The global health epidemic that nobody's talking about

Chris Underhill has a global perspective on mental health. He has worked in development from the age of 21 and in 2000 he founded social enterprise Basic Needs, which adresses mental health issues in the developing world where nearly 75% of the 450 million people with mental illness live.

His work takes him across China, Vietnam, Laos, India, Pakistan, Nepal and a number of countries in Africa addressing community mental health, poverty and stigma. The impressive scale and impact of his work won him the Schwab Foundations Social Entrepreneur of the Award in 2014, the Skoll Award for Social Entrepreneurship 2013 as well as a Senior Ashoka Fellowship in 2012.

Mental health is a major human rights issue.

From a global viewpoint Chris is up against a vast treatment gap – 85% of people in developing countries do not have access to treatment for mental illnesses. The gap is as wide as 95% in Myanmar where only 5% of people are able to access treatment, he tells the Emerge Conference.

There are two prominent characteristics of the global mental health epidemic that have struck him throughout his career: “Mental health is a major human rights issue,” he said, and “an illness that affects young people who are expected to make their way in the world and contribute to their families.” 

Supporting people in the developing world with mental health issues is often about getting “people leveled up to the same as others in the community, involved in the same schools and work", Chris explains. 

"If they’ve been stigmatised then having the opportunity to farm like other people farm has a potency that is comforting.” Getting people into the informal sector might not pull them out of poverty, but that sense of inclusion is “more important,” says Chris.

Underhill spoke about the self-help groups in Ghana, which are a pioneering and much needed initiative to prevent people with mental health issues from being excluded from all areas of productive society. “The informal economy is a good friend to these groups,” he says. It allows group members to look for work for their members who might only be able to work for a few days. If they feel ill another member can take over. 

Much of Chris's work is dedicated to creating these types of situations, which allow people with mental health issues access to employment and a source of income. Basic Needs has helped 79% of participants in its programmes obtain either paid employment or productive, non-remunerative work.

Chris also identifies the potential for resourcefulness, pragmatism and innovation faced with a lack of qualified mental health professionals. A “we are, where we are” approach has given rise to innovations like task-shifting where support work and treatment is distributed across teams of highly qualified professionals, health workers with fewer qualifications, community workers and health volunteers. 

By employing this sort of innovation, and building the field of practice Basic Needs has enabled 94% of mentally ill people in the communities it serves to access treatment.

A lot of mental health work that Basic Needs undertakes also relies heavily on negotiation skills. “At least once a week we are releasing people from chains by negotiation with the family and the local community,” explains Chris. 

And negotiation skills are not just employed in local communities, but also when it comes to funders. The ability to find sustainable solutions is extremely important. 

Understand, understand, understand.

Chris points to work dealing with mass trauma in Northern Uganda where he was helping 13 to 30 year olds return to communities after conflict. “Communities don't welcome them back after the atrocities they may have committed.” It takes a lot of time to reintegrate and address issues of ill health. Chris rejected funders that would only fund three year projects, in order to succeed he said that it was crucial to make clear that “this is a five year job” at least.

Underhill’s anecdotes also revealed that levels of personal resilience need to be very high in order to work towards solving a problem that constantly throws up horrific manifestations of stigma, superstition and misunderstanding. It is not uncommon he says to find people chained up, hidden away by families and in cells. He describes how once he had needed to release a man with his leg nailed to a log.

But he is neither deterred by the scope nor the testing nature of the work. “It’s a huge problem, and there is huge scope for innovation,” he said. And when asked what three things he would suggest others do to help address issues of mental health he said: “Understand, understand, understand.”