Mental Health and Development:

A Model in Practice

A Publication of BasicNeeds
Published by
BasicNeeds
158A, Parade, Leamington Spa
Warwickshire, UK CV32 4AE
UK Registered Charity Number: 1079599

First Edition 2008

This book was funded in part by the Big Lottery Fund, United Kingdom

Copyright © 2008 BasicNeeds

Permission granted to reproduce for personal and educational use only. Commercial copying,
hiring, lending is prohibited. This work is registered with UK Copyright Services.

ISBN: 978-0-9558880-0-7
 Acknowledgements

Concept and content development : Shoba Raja

Written and researched by : Tess Astbury, Mark Tebboth
Project management : Uma Sunder
Illustrations and design : M B Suresh Kumar

Special thanks to:

D.M. Naidu, Joyce Kingori, Peter Yaro, Firdaus Easa and Dharshini Indrasoma for providing
valuable insights into BasicNeeds’ programmes; Lakshmi Mohan for laying such strong
foundations for the content; Will Boyce, Victoria de Menil, Jane Turner and Jesse Zankar for
their thoughtful feedback; Sunita Singh, Lata Jagannathan and Rani Munirathnam for their
warmth, advice and encouragement; Andrew Bates for sourcing the wonderful photographs;
Chris Underhill, who first conceived the model for mental health and development; and,
everyone working to implement BasicNeeds’ programmes without whom this book would
not have been written.

About BasicNeeds
BasicNeeds is an international development organisation, which works to bring about lasting
change in the lives of people affected by mental illness and epilepsy. The organisation
has built an innovative approach that tackles peoples’ poverty, as well as their illness. By
ensuring that their basic needs are met and their basic rights are respected, BasicNeeds
aims to give hope to the thousands of people who struggle daily with the lack of treatment
and stigma surrounding their illness.
BasicNeeds works with people affected by many types of mental and neurological illnesses,
in remote rural countryside and urban slums, in Asia, Africa and South America. The work
is based on the philosophy of building inclusive communities, where people with mental
disorders – through development – realise their own rights.
Established in 1999 by Chris Underhill with funding from Andrews Charitable Trust and the Joel
Joffe Charitable Trust, BasicNeeds has pioneered a way of working, which places people with
mental disorders at the heart of all that it does.
 Preface

The number of people living in extreme poverty, that is, living on less than a dollar a day, accounts
for about 20% of the world’s population. These people are some of the most vulnerable in the
world. Their ability to endure is remarkable yet they are all too aware of the fragility of their
existence and the devastating effects that factors such as mental illness and epilepsy can have
on their lives.

Mental disorder and poverty go hand in hand. If a person with a mental disorder and his/her
family are living in poverty, they are less able to seek and afford treatment or absorb the loss
of a wage. They are less likely to perform socially and economically productive roles. Already
marginalised, they are likely to experience further discrimination both in the job market and from
their own community. Furthermore this link works in both directions, with the effect of poverty
also considered to be a contributing factor to poor mental health. That poverty and mental illness
are associated is a given, and any initiatives that address both issues are welcomed.

BasicNeeds has established an innovative way of working with poor people with mental disorders
called the Model for Mental Health and Development. The model is implemented in poor, rural
and urban communities in 8 low- and middle-income countries. It involves measures ranging
from income-generation activities to community mental health services, from awareness-raising
to policy work. Through its model, BasicNeeds has proved that by working with people with
mental disorders and their families in a holistic and participative way, their mental health can be
improved and their levels of poverty reduced.

The Millennium Village Project of the Earth Institute at Columbia University in New York City exists
to demonstrate that the Millennium Development Goals (MDGs) could be realised by the target
date of 2015. As the advisor to the UN Secretary General for meeting the MDGs, and Director of
the Earth Institute, I am truly grateful to see the efforts of organisations such as BasicNeeds in
helping to translate these goals into reality. I am sure that this book, which provides a description
of the model for mental health and development, will be an important source of information and
inspiration for those who read it.

Jeffrey D. Sachs
Director
The Earth Institute at Columbia University
 Foreword

I first conceived the idea of modelling an approach to very poor and disabled people when I
was the founder Director of Action on Disability and Development. At that time I was writing
a thesis for the School for Policy Studies, Bristol, UK in which I attempted to pin down the
defining moment when power moved from a development organisation to groups of disabled
people. Animation seemed to be a very important part of the mix in bringing confidence to
very marginalised people and I realised that I needed to draw from a much larger pantheon of
skills and activities if effective mainstreaming of very poor disabled people was to be effective in
resource-poor countries. This led me to think of the community as being the essential crucible
for a model and that this was where many of the required skills lay hidden.
Upon founding BasicNeeds in 1999/2000, I took the opportunity of putting the idea into practice
and I have watched the Model for Mental Health and Development develop from that time to
this. My old friend D.M. Naidu did the first field tests of the model in September 2000 and in
2001/2002 we did the same in Northern Ghana with Lance Montia as the principle animator.
If the model helps to create the proper conditions for recovery, then it is the BasicNeeds’
programme that provides the effective motive force to field the overall concept and get the
process going.
We work with people with epilepsy and people with mental illness, and as the first few pages
of this book make clear, there are far too many of each not getting any kind of attention or
treatment. I am interested in reaching as many people as is possible and thus our programmes,
but most particularly our model facilitates this process. It is a model for working with the
many and perhaps this is no better characterised than in the section on capacity building. It
is true to say that I have never attended a meeting where there were less than 60 people in
attendance, though some of course would have carers who are very welcome and an integral
part of the process.
Tess Astbury and Mark Tebboth have done a great job, under the direction of Shoba Raja, of
bringing a great deal of what we have learnt and hold dear about the model into this book. I am
grateful to them for this wonderful effort. The model is a work in progress and we are thinking
over now how we can invite organisations that are not part of the BasicNeeds’ programme
structure to also avail themselves of the model.
Eight years have passed and BasicNeeds is now active in 8 countries and, to date has strongly
supported more than 50,000 people affected by mental illness and epilepsy, their families and
carers. The model for mental health and development has been vital to our success and I am
delighted to bring you this book describing how it actually works in practice. I hope that you
find the following pages both an informative and enjoyable read.

Chris Underhill
Founder Director
BasicNeeds
 Contents

Chapter   1 Introduction 10

Chapter   2 Getting Started 16

Chapter   3 Capacity Building 20

Chapter   4 Community Mental Health 28

Chapter  5 Sustainable Livelihoods 34

Chapter   6 Research 42

Chapter   7 Management and Administration 50

Chapter   8 Training 54

Chapter  9 The People Involved 62

Chapter 10 The Model’s Impact 70

Chapter 1

1 Introduction

The implications of having a mental disorder1 are serious and very real for millions of people
throughout the world. In 2001, the World Health Organisation reported that 154 million people
globally suffer from depression and 25 million people from schizophrenia; 91 million people are
affected by alcohol-use disorders and 15 million by drug-use disorders. In addition, 50 million
people suffer from epilepsy and 24 million from Alzheimer and other dementias2. The stark
reality predicted by the World Health Organisation is that one in four people will develop a
mental illness in their lifetime3. When one considers not only the person with a mental disorder,
but also their families and communities in which they live, it is almost certain that the impact
of mental disorder will affect all of us at some point.
In the context of low- and middle-income countries, the consequences of having a mental
disorder become even more severe. Many governments do not invest in mental health care,
with one third of the global population living in countries that allocate less than 1% of their
total health budget to mental health. Community care facilities have yet to be developed in
about half of the countries4. Even where there are community care facilities, they often are not
accessible to all. Integration of mental health services into local health facilities is very poor. The
current answer to such a lack of infrastructure is placing individuals in institutions, where they
are sometimes physically chained and abused5. This situation is summed up by Patel who states
that, “actual investment in evidence-based mental health services in low- and middle-income

1
Mental disorders refer to the series of conditions known as mental illness (schizophrenia, bipolar disorder,
depression, phobias, post-traumatic stress and others) as well as epilepsy.
2
World Health Organisation, Mental Health: the bare facts [Online] (World Health Organisation, 2001). Accessed
online - http://www.who.int/mental_health/en/ [Date accessed 24/01/2008].
3
World Health Organisation, World Health Report 2001: Mental Health: New Understanding, New Hope (Geneve:
World Health Organisation, 2001), pp 23.
4
World Health Organisation, Mental Health Atlas 2005 (Geneve: World Health Organisation, 2001), pp 15 - 43
5
World Health Organisation, World Health Report 2001: Mental Health: New Understanding, New Hope (Geneve:
World Health Organisation, 2001), pp 49 - 52

10
 Introduction

countries is grotesquely out of proportion to the need” and that “it would not be surprising that
the vast majority of mental health needs in … [these] countries is unmet”6.
If, in addition to this, a person with a mental disorder is also one of the millions living in
poverty, the chances of them achieving even the most basic quality of life become increasingly
slim (see diagram below). Poor people with mental disorders are less likely to know of or
able to access appropriate services, and when they do, are unable to afford the treatment.
Their ability to work is impinged, which has a double effect of lowering their social status
and sending them spiralling further into poverty. Ignorance and fear of mental disorders
results in the person being cloaked in stigma and shame, discriminated against and isolated
from family and community life. They are not included in the development projects that are
designed to help lift people out of poverty, as they are often regarded as incapable. In fact,
mental well-being remains a largely ignored issue in global health, and the fact that it is not
included in the Millennium Development Goals reinforces the position that mental health
has little role to play in major development-related health agendas7.
It is in response to this growing understanding of the global impact of mental disorders that,
in 2000, BasicNeeds was established with a vision that “the basic needs of all people with
mental disorders throughout the world are satisfied and their basic rights are respected”.

Needs of people with mental disorders8

6
Patel, V., Mental health in low and middle-income countries in British Medical Bulletin, Volume 81 – 82, 2007, (Oxford
University Press, 2007) pp 81 - 96
7
Miranda, J. J. and Patel, V., Achieving the Millennium Development Goals: Does Mental Health Play a Role? (Public
Library of Science, 2005). Accessed online - http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1201694
[Date accessed 24/01/2008]
8
Reproduced from World Health Organisation, World Health Report 2001: Mental Health: New Understanding, New
Hope (Geneve: World Health Organisation, 2001), pp 60

11
Chapter 1

BasicNeeds is an international non-governmental organisation, currently working in deprived

rural and urban communities in eight low- and middle-income countries in Africa, Asia and,
most recently, South America. The organisation operates using a decentralised structure,
with offices in each of the countries that it works.
BasicNeeds began its work in South India. Its first priority was to consult with people with
mental disorders, their carers and families, non-governmental organisations, mental health
specialists and government officials. The purpose of these consultations was to find out about
the problems that poor people with mental disorders faced and their ideas for solutions to
these problems.
A model emerges
Throughout these initial explorations, the realisation that, to bring about and sustain positive
change, mental health and socio-economic issues must be addressed concurrently became
increasingly apparent. Built around this central theme, a new approach to supporting poor
people with mental disorders emerged which, in due course, became known as the model
for mental health and development.
The model places people with mental disorders at its core and mental health firmly within a
development context. Holistic in nature, it creates an environment in which people with mental
disorders are able to address not only the illness, but also their economic and social situation.
People with mental disorders do not exist in isolation. Their quality of life is greatly affected
by the attitudes of the communities in which they live and the decisions made by the state
that governs them. Therefore, through the model, these negative practices, beliefs about and
behaviour towards people with mental disorders are challenged.
The model is formed of 5 separate but interlinked modules; these are:
• capacity building
• community mental health
• sustainable livelihoods
• research
• management and administration
Each module is put into practice via mental health and development programmes, which
operate within a defined geographical area where there are high levels of poverty. People
accessing the programmes may be male or female, adults or children. They will all have or be
recovering from a mental disorder9 . Understanding that mental disorders affect more than
just that individual, programmes also work with their carer and family members.

12
 Introduction

Capacity building

Management & Community

administration Mental health

Research Sustainable livelihoods

The model for mental health and development

A programme delivers the modules simultaneously. Whilst each module can operate in
isolation, it is when they are implemented as a whole that the full impact of the model
becomes apparent; that change occurs not only in peoples’ mental health, but also in the
levels of poverty they experience and in their fundamental human rights.
At the time of writing in 2008, 16 programmes in India, Sri Lanka, Lao PDR, Ghana, Uganda, Kenya,
Tanzania and Columbia are being run by BasicNeeds. In just 8 years, these programmes have
reached out to 54,076 people with mental disorders, their carers, families and communities.

