ReviewMental health in Vietnam: Burden of disease and availability of services
Introduction
Beginning in 1986, Vietnam initiated an economic and social reform program called Doi Moi. The main policies of this program were de-collectivization of agriculture, trade liberalization, attracting foreign direct investment and privatization of state-owned enterprises. Thus far, Vietnam has made considerable progress in the economic and social well-being of the population. These accomplishments were the subject of remarks by the World Bank: ‘Vietnam's poverty reduction and economic growth achievements in the last 15 years are one of the most spectacular success stories in economic development’ (World Bank, 2008). Nevertheless, the Doi Moi program has also had some negative side effects, such as larger disparities in access to social and health services among different geographical regions and income groups. These negative effects have been found especially among those who are less successful in the new market economy (Beresford, 2008, WHO, 2005, Adams, 2005). Accessibility to health care services is partly hampered by official and unofficial payments for health services and pharmaceuticals, and private out-of-pocket spending may represent as much as 75% of total spending on health care (Witter, 1998, World Bank, 2004, Dao et al., 2008). Increase in drug and alcohol use, as well as other social stressors have been found to be consequences of the Doi Moi (Hoblyn et al., 2009, Volkow, 2009, Martin et al., 1996, Boyle and Offord, 1991). Moreover, Vietnam had to live through three major wars in the last century, which has had an impact on both the burden and provision of MHS in Vietnam. The aim of this paper, therefore, is to understand the burden of mental disorders and availability of MHS since the implementation of the Doi Moi policies.
Section snippets
Methods
We reviewed national as well as international literature regarding MHS and mental disorders in Vietnam by searching academic literature on PubMed, Medline using the following key words or combinations of key words: mental disorder; epilepsy; psychiatry; mental health (service) and Vietnam. Unfortunately; the body of academic literatures is still very limited. To fill in this gap, we also searched for grey national and international literature, including government reports; WHO reports and mass
Mental disorders in Vietnam
Mental disorders make a substantial contribution to the illness burden in all countries. According to the World Health Organization's World Mental Health Survey Initiative conducted in 17 countries, the highest lifetime prevalence of mental disorder (DSM-IV) occurred in the USA (47.4%) and the lowest in Nigeria (12.0%). The Asian countries had relatively low prevalence ranging from 13.2% in China, 14.4% in Iran to 18.0% in Japan (Kessler et al., 2007, Fakhari et al., 2007). In Vietnam, mental
Policy and legislation
Although Vietnam does not have an explicit mental health law, the 1989 Law on Protection of People's Health recognizes and affirms that all people have an equal right to health care and treatment. It protects certain rights of the mentally ill by explicitly stating the conditions in which a doctor must get a relative's consent before beginning treatment and conditions in which involuntary treatments are permitted.
Mental health policy has since 1998 been declared as one of the main targets of
Discussion
Although research on prevalence of mental health disorders in Vietnam is increasing, there is still a need for comprehensive epidemiological studies on the prevalence of mental disorders. Available evidence indicates that mental disorders are very common conditions and their prevalence rates are similar to those of other Asian countries. They also occur across all population groups.
There are efforts to promote equity of access to MHSs through an integrated approach supported by the CBMHP (part
Conclusion
The provision and accessibility of MHS in Vietnam was considerably improved over the last decade. However, the care demand of persons with mental disorders has not yet been met and the illness burden remains high. The CBMHP needs to be expanded to include more mental disorders and cover more people. In addition, the capacity of MHS needs to be increased by diversifying specialized services and by educating and training more human resources. Lastly, our review signals the need for more
Acknowledgements
The authors would like to thank Thomas J. Barrett (University of Denver, USA), Atieh Novin (John Hopkin University, USA), Julia Kimmerle and two anonymous reviewers for valuable comments on an earlier draft of this paper. Any remaining errors are the responsibility of the authors.
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