Mental health literacy at the public health level in low and middle income countries: An exploratory mixed methods study in Vietnam.

PURPOSE: Mental health literacy (MHL) is key for mental health development, particularly in low-and-middle-income countries (LMIC) where mental health resources are limited. MHL development can be thought of as occurring at two levels: the individual person level (via direct contact, with specifically-targeted individuals), and the public health level (via indirect contact through public media, targeting the general public). Each approach has advantages and disadvantages. METHODS: The present mixed methods study assessed the status of and best approaches for development of mental health literacy in the Southeast Asian LMIC Vietnam. Because there has been relatively little discussion of MHL development at the public health level, this assessment focused on the public health level, although not exclusively. Because mental health professionals generally have the most in-depth understanding of their mental health system, study participants were 82 Vietnamese mental health professionals who completed a quantitative survey, with 48 participating in focus groups. RESULTS: Most of the professionals viewed MHL in Vietnam as low or very low, and that it was difficult or very difficult for the general public to find effective mental health services. Main barriers underlying these problems and more generally for developing MHL in Vietnam identified in the focus groups were: (a) misinformation in the media regarding mental health and mental illness; (b) lack of licensure for non-medical mental health professionals (e.g., psychologists; social workers); (c) lack of interest in mental health from upper-level leadership. CONCLUSIONS: To the best of our knowledge, this is the first study assessing professionals' perceptions regarding mental health literacy at both the public health and individual-person levels. Although sampling was restricted to Vietnamese professionals, results may provide initial preliminary guidance for other LMIC considering mental health literacy development at multiple levels.

Urbanization, and child mental health and life functioning in Vietnam: implications for global health disparities.

PURPOSE: Urbanization is linked to increased health risks, including mental health. However, the large majority of this research has been conducted in high-income countries, and little is known about effects in low-and-middle-income countries (LMIC) where urbanization is occurring most frequently and most rapidly. Within global mental health, children and adolescents are a critical but understudied population. The present study assessed relations between urbanization factors, and child mental health in Vietnam, a Southeast Asian LMIC. METHODS: Most studies investigating urbanization and mental health have used geographically based dichotomous urban vs. rural variables. Because of significant limitations with this approach, the present study assessed parent-reported urbanization factors (e.g., pollution, crime). In Sub-study #1 (cross-sectional), 1314 parents from 10 Vietnam provinces completed the Urbanization Factors Questionnaire, Child Behavior Checklist (mental health), and Brief Impairment Scale (life functioning). In Sub-study #2 (longitudinal), 256 parents from one highly urban and one highly rural province completed the same measures, at three timepoints across 12 months. RESULTS: Cross-sectional canonical correlations identified relatively small (e.g., R2 = 0.08) but significant relations between urbanization factors, and child functioning. Parallel analyses using a geographically defined urban vs. rural variable did not produce significant results. The large majority of longitudinal relations between the different urbanization factors and child functioning were non-significant. CONCLUSIONS: This study, among the first to assess urbanization as a multi-dimensional continuous construct in relation to child psychopathology, highlights the value of the use of an urbanization factors approach. A new "urbanization factors differentials" theory is proposed to suggest how effects of urbanization factors might result in global health disparities.

Development of Clinical Psychology and Mental Health Resources in Vietnam.

In this paper, we discuss development of the Vietnam National University graduate Clinical Psychology Program, which has the goal of training both Vietnamese researchers who will develop and evaluate culturally appropriate mental health treatments, as well as Vietnamese clinicians who will implement and help disseminate these evidence-based treatments. We first review the background situation in Vietnam regarding mental health, and its infrastructure and training needs, and discuss the process through which the decision was made to develop a graduate program in clinical psychology as the best approach to address these needs. We then review the development process for the program and its current status, and our focus on the schools as a site for service provision and mental health task shifting. Finally, we outline future goals and plans for the program, and discuss the various challenges that the program has faced and our attempts to resolve them.