The model in practice

Mental health and development programmes build the capacity of everyone involved in
mental health and development processes. Organisations already involved in development
are equipped with the necessary skills to support people with mental disorders. Carers and

As all activities in the model contribute towards recovery there is no single point at which this begins to occur.Throughout
9

the book, therefore, the term ‘people with mental disorders’, is used to denote people at various stages of recovery and
illness. A distinction is made in the text only in those cases when recovery is a prerequisite to involvement.

13
Chapter 1

people with mental disorders join in self-help groups to provide encouragement, manage
their illness and strengthen their voices.
Community-based mental health services and facilities are also developed. By maximising
existing resources, diagnosis services and treatment are made available on a regular basis and
are extended into areas where previously there was nothing. State health providers commit
to allocating human and financial resources and community workers provide the day-to-day,
on-going support that is so vital for people recovering from mental disorders.
Measures are initiated to secure a sufficient economic livelihood for the whole family via
opportunities to learn new skills or get an education, return to a previous occupation
or access capital. In demonstrating the positive contribution that people with mental
disorders can make, deeply ingrained prejudices in the community and wider society are
challenged. Awareness-raising and education activities explode myths and preconceptions
about mental disorders still further.
Data is collected about the lives of people with mental disorders and the impact of the
model. Everyone involved in the model has the opportunity to analyse the data, out of which
new insights and knowledge emerge. Fuelled by this body of evidence, mechanisms are
introduced that empower people to advocate for change in policy and practice amongst
individuals, communities and governments. The voices of people with mental disorders echo
throughout.
Pulling all these initiatives together are robust management and administration systems;
these ensure the successful delivery of the model in practice.
Cross-cutting themes
Throughout the model, a number of cross-cutting themes or ways of working are apparent,
which shape all aspects of programme delivery.
Working in partnership is the first of these themes and is crucial to the success of a
programme. The statement, ‘the whole is greater than the sum of its parts’ is particularly
apt here. Community-based organisations, government health services, micro-finance
organisations, self-help groups and many others contribute to implementing the model,
enabling its reach to be maximised and increasing the likelihood of its sustainability.
Furthermore, by tapping into existing resources, less energy is expelled in getting a
programme up and running; it also means that each organisation and individual can offer
their strengths as well as build their own capabilities by learning from each other.
Ensuring that programmes are rooted in their community is of utmost importance.
Mental health services are delivered at this level and partnerships are made with local
organisations. Community workers, who carry out much of the work in any programme, are
a major reason in guaranteeing it remains local and responsive. One way in which they do
this is by making home visits, which provide a link between the daily life of a person with a
mental disorder and the model.

14
 Introduction

The practice of animation is based on the belief that by inspiring, motivating and challenging
a group or community, they will be moved to action, and begin defining their own reality,
rather than being passive recipients of assistance. Animation techniques are used throughout
the programme, as a means of breathing life in situations and stimulating change.
Participatory techniques are used widely in all of the modules as a means of ensuring the
full involvement of people with mental disorders, not only as beneficiaries but as active
contributors to the programme. Such techniques create a level playing field and allow
everyone to offer what they can.
The final theme, which resonates throughout the model is flexibility. The model is not a rigid,
unbending structure, with the success of a programme dependent upon being implemented
in one prescribed way. Rather, the model can be understood as a framework that proves
adaptable to different and varied circumstances. The exact nature of any programme will be
determined by the set of needs and situations specific to the area in which it is being run.
Contents
The following pages describe how the model for mental health and development is put into
practice by BasicNeeds and its partner organisations via mental health and development
programmes. Chapter two provides an overview of initiating a programme. This includes
what foundations are required, assessing an area’s mental health situation and shaping the
programme to meet the needs as defined by the beneficiaries. The subsequent five chapters
examine the modules within the model in more detail; outlining the purpose and describing
the activities that commonly take place within each one. As the training element of the
capacity building module is extensive, it is dealt with separately in chapter eight. BasicNeeds
is an outcome-focused organisation and the anticipated changes as a result of a programme,
are stated at the start of each chapter. Chapter nine takes a look at some of the people who
are responsible for delivering a model in practice, while the final chapter explores the overall
impact of the model.
The text is illustrated throughout, with examples from BasicNeeds’ programmes in all of the
countries in which it currently operates and the personal experiences of the people involved.
We hope that these portrayals will give you a real insight into, and true flavour of, the model
for mental health and development, as well as motivate you to find out more.

15
Chapter 2

2 Getting Started

What does it mean?

To stand the test of time, a building requires strong foundations and the same is true here.
Getting started is about ensuring that the right building blocks are in place to enable the
programme to develop and flourish.
This is achieved via a feasibility study, which examines the mental health situation in an area
and the viability of establishing a programme. During this process, the groundwork is also laid,
beginning with identifying and engaging with potential partners. No programme can operate
without resources; identifying donors and accessing funding is, therefore, the next crucial step
and culminates in the appointment of BasicNeeds’ staff. They become the driving force behind
the programme overseeing its implementation as a whole.

How does it happen?

Feasibility
In order to know how best to start and run a programme of mental health and development, it
is necessary to understand the context in which the work will take place. A feasibility study is
carried out before a programme has been established and this reviews all the relevant national
legislation, policies, programmes and resources that impact on the mental health situation in
the whole country. Other information collected includes the numbers of people with mental
disorders, the types of illnesses and their prevalence, possible programme partners and potential
fundraising opportunities. The study is usually undertaken by an individual familiar with the
country and culture and who has an understanding of mental health and development issues.
Excerpt from Ghana Feasibility Study
Mental health services in Northern Ghana hardly exist. Where services do exist they are
hampered by lack of facilities and innate cultural practices, which marginalise people with
mental illness from service provision. There are local and international non-governmental

16
 Getting Started

organisations functioning in Ghana, especially in the north, aware of the plight of people
with mental disorders. However, there is no evidence of immediate or future inclusion of
people with mental disorders into their programmes. The logistical problems of getting
people to the south of the country for treatment, further compounds the difficulties for
those people in the north. (Ghana Programme, 2001)
Identifying Partners
Partners are almost always sought to help with delivery on the ground. This enables a
programme to broaden its reach and impact without dramatically increasing the dependency
on and the resource requirements of BasicNeeds (as the capacity of other organisations is
utilised). Furthermore, it acknowledges the importance of the existing work and value of the
resources that are in place already.
Depending on the specific circumstances, the number and type of organisations and institutions
approached as potential partners will vary as will their role. Initially, partners are identified
through the feasibility study although the process is ongoing and new partners can come on
board at any stage. In all cases, a Memorandum of Understanding (see chapter 7) is drawn
up and marks the beginning of the formal partnership. There is no set method of engaging a
partner but the process usually includes discussions with the staff, consultation and training in
relation to the programme, the model and the needs of people with mental disorders. Training
is a vital aspect of the relationship as it helps to build the capacity of the partner organisation,
increasing the likelihood that the impact will continue as skills are left behind. Partnerships
have been successfully used in all programmes to date, although the individual approach has
differed. For example, some partners have run specific activities in a module while others have
implemented one or more modules. The most important point to take from this is that each
programme has developed in response to the needs and circumstances on the ground, hence
the differing approaches in delivery.
Partnership working in India
In BasicNeeds India, the mental health programme has been extended in Kortegera and
Gowribidanur taluks (unit of local goverment) by Grameena Abyudaya Seva Samsthe (GASS)
with the help of Anuradha Foundation. Social Action for Child Rehabilitation Emancipation
and Development (SACRED) has been invited to submit a concept note to Cord Aid, which
has promised to fund the disability programme including mental health in the extension
area. The Council for Advancement of People’s Action and Rural Technology (part of the
Government of India) has agreed to fund the mental health programme of Nav Bharat
Jagriti Kendra (NBJK) in Jharkhand. (India Programme, 2006)

17
Chapter 2

Programme planning
In order to ensure that a programme is well designed, good planning is required. A logical
framework or log frame is used as a planning and analytical tool and enables BasicNeeds and its
partner organisations to methodically work through all aspects of a programme’s design prior
to submitting a funding application. Once a programme is established, log frames continue to
be developed whenever additional funding is sought.

Project
Overall Source of Assumptions
Description / Indicators
objective Verification and Risks
Narrative
What is the What are the What are the What sources What external
overall purpose wider objectives, quantitative of information factors are
or aim? which the measures or exist or can be necessary to
project will help qualitative provided to sustain the
to achieve? Long judgements that measure the objectives in the
term project help you to judge achievement long run?
impact? whether these of the overall
broad objectives objective?
have been
achieved?
A logical framework
Identifying donors and securing funding
Fundraising is a huge field in itself and this book does not attempt to be a guide to successful
grant-making. Below are some salient points relevant to funding a mental health and
development programme (or aspects of it).
A mental health and development programme can be viewed from many angles, meaning that
grants do not have to be solely drawn from donors with an interest in mental health. Other
donors with the mission of reducing poverty, empowerment of marginalised communities,
community development, advocacy or research may also be contenders.
When putting together a funding application, the feasibility study has been found to be of great
benefit in demonstrating the need for a programme. Furthermore, the fact that such research
has already been done adds gravitas to the proposal and to the applicants. The partners that
have been identified provide proof that there is local backing for the programme and indicate
the likelihood of its sustainability. Basing a proposal on the model for mental health and
development means that the outcomes have already been defined; further, the achievements
are plain to see in other existing programmes. All of the above, plus the fact that participatory
methods are used throughout and the people benefiting are also those defining and shaping
the programme generally helps in the development of a strong proposal.

18
 Getting Started

Assembling the team

Once the feasibility of the programme has been established, possible partners have been
identified and funds have been secured, the BasicNeeds’ programme team can be appointed.
Often the staff will have already been involved in the preparatory work (feasibility study and
funding applications for example) and have a good knowledge of the programme requirements.
The core team tends to include a programme manager, a finance and administration officer and
a research officer; although the precise make-up can and does differ across the programmes
and is influenced by the role of partners in delivery. For example, there may be a merging
of roles and responsibilities or extra staff may be recruited to manage individual modules or
partners. The programme staff along with partners will together be responsible for delivering
the entire programme with their actual roles dependent on implementation (see chapter 8 for
more details).
The following five chapters describe each module of the model for mental health and
development in turn. Collectively, they comprise of the majority of what occurs within a
programme.

19
Chapter 3

3 Capacity Building

Outcomes
• The capacities of people with mental disorders, carers, families and communities to support
themselves are built.
• The capacities of partner organisations, health care professionals and mental health
professionals are increased in order to implement and sustain the practice of mental health
and development.

What does it mean?

Capacity building begins by inviting partner organisations, general and mental health workers,
people with mental disorders, their families and the wider community to identify their needs
and participate in the programme. Activities are then initiated that build on their skills and
abilities in order that all are empowered to work towards achieving a better quality of life for
people with mental disorders.
Training, group development, consultation and awareness-raising measures commonly take
place and are stimulated by powerful animation techniques. Underpinning this module is the
belief in participation; namely, that everyone has the right to realise their potential and play an
active role in defining their future. Through the strengthening of all involved in implementing
the model, the potential for its sustainability is increased.

How does it happen?

Forums for capacity building
Field consultation
A field consultation is typically the starting point of building capacity and one of the
founding programme activities. This activity brings together people with mental disorders,
their carers and families, and partner organisations; what comes out of it shapes the future
work of a programme according to identified need and demand at the grassroots level. Field

20
 Capacity Building

A field consultation takes place in the shade of a tree in Tanzania

consultations are a powerful experience for all involved. For people with mental disorders,
it is often their first opportunity for engaging with other people as well as the first time
that they are asked about the problems they face and their ideas for making things better.
On the day, an animator (see chapter 9) and a process writer1 facilitate the consultation and
document it, respectively. The day begins with the group getting to know one another and
establishing ground rules. All activities take place in small groups. This, plus input from the
animator ensures that everyone has an opportunity to speak. People with mental disorders
form one group, carers another and partner organisations a third. Separating people with
mental disorders from their carers is, in itself, a momentous and sometimes challenging
occasion for many.
The first group activity, ‘My World’ asks participants to outline the people, organisations and
experiences that shape their lives.
Kwame’s world
Kwame, a 14-year-old boy from Ghana has epilepsy. When it first happened, it felt
like punishment he had not in any way earned. Epilepsy, he felt, had disgraced him. He

Normally a member of the BasicNeeds programme team or a community worker records what is said and
1

happens during a gathering.

