with an additional one-month follow-up ‘booster’.

Coaches are recruited and trained in accordance with the existing Strongest Families protocol, which has been extensively tested for quality assurance.

The outcome measure will be collected at baseline and at the end of treatment by an outcome assessor who is part of the research team.

Supported Self-Management (SSM)

This component will make use of existing health workers to implement a low-cost and evidence-based intervention to adults with depression.

The intervention will involve:

  • the use of an anti-depressant skills workbook based on Cognitive Behavioral Therapy (CBT)
  • steps from the workbook to follow, on areas such as structured problem solving, behavioral activation and physical and social activities
  • support provided by a health worker to motivate the patient

The intervention will be tested using a cluster-randomized controlled trial design. Randomization will occur at the commune level, where communes will receive either the SSM intervention first or the control condition. Those assigned to the control condition first will later receive the SSM intervention.

Adult patients attending primary care centers will be screened for depression by a health worker who will administer a self-reporting questionnaire.

Patients meeting the case criteria for depression will be informed about the study and provided with information about informed consent.

At-risk individuals, including mothers of children under one year old, caregivers of people with a serious illness, people who have experienced trauma etc., will be screened by social workers. Social workers are well-placed to identify people at greater risk of depression. They will screen community members using the questionnaire and, based on the depression score, will make referrals to the primary care centers. At the centers, health workers will recruit patients to the study and further assess functional ability.

For participants in the intervention group, social workers will provide ongoing support to use the anti-depressant skills workbook through home visits, in between visits to the centers.

Benefits of the innovation:

The innovation will prove beneficial in:

  • building the capacity of non-specialist healthcare workers and community-based providers
  • enabling primary care centers and social workers to screen for and manage depression
  • helping reduce stigma, fear and discrimination around mental health
  • raising awareness about children’s behavioral challenges and filling a critical gap in support for families facing these challenges

Intended impact

The innovation aims to improve the quality of life of children and adults experiencing common mental health problems and their families. This improvement will be assessed using the appropriate measures for depression (SRQ-20) and for behavioral disorders (Strengths and Difficulties Questionnaire), and by measuring disability scores using the WHODAS 2.0.

The innovation will also help strengthen the mental health system in Vietnam by improving the availability of cost-effective and accessible services for common mental disorders.

The involvement of our partners, in particular MOLISA and Ministry of Health (MoH), will help integrate these enhanced interventions into the health system.

Key drivers

Expertise and capacity

The program benefits from the expertise of a number of partner organizations based in Vietnam, Canada and Australia.

Government commitment

The Government of Vietnam has prioritized enhancing the delivery of community-based mental health services in response to a critical gap in specialist services.

Challenges

Staff Capacity

Competing priorities and already strenuous workloads at primary care centers may pose a challenge. Retention of coaches also represents a challenge.

Enhancing community-based psychosocial services

Changing entrenched practices may require considerable sensitization in the mental health system and the broader community.

 

 

Continuation

During the two-year pilot study for the Supported Self-Management intervention, MOLISA expanded the project to two additional provinces, demonstrating an early commitment to program expansion.

Over the course of the three-year transition-to-scale project, a multifaceted approach to care for common mental disorders (CMD) for adults and children and their families will be introduced where there are currently no available services.

The involvement of MOLISA and MoH means that there is a high potential for sustainability and lasting impact on the mental health system in Vietnam beyond the three-year project.

Partners

Key funders:

Key partners:

Evaluation methods

The improvement in the capacity of patients to manage their own recovery will be measured by assessing their scores using the appropriate measures for depression (SRQ-20) and for behavioral disorder (Strengths and Difficulties Questionnaire), and by measuring disability scores using the WHODAS 2.0.

The Supported Self-Management component will be tested through a stepped-wedge cluster randomized controlled trial design. The Strongest Families component will be pilot-tested in preparation for a full-scale randomized controlled trial. 

Cost of implementation

The cost of creating a mental health specialist workforce in low-and-middle-income countries (LMICs) is costly and inefficient.

Task-shifting approaches to service delivery for common mental disorders (CMD) are cost-effective and can dramatically improve service access and coverage.

In Canada, for example, the Strongest Families model is estimated to cost a third of the price of conventional services. In Vietnam, where there are limited-to-no services for adult and child CMD at present, this approach is a sound investment that will improve lives without putting an unnecessary strain on the health system.

Impact details

The innovation is in its early stages and results are currently unavailable. However the MAC-FI programme is expected to improve both coverage and access to services for common mental disorders in a context where services are largely unavailable.

The innovation will also have an impact at a systems level, contributing to a strengthened mental health system in Vietnam.

The involvement of our partners, in particular MOLISA and MoH, will promote the effective integration of these enhanced interventions into the health system.

Because the services are delivered at community level and involve primary care centers, community-based providers, schools, community organizations and families, we expect that it will contribute to improved awareness of common mental health problems in Vietnamese communities.

The provision of low-barrier, psychosocial and educational interventions at the community level is likely to contribute to a reduction is stigma around accessing mental health services.

References

  1. Goodman R et al. (1997). The Strengths and Difficulties Questionnaire: a research note. J Child Psychol Psychiatry, 38(5), 581-586.

  2. P F and Lovibond S H (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories Behaviour Research and Therapy. 33(3), 335-343.

  3. Shelton K K et al. (1996). Assessment of parenting practices in families of elementary school-age children. Journal of Clinical Child Psychology, 25(3), 317-329. 

  4. Giang K B et al. (2006). The Vietnamese Version of the Self Reporting Questionnaire 20 (SRQ-20) in Detecting Mental Disorders in Rural Vietnam: A Validation Study. International Journal of Social Psychiatry. 52(2), 175-184. 

  5. ​The World Bank. (2015). Vietnam Data.  

  6. ​Üstün T B et al. (2010). Developing the World Health Organization Disability Assessment Schedule 2.0. Bulletin of the World Health Organization. 88(11), 815-823. 

  7. Patel V et al. (2009). Packages of Care for Depression in Low and Middle Income Countries. PLoS Medicine, 6(10). 

Research

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