‘If we lose our friends, we’re done’: mental health and psychosocial wellbeing

amongst children and young people in Viet Nam

Fiona Samuels

Objectives to study

• What is the prevalence of mental health and psychosocial problems, including suicide among Vietnamese children, adolescents, and youth?

• Which factors in the Vietnamese context place children, adolescents, and youth at risk and which factors act as protective factors for mental health and psychosocial problems?

• What laws and policies exist around mental health and psychosocial wellbeing in Vietnam?

• What are the existing mental health & psychosocial service provisions and programmes for children, adolescents, and youth in Vietnam?

Methodology

• Literature review – regional and national

• Primary qualitative data collection - Hanoi, Ho Chi Minh City, rural and urban/peri-urban areas of Dien Bien (north) and An Giang (south);

• Two internationally validated scales for measuring wellbeing: Strengths and Difficulties Questionnaire (SDQ) and the Self-Efficacy and Resilience Scale with school children

• Respondents included service providers, adults, children and young people (total of 110 individual respondents)

Vietnam context

• Rapid economic boom since the 1980s - socialist to market economy

• Growth largely limited to physical infrastructure,

• Rapid change, pressure on families, emotional distress, large disparities in access to health and other social services

• Literature tells us general mental health problems range from 8% to 29% for children and adolescents

• Common mental health problems among children - internalising (anxiety, depression, loneliness) & externalising (hyperactivity, attention deficit issues)

• Poverty, migration, family separation as causes of mental ill-being, not strong themes in the secondary literature which tends to be highly medicalised.

Perceptions around mental health and psychosocial wellbeing...

• Psychosocial and mental health problems widespread and increasing...

• People were seen to be ‘unknowledgeable’, ‘negative’, ‘different’ ‘their way of thinking is different’, they have some kind of ‘disease’, are ‘an exception’, or are ‘unstable’.

• Stigma, although declining, persist, especially ‘inward’ stigma…

• Narratives around ‘social evils’ heard...

• Feelings optimism about the future vs sadness, worry, anxiety…

• Emotional disorders, including depression and suicide (girls/young women)

• Somatic complaints - headaches, loss of appetite, nightmares; substance abuse – alcohol, smoking and drugs (boys/young men)

‘There are more girls among those who commit suicide and do harm

to their bodies like chopping their hands or confining themselves, as

girls are more sensitive to their emotional issues. Their hearts are

easy to be hurt, meanwhile boys are more steadfast and calmer

when encountering a problem’.

Focus group discussion, boys, 17, An Giang

Risk factors for mental health and psychosocial wellbeing...

• Individual level - isolation / self-isolation, early marriage, school drop-out, burden of domestic tasks, access to modern technology / addictive online behaviours (boys); negative perceptions of physical appearance

• Household level - restrictive family rules, parental control, poor/declining household socio-economic status, intra-household tensions, early marriage, parental migration

• School level – academic stress, inadequate support, bullying, being away from the family, romantic relationships

• Community level - harmful norms (mostly north), easy availability of substances, limited economic opportunities

‘Overall I just stay silent, I don’t dare say anything. I also cry, but overall, I just try to finish the work, and then go up to my room and sit alone in silence, feeling sad, and lying in bed crying; I don’t know what else to do’.

In-depth interview, girl, 19, Hanoi ‘I’m very sensitive, so being made fun of by other people affects my feelings the most’.

In-depth interview, boy, 13, Hanoi

‘Girls are forced to drop out to work, marry men they don't love, [are subject to] wife kidnapping, though that is not as commonly practiced anymore’.

Focus group discussion, boys, 15, Dien Bien Phu city

Protective factors / coping responses...

• Individual level - leisure activities, friends, peers, role models, supportive adults; negative – crying, substance abuse, vandalism, suicide ideation

• Household level – better off households, family connectedness/healthy emotional relationships

• School level – school counselling units, life-skills education, peer support, supportive teachers

• Community level – appropriate services, supportive community members

‘Most of [the] teachers at this school listen to us. Teachers are also psychological doctors’ .

Focus group discussion, girls, 16, Ho Chi Minh City

Mental health service provision in Viet Nam

• Three ministries involved

• Ministry of Labour and Social Affairs - social welfare (less severe mental disorder, emotional distress, depression) and social protection centres (severe mental disorders); hotlines; cash assistance provided

• Ministry of Health – mental health hospitals (few towns/cities), community mental health programmes (now stopped)

• Ministry of Education – school counselling units, life-skills education (parenting skills)

• Fledging NGO programmes, mostly in cities, integrated into other programmes

• Informal provision – herbal medicines, shamans, family...

Challenges in service provision – supply side

• Lack of qualified, sufficient and gender-appropriate human resources (esp. counsellors, psychologists, focusing on children/young people)

• High levels of stress, overburden – because few in number and nature of treatment necessary

• Mental health undervalued area relative to other health areas, stigmatised

• Infrastructure is limited – none, poor conditions, no privacy...

• Limitations in coordination among government departments

‘A psychiatrist is always at a disadvantage, because taking care of normal people is already hard work, let alone taking care of this type of patients; we have to care for them day and night, even when they have a fit…’

Psychiatric Hospital, Dien Bien.

Challenges in service provision – demand side

• Limited awareness of mental health and psychosocial related complaints

• Even when recognised, people would rather manage at home, often leading to negative outcomes - late treatment, suicide

• Stigma related to mental health and psychosocial related complaints while declining, still remains high.

‘Mental illnesses are extremely difficult to cure; they can only be

stabilised. Whether it takes a short or long time depends on

whether they take medication regularly or not. Their families get

disheartened. They (people) are poor, and once broke, they don’t

have any more money for treatment’

Psychiatric Hospital, Dien Bien.

Policy and practice recommendations

• Strengthen quality & quantity of human resources with appropriate budget - esp. counsellors, psychiatrists, psychologists, for children/young people

• Increase awareness around psychosocial wellbeing / needs especially the role discriminatory gendered norms (e.g. early marriage) can play

• Support parents with parenting, caring and communication skills training

• Improve infrastructure, capacity, conditions...

• Improved coordination between ministries and service providers

• MOET important champion - reduce academic work pressures, increase in life-skills education, provide parenting skills

Final thoughts...

• Mental health is highly medicalised, very limited services nor time to deal with less severe mental health ill-being and psychosocial issues

• Mental health disorders are associated with autism, leprosy, schizophrenia... depression, sadness, people ‘just have to deal with it’

• Children and young people (everyone) increasingly facing a range of stressors, and are keeping quiet or turning to social media...

• Need to put the ‘social’ back as without an awareness of this, these kinds of everyday stressors will continue and affect multiplying and far reaching effects...