21
Chapter 3

attempted suicide, feeling worthless, an outcast, his life and efforts futile. At BasicNeeds’
field consultation Kwame talked about his world, the isolation, the sense of desolation,
hidden depths of emotion out there in the open for the first time. It brought tears
to people’s eyes, and a new understanding. (Atagona Kwame’s life story, Ghana
Programme, 2006)
The next activity ‘My Needs’ involves listing and discussing the issues of concern for participants
and their needs, as perceived by group members. The concluding activity looks to the future,
and asks the question ‘What Next’? After each activity, all participants come together and one
person from each of the groups reports back key points. Remaining in a large group, discussions
about what should follow on from the consultation take place, as well as an exploration of what
the group could themselves commit to and where external help is required. From the findings,
a concrete action plan is drawn up.
What next?
I first saw Gunasiri at the field consultation that was organised by BasicNeeds in the village
of Rathmalwela, India. Not only Gunasiri, but his mother and father also attended that
day. These three individuals who had come there in search of solutions to many problems
of the mind, played key and poignant roles that day. In particular, Gunasiri had faced
rare and unfortunate circumstances, not often faced by a man during his lifetime.
At the close of proceedings that day, Gunasiri was amongst the group of villagers that
volunteered to form the committee representing the village, the Volunteers’ Committee.
They were invited to help BasicNeeds and its partner organisation, Navajeevana, in their
work with people with mental disorders, getting their needs addressed, their problems
solved and their expectations achieved. (Gunasiri’s life story, India Programme, 2003).
The participatory approach that is adopted in a field consultation and throughout the model is
not new for those who have been involved in development projects of recent years. However,
having so often been excluded, such activities may be the first of its kind for people with mental
disorders and their families. Being absolutely clear about the purpose, their role in the day and
what will follow is therefore of utmost importance.
Other consultations
The field consultation is the first of many consultations that continue to be held throughout the
lifetime of the programme. People with mental disorders, carers, community members, health
professionals and other stakeholders are consulted with, on an on-going basis, to ensure they
articulate their changing needs as the programme progresses and give input as to how those
needs can be met.
Consultation meetings with young carers were conducted by Kalista, BasicNeeds’ staff
member, and peer educators to explore information on the life of young carers and
their opinion with regard to changes in their life that they would like to see. Most of the
young carers expressed their need to go back to school. It was also noted that some

22
 Capacity Building

Everyone has the chance to participate in discussions in small groups, India

primary schoolteachers are discouraging young carers by demanding them to have a

complete school uniform. This has made young carers leave as they cannot fulfill these
requirements. (Tanzania Programme, 2007)
Self-help groups
Self-help groups play multiple-roles and are established for a range of purposes. For example,
carers and people with mental disorders may come together to form, or join, a group to
encourage better integration; others may start or join a group to provide peer support to better
manage their illness; still others may meet to share information and raise awareness in the
wider community. As a self-help group develops and grows in confidence, it often goes on to
advocate for the rights of people with mental disorders. Furthermore, individuals often start a
group as a means of generating income via such economic activities as farming, livestock and
business (described in chapter 5). In most cases, animators are present at the start of the life of
the group to help the members to bond, establish their goals and begin to take action.
Self-help groups vary in structure and in size. Some groups remain small and informal throughout
their lifetime while others decide to become legally constituted or join together to form a network.
A key principle of self-help groups is that the individuals who form the group collectively decide
on its purpose, structure and activities. This, in itself, is a form of capacity building.
Saidi Hamisi said he decided to join the Tuleane self-help group so as to join forces with
people, lend a hand in farm production and raise awareness about mental disorders
in Lisekese ward. This group completely changed the perception of people in the
community regarding mental disorders. They have shown the community that they

23
Chapter 3

are capable of improving their lives. People are pleasantly surprised as they see this
self-help group producing enough from their farming. The group sells their produce to
neighbouring people. They are seen to be normal, like other people. Laiza said that when
they wait for the harvest, she engages in other small businesses like selling vegetables,
fruits and other necessities. (Laiza Jofrey’s life story, Tanzania Programme, 2007)

Tools for capacity building

Animation
Animation is that stimulus to the mental, physical, and emotional life of people in a given
area; which moves them to undertake a wider range of experiences through which they
find a higher degree of self-realisation, self-expression, and awareness of belonging to a
community, which they can influence2.
The primary tool of capacity building, indeed of the entire model is animation. Used in many
community development settings, animation is more than just a set of techniques – it is a whole
approach, requiring certain values and a real belief in the potential of people to be effective.
Trained animators act as a catalyst, mobilising and breathing life into a situation, so that people
first realise then assess their own reality, identify the problems and gain confidence to act.
The animator continues to fuel this cycle of reflection and action, which in turn leads to social
change. The group or community grows in understanding, in awareness and in confidence, and
moves from being passive recipients to active contributors in their own development.
The basic premise behind animation is that, “if a group is sufficiently challenged,
inspired, motivated and encouraged, it will develop an analysis of its own problems
which will lead it, after reflection, to act3”.
There are numerous opportunities to apply animation techniques within a programme. Groups
of people come together in many different circumstances and for different reasons. All benefit
from the stimulation engendered by animation. The results are particularly apparent in field
consultations where people are being asked about their lives and the changes that they want
to make, and in self-help groups where members must unite, plan and act together. Concrete
outcomes of animation can be seen most commonly in a group’s achievements of the goals that
they have themselves defined. Less tangible outcomes include the emergence of new leaders,
growing confidence and self-worth amongst people with mental disorders, and an increased
ability to advocate and challenge the status quo.

2
Simpson 1989, Cited in Smith, M., What is animation (Infed.org, 1999). Accessed online - http://www.infed.org/
animate/b-animat.htm [Date accessed - 25/01/2008]
3
Underhill, C. Defining Moments: A Qualitative Enquiry into Perceptions of the Process of Community Development
Practice with Disabled People in Uganda (1996), pp 3

24
 Capacity Building

Research
Individuals’ capacities are also built through the process of generating data and research (see
also chapter 6). Life stories are a primary data source used for analysis in research. Yet this is not
their only purpose. For the person telling his or her story, the capacity building outcomes are of
equal importance. To talk about themselves, their past experiences and future aspirations with
an interested, non-judgemental listener may have been a rare occurrence. Such a connection
inspires strength, feelings of self-worth and is a form of therapy in itself. Participatory data
analysis sessions (described further in chapter 6) are opportunities for people with mental
disorders, carers and others involved in a programme to meet together to analyse data or
information emerging from the field. Through this process, people with mental disorders
gain new understanding into the issues affecting them on a daily basis. They become better
equipped to deal with these issues and grow in confidence to advocate for change.
Awareness-raising and sensitisation
Awareness-raising and sensitisation campaigns are used widely to challenge preconceptions,
change attitudes and share information about mental disorders. A variety of methods
are used to get the message of mental health and development across – including street

People take to the streets to raise awareness of mental disorders in Uganda

25
Chapter 3

theatre, personal counselling, sensitisation workshops, consultations and media campaigns.

Awareness-raising reflects local contexts, is developed in response to a specific need and
covers a broad range of issues, including:
• increasing the acceptance of people with mental disorders within the community/school/
workplace;
• promoting mental health services;
• dispelling myths about mental disorders and its causes;
• sensitising local officials to the needs and requirements of people with mental disorders; and
• encouraging policy makers to develop policies that take account of people with mental
disorders.
Many awareness-raising activities are targeted at specific groups, such as teachers, the police and
judiciary, health professionals or schoolchildren. Other awareness-raising measures take place in
public places, in towns and villages and aim to attract a large audience. Depending on the situation
any number of people can participate in these activities including community workers, primary
health care workers, people with a mental disorder and partner organisations.
Building a community support structure through a volunteer network made a significant
impact in changing attitudes of the community towards people with mental disorders.
Volunteers conduct community meetings to create awareness on how people should
associate with people with mental disorders with a greater understanding of their
sensitivities. According to the volunteer group interviewed, a community meeting is called
at least once in a month in the location they work. People with mental disorders willingly
participate in those meetings and present their skills, abilities etc., which makes an impact
for attitudinal change of the community. (Sri Lanka Programme 2007)
Games and songs
Few would deny that both mental disorders and poverty are serious matters. However, whilst
these issues should, and are addressed with due gravitas, bringing an element of fun to activities
frequently proves worthwhile.
Games and songs, also known as energisers, are introduced in many group activities within a
programme. They are a means of helping a group of people, possibly strangers, to get to know
each other and bond. They are also a great way to boost the energy of a group, particularly
when re-gathering after a meal or at the start of a day. They may engender freer discussion of
difficult or painful topics. Finally, they facilitate an environment where, despite the seriousness
of the issues at hand, people feel that they can, should they wish to, express feelings of joy.
A one-day in-door games event was organised at Ti Sampaa (a mental health facility) for
people with mental disorders, carers and community-based youth clubs, traditional healers

26
 Capacity Building

Games are excellent ways of re-energising a group, Kenya

and drama troupes in the suburbs of Tamale, all geared towards educating society on the
need to respect people with mental disorders, roles and responsibilities of society towards
them and integrating the person with a mental disorder into societal acceptance and life.
(Ghana Programme, Oct 2007)
Training
The range and breadth of training that is carried out within a programme is considerable.
Therefore, whilst acknowledging that training is a key component of capacity building, it is
dealt with separately, in chapter 8.

27
Chapter 4

4 Community
Mental Health

Outcomes
• Effective delivery of community mental health services is demonstrated
• People with mental disorders, their carers and families are better able to manage treatment
and care needs.

What does it mean?

Accessible treatment
Lallappa has regularly attended monthly treatment camps conducted by doctors from the
National Institute of Mental Health and Neurosurgery in the nearby town of Gowribidnur.
This means he does not have to travel to Bangalore but is still able to continue regular
treatment and follow up. His condition has become much more stable and he has again
returned to work. He has regained his self-respect and once more takes an active role in the
life of his family. (Lallappa’s life story, India Programme, 2004)
The availability and effectiveness of mental health services in many low- and middle-income
countries is woefully inadequate. This module has been developed in direct response to this
problem, and envisions extending the reach of appropriate mental health services to large
numbers of people in a community setting.
This is achieved by optimising the use of the states’ and other local resources. Partnerships
are built with state health care providers, who commit to allocating human and financial
resources to mental health. Mental health professionals work closely with the BasicNeeds
team and partners to deliver community mental health services. Community workers play
a vital role in ensuring the success of the module by providing on-going support to people
with mental disorders.
Over time, by demonstrating that effective community mental health care can be achieved
using existing resources, it is expected that the state will agree to take responsibility for these
services themselves.

28
 Community Mental Health

How does it happen?

Building partnerships
Correct diagnosis and treatment is an important step towards recovery for a person with a
mental disorder. Often people with mental disorders, especially those that are also living in
poverty will not have had access to the mental health services that they require.
“It is a long distance to go by bus and there’s no money. If he is told to go alone, he wants me to
go with him. We don’t have money [to pay] for two persons. One has to earn something to be
able to pay! I have to work in the field. No one has peace of mind – always thinking about work
and these problems.” (Carer of a person with a mental disorder, India Programme, 2004)
In order to extend diagnostic and treatment provision, partnerships are developed with state-
run health services and other existing local health resources. Having first established what
mental health care provision is currently available through the state, BasicNeeds works to gain a
commitment for mental health professionals to provide services in areas of need, or to increase
the frequency of services. To further increase the reach and in acknowledgement of the limited
numbers of mental health professionals, mental health is integrated, wherever possible, into
general health care. Training (described in chapter 8) is provided to general health staff to
enable them to treat people with mental disorders as part of their work.
In many of the countries in which BasicNeeds operates, there is either a lack of drugs or an
unreliable supply of them. In addition to ensuring that human resources are allocated to
mental health care, BasicNeeds also works to facilitate an adequate supply of low-cost or free
psychotropic drugs.
Community mental health services
The model demonstrates that effective community mental health services can happen in
a variety of ways. Once resources have been committed, services begin to be provided on a
regular basis, in areas where there is most need and where possible, in a community setting. In
some cases, clinics may be held at existing health facilities, such as hospitals or health centres
and are wholly provided for by the state.
The Nairobi City Council continues to host the outreach clinic while the Director of Mental
Health provides a regular psychiatric nurse to run the clinic in addition to psychotropic
drugs. A consultant psychiatrist visits the clinic once a month to enhance the capacities of
Primary Health Care staff in mental health management. (Kenya Programme, 2006)
In other circumstances, community-based organisations host the clinics at their own venues or
in community centres. They take on the bulk of responsibility for the organisation of the clinic
and mental health professionals attend to diagnose and provide treatment.
Birungi registered with the mental health clinic [hosted by the] Kamwokya Christian
Caring Community (KCCC) in September 2005. She was referred by Daisy Kamwezi, a
community‑based volunteer with the programme. I asked Birungi about her medication

29
Chapter 4

Mental health professionals at work at an outreach clinic in Tanzania.

