Outcomes and future directions of the national community mental health care program in Viet Nam

Abstract

The mental health system in Viet Nam (population >85 million) has services provided at the central, provincial, district and community levels. There are 31 central and provincial mental hospitals, 27 psychiatric departments in general hospitals, 60 outpatient mental health facilities and 17 social care centres. Its workforce comprises about 950 mental health doctors, 2700 nurses and 800 other staff. Each of Viet Nam's 10,750 communes has a primary health centre (PHC), and there are over 47,000 primary health staff. Delivering mental health care via the primary care system is endorsed as a suitable option for many developing countries 1,2,3. A national community mental health care (CMHC) program was launched in Viet Nam in 2001 to build up community mental health service by integrating mental health care into PHCs. The components provided were illness identification, basic treatment, relapse prevention, and reduction of risk and disability. Activities included training of PHC staff, screening at the community level, monthly review and medication provision, rehabilitation in activities of daily living, community education and regular interactions between the PHCs and the provincial and central hospitals. In 2009, the National Psychiatric Hospital No. 1 in Hanoi implemented a World Health Organization (WHO)-funded review of the CMHC program. The review consisted of a national workshop of 40 provincial hospitals leaders, site visits of several CMHC services and selective data from the national monitoring system and various community mental health stakeholders 4. After being initiated in all 64 provinces in Viet Nam, the program has driven the development of country-wide community mental health network and services 5. It has achieved a national coverage of 64%, reaching about 145,160 patients. The strengths identified include: better access to treatment for community patients especially from remote areas, thus reducing treatment gap; greater opportunities for rehabilitation and reintegration into community; and increased public awareness of mental illness. The main limitations concern human resource and facilities, scope of treatment, scale of service coverage and linkages with families and community. A framework for the revised model of community mental health care in Viet Nam was collaboratively developed by service providers and consultants, in line with best-practice recommendations in the region 6. This includes: broadening the scope of mental health care to include mental health promotion, prevention, and intervention at the primary care level; strengthening the partnership with community supports to deliver mental health services together with PHCs; and developing specialist mental health teams to initiate and support the service implementation in order to build local expertise and long-term sustainability. The revised CMHC program will strive for an integrated mental health service in the primary health system which is supported by strong community partnerships and reliable governance. Building the capacity of PHC staff to meet these aims requires significant initial investment but is likely to be a cost-effective and viable strategy in the long term.