and other forms of treatment she gets from the programme. She was very positive about
the services she receives. She said, “The medication I get from here has helped me get well
and you can see the remarkable difference in my appearance. (Patricia Birungi’s life story,
Uganda Programme, 2006)
In India, health camps initially began as a way of treating large numbers of people in a relatively
short amount of time for various medical needs such as eye care and dental care. In recognition
of their success, they have since been adapted to provide mental health care. Camps are
generally temporary facilities and are set up just for the day that it is being held. This has the
advantage of being able to easily move locations to the areas of most need.
At the camp [in Jharkhand], two psychiatrists and one general physician attached to the
State psychiatric hospital attend to people with mental disorders. Before the doctors arrive,
registration is done, with each person having to pay a fee of Rs.20 ($0.50) for which they
get a stamped receipt and token number. People start queuing up at the gate from 5.30
am. Once the doctors arrive, people queue up according to their token number, and wait
their turn for the brief consultation. Research officers, who usually accompany the doctors,
take down the ‘history’ from ‘new patients’. The drugs prescribed are then collected at
the first window where the pharmacist distributes with instructions of dosage etc. (India
Programme, 2007)

30
 Community Mental Health

The mental health services described above are not only for those attending for the first
time to receive a diagnosis. Individuals return to them on a regular basis for check-ups and
to collect their medicine. For many, these services are the only means of formal contact
with a mental health professional and their only opportunity of getting a continual supply
of the correct drugs.
Adalah Mafula, an epileptic person, told Alfani’s mother that in Mahuta dispensary (a
mental health clinic), treatment is provided for mental disorders, and that the service is
free of cost. Alfani’s mother decided to take her son to Mahuta dispensary. The psychiatric
nurse advised Alfani’s parents to start treatment for their son.
Alfani’s health showed remarkable improvement after he started treatment. His seizures
reduced to once a month and later they stopped completely. The last time he fell down was
in June 2005 when he was in the 6th standard. Alfani has not had a fall since. He attends the
clinic every month and he is still getting treatment. “I was able to study well and understand
what I was studying after I stopped falling. While in the 7th standard I didn’t fall at all. I was
therefore able to study without problems. That’s why I passed my exams.” (Alfani’s life story,
Tanzania Programme, 2005)

Mental health camps in India ensure that treatment is more widely available.

31
Chapter 4

A Ugandan community worker visits the home of a woman with a mental disorder

Identification
Once regular community mental health services are established, it is important that people with
mental disorders attend them. However, a person with a mental disorder may be less visible in
their community, perhaps physically hidden or not welcomed at community events because
of their illness and the stigma that so often surrounds it. As a result, it can be that much harder
to make initial contact. Furthermore, many people with mental disorders live in rural areas
and may simply be unaware of these services. Identifying and encouraging them to attend
community mental health services is, therefore, crucial. Having received appropriate training,
community workers undertake outreach in the areas in which they live. Frequently, they have
the added benefit of being known and trusted by those that they are reaching out to.
Eunice got to know of the mental health clinic through the community health volunteers
in the area. “George Ratemo comes from this village and he knows that I suffer from a
mental disorder so he informed us - my mother and I - that a clinic was starting in the
neighbourhood in the beginning of May 2006. He even sent someone to keep reminding us
of the date.” (Eunice Wangeci life story, Kenya Programme, 2007)

32
 Community Mental Health

BasicNeeds staff and partner organisations may also carry out this work. As well as identifying
people with mental disorders, they may physically attend a camp or clinic with them, as a
means of offering moral support. Identification is aided by activities such as street theatre
performances, which raise awareness of mental disorders and begins to dispel the prejudices
attached to it.
Follow-up support
Community psychiatric nurses continue to support community volunteers to monitor the
people under treatment, provide support to carers and appropriately advise and report on
the progress of each of the people under treatment. (Ghana Programme, 2006)
For people with mental disorders, the continuous support that they receive in their own
community is of equal importance to the initial diagnosis and treatment at a clinic or camp. This
support is usually provided via home visits. Mental health professionals play a part in providing
on-going support, but it is community workers who undertake the majority of this work. Living
in the same neighbourhood, it is more convenient for them to drop by on a frequent basis.
A major reason for follow-up support is to ensure that the medication prescribed is being
taken correctly. As many people in the programme are illiterate and reading the prescription
instructions is not an option, assistance in this matter is essential. However, follow-up
support goes far beyond the boundaries of clinical treatment: offering encouragement to
continue with treatment; giving assurance that there are people who care for them; and
providing information about clinics and other activities happening with the programme.
Each time an interaction occurs, it is logged in the person’s individual file and/or their
clinical file (described in chapter 6).
“One day a community volunteer told me they had mental health services at Kamwokya
Christian Caring Community (KCCC). I started getting treatment from there in January
2005. I was due for my next appointment at Mulago (psychiatric hospital) on 19th January
2005, but I decided to go to KCCC because it is nearer.
I have seen a difference, at KCCC. The drugs are always available and I have a community
volunteer who is responsible for following up and checking on my progress. She is a good
woman. She is elderly and like a mother to me. She has a file in which she writes about
me. They [KCCC] promise that when you recover, they can get you something to do, a job.”
(Beatrice Amongin life story, Uganda Programme, 2005)

33
Chapter 5

5 Sustainable
Livelihoods

Outcomes
• Income earning or productive activity by people with mental disorders occurs
• New skills, confidence and self-worth amongst people with mental disorders and their
families are developed
• Poverty levels of people with mental disorders and their families are reduced
• Social status of people with mental disorders and their families is improved

What does it mean?

“We may be able to overcome mental illness, but we cannot overcome poverty”, said a
woman recovering from illness. (India Programme, 2006)
“I wish to go to school like my fellow pupils, but I’m afraid of being called awful names. I feel
very bad, it pains me to hear such names.” (Fatuma Mohamed, Tanzania Programme 2006)
Mental disorders often have a devastating economic effect on the whole family. Conversely, a
gainful occupation not only reduces a family’s level of poverty but is also a significant factor in
sustaining recovery from mental disorders . Of equal importance is the positive impact purposeful
work has on reducing stigma and facilitating reintegration into family and community life. The
sustainable livelihoods module acknowledges this reality and demonstrates that people with
mental disorders and their families have the right and the capacity to be included in the process
of economic development.
In practice, for adults recovering from mental disorders, this means encouraging and supporting
them, their carers and family members to evaluate their existing capabilities and potential,
develop new skills and ultimately enter into employment or productive work . As programmes
take place in low- and middle-income countries, where employment opportunities may already
be scarce, the module has the additional challenge of operating within these confines.

34
 Sustainable Livelihoods

For many people with mental disorders, employment means more than the income they earn. It also
means regaining a sense of self-worth and pride in oneself.

35
Chapter 5

Children with mental disorders face similar barriers of stigma, discrimination and exclusion as
their adult counterparts. As they recover, they are also supported within this module, to begin
or resume their education.

How does it happen?

Assessment of livelihood opportunities
A central feature of the sustainable livelihood module is identifying available employment
or other productive opportunities to ensure that people recovering from mental disorders,
their carers and families have the best possible chance of accessing them. The type of
information collected could be on local facilities and services available, skills shortages in
the area, organisations that offer or could provide employment opportunities, micro-finance
organisations, vocational-training institutions and locally-based work schemes run by local
or national government. This information is collected by the programme research officer and
is usually done in partnership with a number of other organisations. This inclusive approach
ensures that all available and potential opportunities are recorded and links with stakeholders
are established. Furthermore, these stakeholders often become more receptive to the needs of
people with mental disorders as they are exposed to the difficulties faced by them in achieving
a sustainable livelihood.
Excerpt from Kenya (Kangemi) baseline study
The Presbyterian Church of East Africa offers computer training at minimal fee and St
Joseph the Worker Catholic Church development program offers dressmaking training,
carpentry, and computer training. Furthermore two major micro-finance institutions in the
area, Kenya Rural Enterprise Programme and Kenya Agency to Development of Enterprise
and Technology, offer loans to groups. Vocational-training institutions exist in the area.
The Government of Kenya’s Poverty Reduction Strategy Paper fundamentally emphasises
economic growth as a way to raise income opportunities and improve the quality of life of
the poor. Constituency Development Funds, available at the constituency level and the Local
Authority Transfer Fund available at the local government (ward) level can be tapped to
specifically address the plight of people with a mental disorder. (Kenya Programme, 2006)
Home visits
Home visits facilitate a culture of work and self-sufficiency amongst people recovering from
mental disorders and their families by providing encouragement and support, guidance and
mentoring and information on opportunities. They are a key link between the coordinated
activities that take place in the programme and a person’s daily life. In this module, home visits
focus on assisting people recovering from mental disorders, their carers and families to improve
their economic status and secure sustainable livelihoods. This is achieved through a process
of consultation to establish the choices, aspirations and needs of the individual; providing
information on skills and training opportunities; and ensuring that suitable occupational
therapy is accessed (where necessary).

36
 Sustainable Livelihoods

Once a feasible choice has been made, a person is offered support to become active. Broadly, this
encapsulates all forms of gainful occupation, whether this is earning an income, undertaking
productive work or accessing education. Home visits can be undertaken by a number of people
involved in the programme including community workers.
Making links with development organisations
In pursuing a sustainable livelihood, a person recovering from a mental disorder may opt to
return to a previous occupation or decide to pursue other options that require additional skills
or capital. To maximise possible avenues for gainful employment, BasicNeeds builds links with

Vijaylakshmi in her shop in India

37
Chapter 5

stakeholders such as local development organisations, micro-finance and enterprise groups

and local and national government agencies and schemes.
These organisations receive training, education and awareness-raising activities to sensitise them
to the needs and abilities of people with mental disorders. In turn, people with mental disorders
are encouraged to access the services (such as training programmes, loans, occupational skills
and business planning), that reflects their needs. This approach ensures that the module as a
whole can deliver a broad spectrum of opportunities enabling people with mental disorders to
pursue livelihood opportunities that they were previously excluded from.
Amasachina Self-Help Association is a local community-based organisation located
in Tamale, Ghana, and its primary area of work is micro-finance. Amasachina works
with community-based groups that are involved in income-generation activities and is
BasicNeeds’ partner organisation for implementing the Sustainable Livelihoods module.
Amasachina now involves people with mental disorders and their carers in its credit
schemes. The key aim of the joint efforts of the two organisations is to develop systems for
the integration of people with mental disorders and their families into mainstream society
through the provision of productive capital. (Ghana Programme, 2004)

Children are supported to access education through the sustainable livelihoods programme, Kenya

38
 Sustainable Livelihoods

Income-generating and productive activities

There is a real diversity of employment and productive work that result from this module. At
an individual level, people recovering from mental disorders have returned to their previous
occupations, developed new skills, started businesses and entered into new professions
and livelihoods. At a collective level, self-help groups and cooperatives have been formed
enabling people to access opportunities and pursue income-generating activities that are
unsuitable or unavailable for individuals. These groups provide members with mutual support
and encouragement, access to micro-credit schemes, capital at favourable repayment rates,
security, information and a more powerful voice.
The examples below illustrate some of the income-generating and sustainable livelihood
activities that have occurred through this module.
Self-help groups
The livelihoods programme in Mtwara is making progress through the 19 self-help groups
with a total membership of 163. The self-help groups have been specialising in goat and
chicken nurture, gardening of vegetables, farming of rice, maize, pineapples, beans and
sesame productions. Most of the self-help group members have managed to support their
family with some food, which was not the case earlier. Capacity building in the case of Mtwara
has focused on people with mental disorders and carers for building entrepreneurship and
specific skills training. (Mtwara, Tanzania Programme, 2007)
New business
Before he became ill, Venkatesh worked for thirty years in the weaving industry. He gave
it up and concentrated in overcoming his illness with the support of his family. Following
treatment and ongoing assistance from one of BasicNeeds’ partners, Grameena Abyudaya
Seva Samsthe (GASS), Venkatesh decided to set up a small business – supplying snacks
to travellers using the bus shelter in his village. He starts preparing the food at 4.00 a.m.
and sells from 8.00 a.m. until noon. Trade has been good and he turns over about Rs.300
[$7.50] each day, a modest sum but comparable to incomes of many people in the area.
Most importantly, Venkatesh, describes himself as having a completely new beginning. He
is confident and contented, enjoying the relative freedom of the work that he does now.
Notably, the local panchayat has been instrumental in allowing Venkatesh to use the bus
shelter, which is a favourable situation for his business (India Programme, 2006)
Access to resources
Mr. Ddangu has received a bicycle through the sustainable livelihoods programme. He
has already hired it out to a member of the community to go to school daily. He will be
paid a daily amount of 1000 shillings [$0.60] for this and will use this money to start up
another livelihood project. (Uganda Programme, 2006)

39
Chapter 5

A man tends to his crop and earns an income, Ghana.

Returning to education
Amatu [Fadila’s mother] said that when she saw other children going to school, she felt
disheartened that Fadila was at home. Hence, their appeal to BasicNeeds to support Fadila’s
education. Nashiru [her father] came to the BasicNeeds office seeking financial assistance
to enable them to send Fadila back to school. BasicNeeds supported him with an amount
of 500,000 cedis [about $51] under its sustainable livelihoods programme. Fadila returned
to school, to Future Leaders, an early Childhood Development Centre and now looks neat
and more cheerful than before. (Ghana Programme, 2005)
Therapy and income generation
Manel is a woman who has suffered from depression, and a widow with children. Home
gardening built up her confidence to work. She commenced pot cultivation of chillies,
tomato, cabbage and carrots. She said “this beautifully growing garden gives me pleasure

40
 Sustainable Livelihoods

when I see it every morning”. As a consequence of improving her confidence and skills, she
started another income-generation activity. She was given training in making ekel brooms
which she has taken up as a livelihood. She sells these brooms at Rs 50 [$1.20]. She has
carefully collected the money and spent Rs 2500 [$63] for purchasing a tractor-load of
metal for building her kitchen”. (Sri Lanka Programme, 2006)
Entering into productive work
Mohamed is a person with a mental disorder from Mpekso village. Since starting medication,
he now carries out productive activities for his family. “Thank god, ever since undergoing
treatment, I have been able to co-operate with others in doing homely manual activities
such as preparing coconut juice, rinsing utensils, doing some laundry and selling charcoal.
And this, to me, is a pure sign of recovery as I never did something like that before” (Tanzania
Programme, 2006)
New skills
The Tamale Tin Laayisi Horticultural Project trains interested people with mental disorders
to acquire skills in vegetable gardening. The project provides an alternative source of
livelihood for people with mental disorders. It has contributed to providing vegetables to the
people of the Tamale metropolis, especially for two hotel restaurants. … The management
and marketing skills of people with mental disorders in the project are growing as they take
charge of selling produce themselves in the market and to the restaurants in town. (Ghana
Programme, 2006)

41
Chapter 6

6 Research

Outcomes
• Experience, insights and perspectives of people affected by mental disorders become part
of the mental health evidence base and new knowledge
• Better understanding is gained of policies that affect mental health and their practical
applications in low- and middle-income countries

What does it mean?

Research is embedded in the model for mental health and development and occurs throughout
a programme’s implementation in three main ways. First, through participatory action research
methods people with mental disorders generate and analyse data to evaluate the programme
interventions and to make a direct contribution to policy applications. Second, outcome research
shows the actual changes that have occurred in the lives of people with mental disorders as a
result of interventions through the model. Finally, further insights, through policy research, are
gained into the external factors that affect people with mental disorders. Taken as a whole, the
analysed data or evidence emerging from these different but complementary research strands
are used to influence and bring about change in policy, as evidence for a programmes efficacy,
and to build a knowledge base.

How does it happen?

Research methods
Primary data is generated and analysed through the research methods described below.
Participatory action research
Participatory action research forms a significant part of BasicNeeds’ research work and is
integral to a programme. The process involves cycles of data collection, analysis, feedback and
reinterpretation with the outputs used to assess need and the effectiveness of interventions. Data
collection occurs mainly in the field and is a mix of qualitative and quantitative information

42
 Research

Participatory action research in Sri Lanka

(the specific types of primary data used are addressed later on in this chapter). In addition to its
research purposes, the data forms the basis of statistical monitoring (described in chapter 7).
To ensure that people with mental disorders and other stakeholders are able to actively
participate in all stages of the research-analysis cycle, a range of different forums are used,
including consultations, focus groups, interviews and home visits.
The data emerging from the field is analysed against the themes of health status, treatment
approach, health services, socio-economic status, care giving, community acceptance, programme
interventions and participation. Analysis occurs at different levels within the programme, starting
at the field with people with mental disorders and working its way up through partners and
other stakeholders to the BasicNeeds programme staff. At each level of analysis, synthesized
documents from the previous level are used. This process helps to build up a comprehensive
picture of outcomes and emerging issues and results in an annual research report.
Participatory action research employs a technique called participatory data analysis, developed
by BasicNeeds to operate in a mental health and development setting. Lead by an animator
and recorded by a process writer, the purpose of the participatory data analysis is to develop
local-level findings and operational policy recommendations for local implementation. This is

43
Chapter 6

achieved by bringing together people affected by mental illness and others in a programme
to analyse data that they have played an active role in generating. Participatory data analysis is
used wherever resources permit.
Instructions given during a participatory data analysis session.
• Count and write down the number of people with mental disorders against the major
occupations they were in before their illness.
• Also indicate whether they are still in the occupations they were in before their illness.
• Count and write down the number of people with mental disorders against the
household chores they are able to do.
• Group the responses of people with mental disorders into those who earn in cash,
those who earn in kind and those who earn in both cash and kind.
(Ghana Programme, 2007)
Outcome studies
Outcome studies build on the data generated through participatory action research and
use it to evaluate the efficacy of the model outcomes. The purpose of this type of evaluative
research is to evidence how effective the interventions of the model are in bringing about
real change in the lives of people with mental disorders. In order to do this, these studies use
representative samples to investigate specific outcomes around topics such as integration,
treatment and economic sustainability. Outcome studies draw on individual and clinical files
for data (described later in the chapter) and use additional sources where required.
Policy studies
Policy studies involve specific, one-off pieces of research that focus on a particular set of
issues that significantly affect intervention quality or model outcomes. Often the reason for
commissioning a study will have resulted from issues highlighted through participatory action
research and the outcome studies. The data required for a policy study is not available from the
sources that participatory action research and outcome studies draw from. As a result, targeted
research to generate specific data for analysis of the subject in question takes place.
Excerpt from a recent policy study on the availability of psychotropic drugs in 6 low- and
middle-income countries where BasicNeeds has programmes:
• There is an absence of specific policies for the supply of psychotropic drugs.
• Distribution of these medicines to health service points is ‘supply-driven’ rather than
‘demand-driven’ resulting in skewed availability and shortages
• Lack of trained staff results in poor procurement of medicines.
• There is no separate budget for psychotropic drugs so funds are used to buy other
medicines.

44
 Research

• Psychotropic drugs were often not available free of charge and purchasing them was
often prohibitively expensive for poor families.
(BasicNeeds Policy and Practice Directorate, 2007)
Baseline study
A baseline study is a review of the situation of the programme area specifically looking at the
lives of people with mental disorders and all of those factors in the external environment that
affect them. Normally undertaken at the start of a programme in a specified geographic area,
the baseline study helps to shape subsequent development on the ground. Furthermore, the
study is used as a point of reference against which progress and change can be measured.

Primary data
Primary data collection is an on-going process, which involves complete documentation of
the lives of people with mental disorders, their carers and families, via a number of formats.
The main types of primary data collected through a programme are listed below. These are
analysed through participatory action research and outcome studies.
Life stories
Life stories are a way in which the lives and experiences of people with mental disorders can
be recorded, as told by them. Life stories serve multiple purposes. They provide meaningful

A woman tells her story to a community worker in India

45
Chapter 6

Individual files are a crucial primary data source

insights and enable greater understanding about not only the reality for that person but that of
his or her family and community too. They are also used to highlight the issues they face, which
in turn are a starting point for further research.
Extract from Hakmany’s life story
In 1996, when she was studying in grade five in primary school, she felt her head rotating
heavily. She had vertigo, high fever and seizures. She was referred to Phonhong District
Hospital located in Vientiane Province by her uncle with whom she lived for a year. Her
physician diagnosed her with meningitis.
She described her seizures very well. “One thing I remembered well was the feeling that
my legs and arms were becoming progressively heavy and I was suddenly falling down.
After that, I was unconscious. I do not remember what happened. When I woke up after the
convulsion, I felt lost; my memory had gone away... I could not talk. I was made to lie down
on the bed, drowsy and confused, for at least half an hour. I was hospitalised for two weeks.
(Lao PDR Programme, 2007)

46
 Research

Individual files
Every person with a mental disorder who is involved in the programme will have an individual file.
Such files are a factual account of the individual, including information on their background and
history; their medical information, including type of mental illness, symptoms and treatment;
and their family situation. The file also documents the interventions of the programme and
significantly, the changes that are unfolding in their lives.
Clinical Files
As with individual files, clinical files are kept for every person with a mental disorder participating
in the programme. They contain information solely relating to their medical history and are
a record of all clinical interventions that have occurred. The information within the file is
confidential and is maintained and updated by a mental health professional.
Process documents
All field consultations and focus groups involving people within the programme are recorded
via process documents. To ensure accuracy, a trained process writer has the sole task of noting
down what is said and happens during a gathering. Process documents are an important source
of data, because they not only describe, word-for-word, what has been said and by whom, but
also capture other revealing information such as the atmosphere in the room and the body
language of participants.

Uses of evidence
The research methods described above generate a body of evidence that is used for many
purposes.

A process writer records everything that is being said at a consultation meeting in Kenya

47
Chapter 6

Influencing policy and advocacy

At a local level, people with mental disorders and other stakeholders are able to make a direct
contribution when identifying problems and solutions and reflecting on how successful any
intervention has been. This cycle ensures that the research is highly responsive and results in real
change on the ground. For example, a group of people with mental disorders analyse the data
they generate to evidence that the provision of mental health care in their area is unsatisfactory.
This evidence is used to advocate for specific change, such as an increase in the frequency
of clinics or access to more resources from the local government. The response by the local
government is then analysed to see how successful it has been and whether further change
is necessary. This process of evidencing need, demanding change and then reflecting on the
intervention provides people with mental disorders and other stakeholders with the necessary
skills to advocate successfully. These skills can then be applied at a regional or national level as
people with mental disorders and other stakeholders gain the confidence to use them in more
demanding arenas. The method is the same but the scale and impact is far greater.
Excerpt from Kenya Impact Report
The National Mental Health Policy was reviewed with the participation of BasicNeeds and
partners. Experiences in community mental health were incorporated into the final draft.
Being a member of the drafting committee positions BasicNeeds Kenya prominently in the
development of attendant legislation, the first one being the review of the Mental Health
Act, which is not current in its outlook and stipulations. (Kenya Programme, 2008)
Evidencing efficacy and challenges
The knowledge gained from the research discussed above contributes to demonstrating the
efficacy of and the challenges faced when implementing the model for mental health and
development. Firstly, the evidence is used to show how effective particular interventions
are in relation to people with mental disorders. This work enables BasicNeeds to show to
governments, funders, partners and others involved in a programme, the validity, importance
and cost effectiveness of the model’s interventions. Secondly, the research allows BasicNeeds
to evidence the challenges that a programme faces, enabling it to learn from the work already
occurring and improve upon it in the future. This approach ensures that newly-established
programmes can avoid making similar mistakes to those already in existence and put in place
measures to tackle potential difficulties before they arise.
Excerpt from research report
The major problem faced by people with mental disorders in every programme area was the
lack of mental health services within their locality. This is evident in every process document
written for initial consultation workshops. (Sri Lanka Programme, 2006)

48
 Research

Knowledge base
The evidence generated through this module, contributes to a significant knowledge base that
serves two main purposes. Firstly, the evidence includes the views, experiences and insights
of people with mental disorders. This helps to give people with mental disorders a voice to
demand that they be included in decisions that directly impact upon them. Secondly, the
evidence from which the efficacy of interventions can be assessed is drawn from different low-
and middle-income countries across the world. This helps to promote a developmental rather
than a clinical approach to mental health.

49
Chapter 7

7 Management
and Administration

Outcomes
• Organisations implementing the model are robust, capable and sustainable
• A mental health and development programme is implemented to the highest possible
standard

What does it mean?

To deliver these separate but overlapping modules of the model simultaneously, often involving
numerous partnerships and with the full involvement of people with mental disorders, is a
complex task. This module ensures the effective implementation and smooth running of
a programme as a whole by establishing and maintaining partnerships; ensuring efficient
project management, such as budgeting, reporting, monitoring and evaluation; and providing
adequate resources. In short, the management and administration module is the glue that
holds the model together.
All organisations have a duty to carry out numerous functions in order to stay healthy. This
section is not intended to be a description of the standard requirements expected of every
organisation. Rather, it focuses on those management and administrative tasks specific to
running a mental health and development programme.

How does it happen?

Fundraising
Without funding, putting the model for mental health and development into practice would
not be possible. Funding is secured at the start of the programme by BasicNeeds, and is
allocated accordingly to those involved in its delivery. As the programme goes on, partners
are encouraged and supported to seek funds for the aspect that they are responsible for. This
strategy ensures that skills remain with the partner organisation, reduces the dependency on
BasicNeeds and increases the likelihood of the continuation of the programme.

50
 Management and Administration

Managing and building partnerships

All of the programmes that are currently running are dependent on partnership work for their
success. Partnerships are formed with a range of organisations (see chapter 2), which agree to
deliver one or more of the modules. Once a suitable partner has been identified and funding
secured, the next step is to formalise the relationship via a Memorandum of Understanding.
This is a legally binding-document, which includes:
• Underlying values and principles
• Relationship between the two parties
• Planned activities to be carried out
• Role of each organisation
• Annual budget
• Dispute resolution
The Memorandum of Understanding is drawn up and signed by BasicNeeds and its
partner and is reviewed on an annual basis, at which time the following year’s activities
and budget are also agreed.
Throughout the programme, as and when required, BasicNeeds offers technical assistance to
its partners. On an informal basis, there are frequent visits by programme staff to the field areas
of its partner organisations and regular exchanges with the staff members of each partner.
Every three months, a quarterly review is held with the partner organisation, during which
both successes and challenges are discussed, and plans for the next quarter are reviewed and
agreed upon. At the quarterly review and on an on-going basis, skill shortages are identified
amongst the partner staff, and suitable training is provided (see chapter 8).

Partners meet on a regular basis to share information in Tanzania.

51
Chapter 7

Once a year, all partners assemble for an annual review - a great opportunity to assess the
programme in its entirety.
Partner meetings
Partner meetings provide a platform for all organisations involved in the programme to share
information and experiences and learn from each other. During the meetings, organisations with
expertise in a particular aspect of the model may be asked to give presentations; alternatively,
there may be more informal gatherings allowing for networking. Via these meetings, lasting
relationships are built that enhance and help to sustain the programme’s delivery.
Monitoring
All the activities carried out and details of the people who benefit from them are tracked
within the programme. Activity tracking sheets, statistical tracking sheets and process tracking
sheets are used by BasicNeeds and its partners to collate this information. The fact that they
are standardised documents makes it easier for different organisations to share and combine
data. What has changed as a result of the programme’s activities and its wider impact is also
carefully monitored via the collection of qualitative and quantitative information. Monitoring
is closely linked to the research module and this information is also used for research purposes
(see chapter 6). All monitoring is collated and reports are produced on a regular basis, ensuring
a complete picture is built up of the programme and its resultant impact.
Financial management
Setting accurate budgets and monitoring income and expenditure occurs throughout a
programme. At its most frequent, this is on a monthly basis, but cycles exist for quarterly and
annual reporting in addition to the start-up budget and the evaluation when the programmes
funding cycle comes to an
end. Financial monitoring
takes place both by the
individual organisation and
centrally by BasicNeeds.
Reporting cycles
Partner organisations collate
the monitoring data on a
monthly basis and then
submit quarterly reports
to BasicNeeds describing
what has occurred in the
programme over the last
three months. Annual
reports,lookinginmoredetail
A management meeting gets underway in Kenya. and focusing specifically on

52
 Management and Administration

outcomes, are also produced

by all partners. BasicNeeds
consolidates these reports
and puts together an Impact
report, which describes the
work and outcomes of the
programme overall. The level
of change that has occurred
as a result of the programme
is measured against a set of
impact indicators, developed
specifically for this purpose.
These reports are used in
many ways, for example, to
keep Trustees up-to-date, to
meet funders’ requirements,
as an official written record of
Participatory techniques are used to evaluate a programme the programme and as a basis
in Uganda for publicity.

Programme evaluations
Evaluations are undertaken at two points in the lifetime of a programme – one halfway
through and one at the end of a programme’s funding cycle (normally every three or four
years). Typically, the mid-way evaluation is carried out internally and an external evaluator
completes the final evaluation. In line with other programme activities, participatory
techniques are used and people in any aspect of the programme are asked to be involved in
evaluating its progress. Evaluations are an important part of the ongoing reflection–action
cycle and are seen by all as an opportunity for further learning and improvement as well as
the chance to celebrate successes.
Extract from evaluation report
In assessing the design of the overall programme, the evaluation team found that in large
part, the programme goal, purpose and outputs were being met in a commendable and
interesting way.
[The programme should ensure] greater involvement of the districts, and their relevant
structures and institutions, since the other criterion for effective programming needs to be
that of sustainability. (Uganda Programme, 2005)

53
Chapter 8

8 Training

How does it happen?

Training is an ongoing activity and a key component of capacity building for almost everyone
involved in the model’s delivery. Training is developed for partner and BasicNeeds staff,
government officials, development organisations, community leaders, people with mental
disorders, carers, traditional healers, health workers and mental health professionals for
example. The sheer quantity of training that takes place in a programme is impossible to show
in great detail but broadly it is split into two strands.
The first strand focuses on developing the competencies of all who are working in mental
health and development and specifically in implementing programmes. The diversity of people
involved brings great benefits but also requires quality control to ensure that standards are
high throughout. Training is one of the ways of achieving this.
The second strand revolves around direct training for people with mental disorders, their carers
and families to enable them to better manage their illness or gain new skills to help achieve
sustainable livelihoods.
Training is tailored to specific circumstances and is often in response to a newly identified need
of a group or individual. As such, it tends to be done on a flexible basis, ensuring it is highly
responsive and provides the necessary knowledge, skills and experience where and when required.
Training is delivered by a combination of skilled people including BasicNeeds staff, partners and
development and mental health professionals. Furthermore, those who have had first-hand
experience of the activities within the model also help to deliver training where possible.
In line with the ethos of the model, training is designed to be participatory in its delivery, ensuring
that the recipients, whether directors of a community-based organisation, government ministers
or a person with a mental disorder, are fully engaged and stimulated. Animation techniques,
which are used in all training, further aid participation. Emphasis is placed on learning from
each other; discussion and exploration of ideas are encouraged, with much of this occurring
in small groups. The proverb, which states that you must ‘walk a mile in another mans shoes’
is embraced via role plays, which enable participants to really understand the issues faced by
people with mental disorders.

54
 Training

Training takes place in culturally appropriate and preferably familiar settings, where participants
will feel most comfortable. Community halls, places of worship and even outside spaces are all
regularly used as venues. In general, only basic materials are used – paper, pens, flipcharts -
with drawings and images considered as important as words to get a point across.
The following is a description of some of the most common training delivered as part of
the model. Due to the broad spectrum of training that occurs, the list below is by no means
exhaustive but provides a flavour of what takes place.

Training to implement mental health and development

programmes:
Community mental health training
Mary, a Mental Health Coordinator in Temeke Municipality reported that her work has
become easier. As opposed to her having to go around treating people at each clinic
(difficult due to transport constraints and poor drugs supply), now that all the nurses in
her Municipality were trained, it meant that they were able to provide the treatment. All
she now handles are difficult cases, which are referred up to her in Temeke. (Tanzania
Programme, 2006)
Building on the capacity of existing primary health care or community infrastructure, the
training equips participants with the skills to undertake and deliver more effective mental
health care. For example, a nurse with limited knowledge of mental health issues is trained to
deliver more effective treatment of mental disorders. A community worker is given the skills to
recognise mental disorders and refer people for diagnosis. This training enables the recipients
to deliver better care, widening the reach and accessibility of services and helps more people
with mental disorders to get improved, sustained treatment. Usually delivered by a mental
health professional, the participants are challenged to evaluate whether the existing health
care system is able to respond to the needs of a person with a mental disorder, what changes
are required for it to improve and their role in helping to deliver this change.
The Mental Health Unit jointly organised a 5-day Community Mental Health Training with
BasicNeeds in the capital of Lao PDR, Vientiane. 90 people attended in total including
health professionals, representatives from Lao Disabled Peoples’ Association, Belgium
Technical Cooperation, Handicap International, community workers, people with mental
disorders and carers.
The training aimed to provide more knowledge about the recognition and understanding
of people with mental health problems, mental diseases, diagnosis and treatment, referral
systems for people with mental disorders and how to provide mental health care through
community partnership. (Lao PDR Programme, 2007)

55
Chapter 8

Practical demonstrations form part of a community mental health training in Tanzania

Research training
The research approach adopted by BasicNeeds uses participatory processes that place the
stakeholders at the heart of generating and analysing the data. Within the model, people such
as health workers, community workers or partner organisations may be involved in carrying
out research.
Training is delivered by people with direct experience of the research methods used by
BasicNeeds. It begins by highlighting the importance of and significance that research plays
in a programme; it also shows how the findings can be used to influence policy and practice
from a local to national level. Broadly, the training covers what is research; why do research;
participatory approaches to research (specifically participatory data analysis, see chapter 6);
the types of research; how to collect and analyse data; and the uses that research findings can
be put to. Working from the premise that ‘doing’ is the best way of ‘learning’ throughout the
training participants are guided through the research process using actual data from the field.
Feedback on research training
“Data is something that we simply collected and kept in storage. Now we know that this
should not be so. How important it is to analyse it – to get a better understanding of the

56
 Training

person/situation. We have learnt the proper ways of analysing data. The value of data
being analysed both quantitatively and qualitatively.” (Sri Lanka Programme, 2004)
Documentation training
A strong feature of a programme, is that everything that takes place is thoroughly documented;
including life stories, process documents and individual and clinical files as well as activity
and statistical tracking sheets and the various reports (quarterly, annual and partner). Yet
problems do arise as documentation standards and practices can vary significantly within and
between different organisations and people. This training is designed to improve the levels
and standards of documentation and covers: the types of documentation required; the need
for documentation; confidentiality; its importance, uses and management; and the differing
requirements of partner organisations.
Three days of documentation training was held, to strengthen the documentation
skills of the partner organisations of the community mental health project in the North
India programme. These partners are working at the grassroots level but being small
organisations do lack in essential skills of documentation and presentation. At the end
of the training, all the participants were quite happy by discovering their potential to
document properly and make their work presentable. In fact, all participants pledged to
practice good documentation as they could see its importance in their expansion. (India
Programme, 2007)

Skills learned in research training are put into practice in Kenya

57
Chapter 8

Training volunteers in Lao PDR

Animation training
Animation transcends individual modules and is vital to delivering change, increasing capacity
and empowerment. Training in animation techniques is therefore essential, particularly as it is a
new technique for many. In the model, various individuals may become animators, as emphasis
is placed not on the qualifications of the person but on their personal qualities.
Typically, the training will include key ideas and concepts; why animation is necessary; feelings
and energy, group dynamics; types of relationship (mentioned below); how to deal with
resistance; how to say ‘no’; the role of an animator as motivator; and how to manage and get
the best out of individuals (affiliation, achievement and power). During the course, participants
practice animation techniques, perhaps for the first time, in a safe environment. Examining
one’s own motivations, beliefs and prejudices is central to becoming a good animator and
participants have often learnt just as much about themselves by the end of the course as they
have about animation.
Excerpt from animation training course
Animators deal with feelings and energy. So-called “negative” feelings are not just negative:
they often have useful, maybe important, information in them. They can motivate and give
energy, although they can also block/distort good thinking and decision making. So notice

58
 Training

when people (including yourself) are upset, and help/support them through those feelings
by actively listening, acknowledging the feelings, noticing the ways that they are expressed
and giving the person time to talk through how they feel, without prematurely pressing them
into thinking. (India Programme, 2002)
Delivering sustainable livelihoods training
The sustainable livelihood module is often delivered in partnership with development and
other organisations or institutions and helps individuals to access opportunities and resources
to make a living. Ensuring
these organisations have the
right skills and experiences to
effectively support people to
access livelihoods is vital and
can require specific training.
A standard training session
covers definitions of sustainable
livelihoods; approaching
sustainable livelihoods at the
individual/micro level and at
the macro level; relationship
between poverty and mental
disorders; and meaningful work.
The training sensitises individuals
and organisations to the needs
of people with mental disorders
and how best to respond to them
to ensure that they are afforded
opportunities for meaningful In the training, participants learn about how best to support
work or employment. people with mental disorders into different livelihoods, Ghana

Excerpt from sustainable livelihood training

Participants are asked to consider the following scenarios and consider which is a
sustainable livelihood?
1) Two brothers both with a mental disorder in Wakiso district; one is a brick layer and
another trades in firewood. When they relapsed, their wives sold their bricks and firewood
respectively in order to sustain the families. When their condition improved, they had no
where to start from.
2) A person with a mental disorder has a poultry business; when she relapses, the family is
very supportive. They take over her work and when she improves, she takes over from where
the family had reached. This is because her family took the interest to support her, and they
try to learn all the skills they would require to support her. (Uganda Programme, 2006)

59
Chapter 8

Management and administration training

The management and administration training provides partner organisations with relevant
project management skills required to implement the aspects of the programme they are
responsible for. Topics such as, preparing logical frameworks, budgeting, finances and reporting
are offered to partners where there is an identified need. The benefits of this training can be split
broadly into two areas: firstly it helps to ensure that the programme work is implemented in an
effective manner; and secondly partners can apply the new skills gained to develop themselves
and improve their work in other areas not related to the programme or the model.

Training for people with mental disorders, their carers and families
Managing illness training
To sustain effective treatment, people with mental disorders, carers and family members need
to know how best to manage their illness. The training is often informal and provides practical
advice, as well as, encouragement and support. Issues dealt with through the training include,
recognising and managing symptoms, the importance of taking drugs as prescribed (when
and how); how to manage and mitigate any side-effects; and how best to care for a person
with a mental disorder. The training tends to be ongoing and can be delivered by a number of
people such as community workers, health care professionals and partner organisations.
One of BasicNeeds Lao PDR’s main implementing partners is Lao Disabled People
Association (LDPA). It delivers mental health training. People with physically disabilities are
identified to be at high risk of being affected by mental illnesses. This is partially due to the
fact that they have been through difficult situations in coping with their physical disability
and this may often lead to some series of mental illnesses. They receive training in basic
knowledge on mental health, how to identify a person with mental illness and the rights
people with physically disabilities. (Lao PDR Programme, 2007)
Employment or productive work training
Sustainable livelihoods training enables people recovering from a mental disorder, carers and
family members to pursue a path that will lead to employment or productive work. The training
is highly specific and can range from horticulture skills to bicycle maintenance, from mechanics
to business planning. Most frequently, the actual training is delivered by partner organisations.
The initial groundwork involves mapping the organisations that provide suitable training and
building alliances with them. This is usually undertaken by the BasicNeeds staff. On an ongoing
basis via home visits and in focus groups, individuals are consulted to establish their needs and
aspirations. The final stage is matching the available training opportunities to the requirements
of individuals, in doing so equipping them with the necessary skills to enter into a gainful
occupation.
A workshop was conducted at the Tangalle town hall for people recovering from mental
disorders, carers and volunteers engaged in income-generation activities. There were 30
people with mental disorders among 103 participants. All the participants have started

60
 Training

some sort of business with the vocational training they obtained during the past few months
such as mushroom cultivation, fabric painting, sewing, shoe making and coir products. The
main objective of the workshop was to do a follow-up on their income-generation activities
and introduce new organisations for getting support. Livelihoods Coordinator, Asoka
Vitharana conducted the workshop and participants made links with representatives from
Hambantota Chamber of Commerce and Sarvodaya Economic Enterprise Development
Services for developing their businesses further. (Sri Lanka Programme, 2007)
Advocacy training
Advocacy training aims to equip people with mental disorders, their carers and families with
the skills and abilities to demand the services they are entitled to and the confidence to speak
up for their rights. The participants actively take part in the training, identifying issues that they
want to advocate on and how best to do this. Examples of issues raised in the past are a lack of
drugs and mental health personnel, and the need for water and farming implements.

In India, people gather to speak out for the rights of people with mental disorders

61
Chapter 9

9 The People Involved

Without people the model for mental health and development remains just that – a model. This
chapter describes those responsible for bringing it to life, from people with mental disorders to
traditional healers, programme staff, partners, health professionals and community workers.
People with mental disorders
The model for mental health and development exists to help people with mental disorders.
Whether it is discussing their needs and requirements through field consultations, pursuing
livelihood ambitions or participating in generating and analysing data, people with mental
disorders are at its heart.
Participation in a programme brings direct tangible benefits for
people with mental disorders. They gain access to treatment, which
leads to stability and, significantly, involvement in income-generation.
Furthermore, participation builds their capacity and enables them to
make their voices heard. A key feature of the model is that people
with mental disorders may both be beneficiaries of the programme
and active contributors to it. Many people recovering from mental
disorders go on to become animators and community workers;
others form alliances to demand their rights.
Jayantha Gunesakara,
Sri Lanka
Jayantha has now recovered successfully and he is working actively as the Secretary of the
Volunteers’ Committee of Katuwana Division. He developed all the required competencies by
following training courses organised by BasicNeeds. He also contributes his valuable efforts
to therapeutic programmes organised for people with mental disorders by BasicNeeds at
Katuwana Hospital. At the vegetable farm set up and managed by people with mental
disorders, carers and volunteers in his division, Jayantha is an active contributor. (Jayantha
Gunesakara’s life story, Sri Lanka Programme, 2007)
Furthermore, merely the visible presence of people recovering from mental disorders returning
to work or getting involved in community life can have a huge positive impact. These individuals

62
 The People Involved

are the beacons of hope for others, ambassadors of the programme and responsible for
changing attitudes and beliefs of many around them.
“Many people since my recovery have been asking me where I have been accessing the mental
health service and they now believe that mental disorders are treatable (most especially for
those who knew my condition before and now see me recovered). This has made them start
referring other people with mental disorders to the health centre in Kamwokya”. (Woman
recovering from a mental disorder, Uganda Programme, 2006)
Carers
The lives of people who care on a daily basis for a person with a mental disorder are usually
greatly impacted upon. Carers are often, but not always, a family member, and may be an adult
or a child. Through association, they may experience similar discrimination as the person they
care for. Many have to give up work or school. At the same time, they often use much of their
finances in seeking cures from traditional healers, travelling to hospitals or health centres or
buying expensive medicines. This double economic loss often results in additional stress and
anxiety for the carer.
The model seeks to address carers’ needs by including them within a programme. Their opinions
are sought as to the needs of the person they care for as well as their own via consultations.
They attend training in supporting people with mental disorders and are targeted to raise
awareness of causes of mental disorders. Within the sustainable livelihoods module, their own
ambitions are listened to and they are given support to act upon them. They become members
of self-help groups, which also include people with mental disorders, further helping to break
down barriers and prejudices. Similarly, to people with mental disorders, many carers move
from being a beneficiary to a contributor within a programme, becoming community workers,
or advocating for change for example.
BasicNeeds staff
BasicNeeds staff are responsible for coordinating the implementation of a programme for mental
health and development and ensuring that it runs successfully. Almost without fail the staff will
be nationals of that country, have a good knowledge of mental health and development and
be skilled in developing partnerships and alliances. The number and roles of the BasicNeeds
team will vary according to how a programme is being implemented in a particular area.
For instance, some programmes may involve multiple partner organisations, reducing the
number of BasicNeeds staff required. In these cases, BasicNeeds provides a support service
to the partners and coordinates the overall programme delivery. In other cases, BasicNeeds
may have a more ‘hands-on’ role, being involved in running the actual activities alongside its
partners. In the latter scenario, BasicNeeds is more likely to employ additional staff. However,
there are some common responsibilities found across all programmes. These include engaging
and coordinating partner organisations, implementing management and reporting systems,
undertaking research, lobbying state and other institutions and securing funding.

63
Chapter 9

A carer expresses his view at a consultation in Ghana

Community workers
From the community mental health module to sustainable livelihoods and capacity building,
much of the work that occurs on ground is undertaken by community workers. This is not
least in acknowledgement of the importance of embedding support for people with mental
disorders firmly in their own community.
Depending upon the specific circumstances of the programme, some community workers will
be volunteers; others may receive expenses or be paid wages. Additionally, in the different
countries in which programmes are running, they are referred to differently - as community
health workers, volunteers or members of the village health team for example. Furthermore,
where they are employed directly by partner organisations they are known as field staff. To
avoid confusion, we have used the term community workers throughout.

64
 The People Involved

Community workers receive training to undertake a broad spectrum of activities including

street theatre, identification of mental disorders, referral and follow-up support. They provide
a crucial bridge between people with mental disorders and the wider community, exploding
myths and breaking down barriers leading to better acceptance and understanding. Below are
just some examples of their involvement within the programme:
• Coordinating and running the activities such as field consultations and community
meetings
• Helping a person with a mental disorder to pursue a course of treatment
• Assisting in the establishment and operation of self-help groups and cooperatives.
• Supporting and encouraging a new business venture
• Identifying a person with a mental disorder and referring for treatment
• Helping at mental health camps and outreach clinics
• Providing follow-up support, managing side-effects and relapses
• Recording and documenting life stories and maintaining individual files
• Providing the link between the person with a mental disorder and BasicNeeds/partner
organisations
In many cases, community workers are already involved in some aspect of health care in their
locality and they agree to extend their responsibility to include mental disorders. Others may
be involved in the disability movement or more generally in development1 . Significantly,
they count people recovering from a mental disorder amongst their number. This has an
undeniable effect on both the person with a mental disorder and the community in which
they live. Having directly reaped the benefits, he or she can be a powerful advocate for the
programme, encouraging other people with mental disorders to come forward for consultation
and treatment, whilst also understanding the barriers that person is facing. In addition, the
community sees someone, who they once deemed as ‘incapable’ now making an active and
valued contribution to community life. In short, community workers are largely responsible for
implementing the activities that result in changes on the ground. They put into practice the
theory of the model and are essential to the success of the programme.
Indrani and Lalitha are active volunteers of the Mental Health and Development programme
in Angunakolapelassa, Sri Lanka. They referred Pathirathne to BasicNeeds’ mental health
camp. … That day he was given an injection. Apart from that he was also given indigenous
medicine. Indrani undertook the responsibility of giving him his medicines at the proper
time. This was a challenge for her but she did it tactfully.
Indrani prepared lunch at dawn and kept it in a boutique where Pathirathne used to come
regularly. This way, Pathirathne was given the necessary nourishment and the necessary

1
Raja S, Boyce WF, Ramani S, Underhill C. Success indicators for integrating mental health interventions with
Community Based Rehabilitation projects. (in press, International Journal of Rehabilitation Research, Dec 2007)

65
Chapter 9

Community workers gather, before going out into the field, Uganda
medicine. The medicines were given at regular intervals without a break for a few months.
He showed signs of improvement. He himself started taking his medicines without any
hesitation. After about five months Pathirathne was able to go alone to the medical camp
… for treatment. His health improved to a great extent. (Pathirathne’s life story, Sri Lanka
Programme, 2007)
Mental health professionals
Mental health professionals play a very important role in diagnosing, treating and assisting
people with mental disorders in their recovery. Including people like psychiatrists, clinical
psychologists, clinical social workers and psychiatric nurses, their primary involvement in the
programme is within the community mental health module where they carry out a number of
functions and duties. In relation to a person with a mental disorder this includes activities such
as diagnoses, prescribing a course of treatment and administering drugs. In many cases this
will be the only access people with mental disorders have to mental health professionals and
the demand can be enormous.
Other activities include maintaining clinical files, participating in data analysis sessions, training
people in mental health issues and raising awareness about mental disorders. In most cases,

66
 The People Involved

they are not employed directly by BasicNeeds or partner organisations; rather, a relationship
is built with a health service, normally state run (see chapter 3), which leads to it committing
some staff time to the programme.
Animators
The animator has “a special responsibility to stimulate people, to think critically, to identify
problems, and to find new solutions.” 2
In most cases, individuals are not employed solely as animators. Rather, everyone working
within or involved with the programme has the opportunity to take on the additional role of
animation. Those who are interested and have the potential to be good animators go on to
receive training in the subject (see chapter 8).
The part that animators play in driving a model for mental health and development can not be
underestimated. Animators are chosen for their personal qualities rather than such factors as
age, gender, economic or employment status. They must genuinely believe in the capacity and
ability of people, no matter how poor or ill they are, to make a positive contribution to social
change. They must also believe in the principle of equity. Animators create an environment
where the traditionally distinct roles of learner and teacher are merged, and urge community
members to see that they are the experts when it comes to their own development.
They are dynamic individuals, able to work with a group to identify its needs and goals, to act
on its decisions and then evaluate. This may sometimes require the group to be challenged,
encouraged or motivated, but never controlled. An animator also spends time building up
relationships, and ensuring that everyone feels able to be involved in the process. For this to
happen, the animators must be familiar with all members and be fully aware of the underlying
dynamics that exist within all groups.
Within a programme, an animator may be involved in any number of activities (see chapter 3).
Field consultations, participatory data analysis sessions, community reviews are all enhanced
by the presence of an animator. Self-help groups, particularly at their inception, will often have
an animator amongst the members – in fact, animators are likely to be found wherever groups
of people are meeting.
Traditional healers
In many countries in which the model is being implemented, traditional healers continue to be
a widely used source of primary health care. Methods of traditional healing will vary between
countries according to the knowledge, skills and practices indigenous to that culture, but
commonly include the use of herbs and/or prayer to heal.
The significance of traditional healers in many poor peoples’ lives and the part they play in

2
Hope, Timmel & Hodze, 1984, cited in Underhill, C. Defining Moments: A Qualitative Enquiry into Perceptions of
the Process of Community Development Practice with Disabled People in Uganda (1996), pp 3

67
Chapter 9

A traditional healer treats a woman with a mental disorder in Ghana

diagnosing and treating mental disorders must be given due emphasis. Within the programmes,
relationships have been built with healers and in some cases a strong collaboration has
developed between the two parties. For instance, traditional healers have begun referring their
cases to a programme, attend meetings to share ideas and information and have introduced
new forms of treatment into their work. In turn, they have received support to gain more
recognition and to standardise their practice in ways such as keeping detailed records of the
people they treat. In developing a relationship, harmful and abusive practices such as chaining
people or beating them can also be raised and addressed.
“The nature of my treatment is purely spiritual. Sometimes when the patient is violent, I
make some herbal preparations and boil it. The patient bathes with it and it calms him
or her down. When my herbs are not readily available, I do send for medicines from Ti
Sampaa (Community Psychiatric Unit) to calm the patient down before I can commence
treatment. I don’t put my patients in shackles like other healers do. I don’t also charge fees
for my treatment, but sometimes after my treatment I ask for fowl, goats, cowrie shells etc.,
depending on what the gods might ask for.” (Mayiya Lansah’s - traditional healer - life story,
Ghana Programme, 2006)

68
 The People Involved

Partners
Effective partnerships help BasicNeeds run effective programmes. Partners increase the reach
of the model, complement and add value to the work and support its sustainability. Depending
on which aspects of the programme require partners any of the following organisational groups
could be approached:
• Community-based organisations
• Development organisations
• Community-based rehabilitation organisations
• Primary and mental health care providers
• Micro-credit organisations
• Training and educational institutions
• Self-help groups
• Government departments
Broadly, partners are split into two groups: implementation partners and resource partners.
Implementation (also called delivery or operational) partners are responsible for delivering one
or more of the modules of the model. Implementation partners tend to stay the same for the
duration of the programme and have a formal agreement with BasicNeeds, characterised by a
Memorandum of Understanding.
BasicNeeds works in partnership with Kamwokya Christian Caring Community (KCCC), a
community-based organisation, to implement its model of Mental Health and Development.
Previously, KCCC was already running similar health programmes for HIV/AIDS. One of the
activities in implementing the model is the support for regular mental health outreach
clinics. These are operated by KCCC, with the help of a Psychiatric Clinical Officer from
Butabika National Mental Referral Hospital. KCCC operates these clinics weekly … on every
Thursday. (Uganda programme, 2005)
Resource partners are responsible for activities such as training of staff, health care professionals,
and other people involved in programme implementation. The resource partners are used in
response to a specific need (usually training) and can change over the course of a programme.
As with implementation partners, Memorandums of Understanding are often agreed although
this does not occur across the board.
The programme worked closely with the Division of Mental Health, which continued to
resource the community mental health clinic and the Nairobi City Council, which hosts
the clinic and also provide back up support to the psychiatrist team through the Primary
Health Care workers. A couple of resource partners assisted BasicNeeds Kenya with various
tasks in the programme management module, which includes human resources manual,
media outreach and communications strategy development. (Kenya Programme, 2006)

69
Chapter 10

10 The Model’s Impact

Model Outcomes
• People with mental disorders have an improved quality of life
• The human rights of people with mental disorders are respected
• Gender inequalities amongst people with mental disorders are reduced
• Positive change is sustained for people with mental disorders
• People with mental disorders are visible in all spheres of life
• People with mental disorders are fully included

The last nine chapters have described what a model for mental health and development means
on the ground – what are the activities that take place, what do they achieve, who benefits and
who are the people that make it all happen?
This final chapter looks at the model as a whole and asks what drives it forward and what does
it leave behind?
A better quality of life for poor people with mental disorders
“We have become a happier family ever since we realised my daughter is responding to
treatment. Her ill-health was silent torment to all of us and we are happy to see she is
improving by the day. We wear happier smiles and our neighbours are closer to us than
ever before”. (Ghana Programme, 2008)
A huge motivation behind the model is improving the quality of life of people with mental
disorders. The cycle of poverty and illness sustaining each other is well documented. The model
seeks to break this cycle by addressing the issues that are part of the problem. So, people with
mental disorders are provided with the means to better manage and recover from their illness,
to pursue more sustainable livelihoods, and to feel increased acceptance in the community.
This approach ensures that the overall quality of life of people with mental disorders is improved
dramatically. Yet the work does not end there. Changes are also sought in society and the state

70
 The Model’s Impact

as a means of ensuring that the individual gains in quality of life achieved through specific
interventions can be replicated many times over benefiting whole populations.
Human Rights
“People visit this clinic and demand treatment and medication… they know that it is their
right to be treated. Challenges notwithstanding, we must continue to offer these services”.
(Kenya Programme, 2008)
People with mental disorders and who are living in poverty are often at the bottom of the pile.
They have been denied their human rights for too long. It is in direct response to this that the
BasicNeeds vision was born. A respect for and belief in human rights is therefore a fundamental
requirement for all those involved in the model, and is largely responsible for their motivation
and for driving its implementation forward. Everything that takes place within the model is
directly or indirectly working towards people with mental disorders achieving their human
rights, beginning with a basic level, but not ceasing until all their rights are met.
In some cases, there is a direct correlation between activities on the ground and the human
rights it is championing. For instance, an outcome of the sustainable livelihoods module is
that people have the right to work and to an education; community mental health supports
the right to an adequate standard of health and well-being; and capacity building strives for
people to participate, enjoy and be accepted by their community.
Other human rights are sought and achieved by the delivery of the programme as a whole;
the right to freedom of opinion and expression; the right to be free from cruel, inhuman or
degrading treatment; the right to life and liberty.
Addressing gender inequalities
“This time I brought our son for the quarterly review as I have decided to relieve my wife who
has been doing this all alone. It is time I also understood how things work here so that I can
be of help to her at home”. (Ghana Programme, 2008)
That the effects of mental disorders impacts differently on men and women is widely recognised.
Unequal power relations within a household can be, to some extent, neutralised when the person
with a mental disorder is a man and the woman assumes his responsibilities. However, women
more commonly experience disadvantage, with imbalances apparent in terms of the numbers
of men and women being diagnosed, accessing treatment and in care responsibilities.
Whilst it was never envisaged that the model would have gender inequalities as its primary
focus, all those working within a programme are aware of these issues and take active steps
to ensure that gender imbalances are addressed. The use of participatory methods helps to
redistribute power, and ensures that women have the opportunity to make their voices heard.
Women are targeted for leadership roles within a programme, which results in increasing the
self-esteem of the individual and demonstrates their capabilities to the wider community. The
traditional role of women as primary care-givers is questioned and men are actively encouraged

71
Chapter 10

to share this responsibility. Women are supported in the livelihood choices that they make, the
outcome of returning to productive work is valued as much as paid employment. Many self-
help groups are established specifically for women, through which they gain new skills and
autonomy. As a whole, the activities within the model contribute towards improving the rights
and status of women.
Permanence of change
“Government of India has agreed to provide diagnostic and treatment facilities locally for
all people with severe mental disorders in the next 18 months”. (India Programme, 2008)
Most would agree that facilitating change at a superficial level is straightforward and, conversely,
that it is relatively easy for a situation to return to its original state. Therefore, enabling enduring,
lasting change is an essential factor behind the model.
The causes of many issues that affect people with mental disorders are deep-seated and their
roots reach out well beyond the boundaries of the individual into the sphere of politics and
economics and into the society in which an individual lives. To sustain change, it is not enough
to only treat a persons’ illness; rather the problems must be tackled at its roots. The model
does just that and the result is positive change in the community, in wider society and in
government, change in the negative beliefs and attitudes that are held, change in the poor,
inhumane practices that are implemented and the policies that maintain them.
Becoming visible
“Previously, when a mentally ill person raised his hand in a meeting, he could never be
appointed to express his view. But things have changed nowadays; whenever I raise my
hand, I am instantly appointed to express my views”. (Tanzania Programme, 2008)
A further motivation for the model is concerned with raising the profile of people with mental
disorders. The model was structured in such a way as to be able to support large numbers of
people. Of course this increases the efficiency and effectiveness of a programme but there is an
additional consequence; that is an increase in the visibility of people with mental disorders. The
issues that they face become more public, people are aware that they can and do recover.
However, visibility is not only brought about by sheer numbers. People with mental disorders
are encouraged to be active participants in this quest. From their involvement in a programme,
they gain the confidence to speak out, to advocate for their needs and rights and to join
together to strengthen their voice. A more subtle but just as effective means towards visibility
is their presence in family and community life. It is often enough just to be witnessed by others
in going about one’s day-to-day life or taking part in local events. Some go a step further and
play a significant role in their community, as a community worker or member of a local council
for instance. The resultant impact is that people with mental disorders are seen, they are heard
and they have taken another step towards being included.

72
 The Model’s Impact

Inclusiveness
“Those days the neighbours called him a lunatic and said that his sickness could not be
cured. Now he does not faint or fall like those days. Now the neighbours do not tease
him. They love him as he too helps them. Now people are aware that mental illness can
be cured and that mentally ill people are a useful set of people in society”. (Sri Lanka
Programme, 2008)
The inclusion of people with mental disorders can perhaps be seen as the ultimate achievement
of the model and the culmination of all that has gone before.
If, when a programme draws to a close, it can be said that people with mental disorders are
now included in development processes; that they are now included in family and community
life; that they are now included in livelihood opportunities; then at an individual level the
model will have succeeded. If their needs are taken into account when resources are allocated,
when policies are written, when strategies are developed; then the possibility of the sustained
inclusion for people with mental disorders becomes real.

73
List of BasicNeeds publications from which excerpts have been taken

Date Name of document

2001 Ghana Feasibility Study
2002 Animation training, South India
2003 BasicNeeds Sustainable Livelihoods Policy Paper
Gunasiri Life Story, Northern Ghana
2004 Fati Abukari’s Life Story, Ghana
Lallappa’s Life Story, India
Participatory Workshops for Participatory Research, Sri Lanka
Process Document, South India
2005 Beatrice Amongin Life Story, Uganda
Evaluation, Uganda
We Count Issue 1, Ghana
Yallava’s Life Story, India
2006 6 Monthly Report, India
6 Monthly Report, Sri Lanka
6 Monthly Report, Uganda
Atagona Kwame Life Story, Northern Ghana
Baseline Study, Kenya
BasicNeeds Six Monthly Review
Evaluation, South India
Internal Evaluation, Tanzania
Internal Review, South India
Mayiya Lansah’s Life Story, Ghana
PMS Newsletter 47, Northern Ghana
Programme Evaluation, South India
Quarterly Report, Ghana
Quarterly Report, Kenya
Quarterly Report, Northern Ghana
Sustainable Livelihoods training, Uganda
2007 Consolidated Report, Policy and Practice Directorate
Documentation Training Report, India
Eunice Wangeci Life Story, Kenya
Hakmany’s Life Story, Lao PDR
Jayantha Gunesakara’s Life Story, Sri Lanka
Laiza Jofrey’s Life Story, Tanzania
Mariappa’s Life Story, India

74
 Mental Health and Development in Sri Lanka: Changing Attitudes
and Practical Approaches to Social Integration, Evaluation Report
Nav Bharat Jagriti Kendra Visit Report, India
Pathirathne’s Life Story, Sri Lanka
Project Management Systems Newsletter 59
Project Management Systems Newsletter 61
Project Management Systems Newsletter 64
Process Document, Focus Group Meeting, India
Process Document: Participatory Review Meeting with
people with a mental Illness, carers and people suffering epilepsy
in Damongo and Larabanga, Ghana
The way I have recovered, BasicNeeds/Actionaid International India
2008 Ghana Programme Impact Self-Assessment Report
India Programme Impact Self-Assessment Report
Kenya Programme Impact Self-Assessment Report
Sri Lanka Programme Impact Self-Assessment Report
Tanzania Programme Impact Self-Assessment Report

75
To find out more about the Model for Mental Health and Development or about BasicNeeds

BasicNeeds BasicNeeds
158a Parade, Policy and Practice Directorate
Learnington Spa, 114,4&Cross, 1" Floor,
Warwickshire. OMBR Layout, Banaswadi,
CV32 4AE. Bangalore, 560 043
England India
Phone: +44 (0) 1926 330101 Phone: +91(0)80 2542 8235
Email: info@basicneeds.org Email: info.ppd@basicneeds.org