When mindfulness goes mainstream
There are nowhere near enough psychiatrists, psychologists, and other professionals in the Philippines to deliver mental health care, and the cost of drugs is prohibitively high for most of the population. The result is that except for severe psychosis in major cities, mental illness (particularly depression) goes untreated, with the consequent human cost and suffering.
There are two fundamental strategies for making treatment more accessible. The first is to use paraprofessionals (the mental health equivalent of barefoot doctors); the second is to leverage their work through group psychotherapy. These strategies address the issue of cost. Then the question is which, among the competing modalities (e.g., interpersonal therapy, CBT, mindfulness-based cognitive therapy) should you focus on? This is the subject for intense research globally.
We obviously believe mindfulness-based therapies will be a significant part of the solution. A steady flow of meta-analyses has been documenting their efficacy. And we have been training MBCT facilitators of all kinds for several years, including front-line workers in social service agencies; we have found that relatively modest training, coupled with a strong personal practice in mindfulness, can create effective leaders for group MBCT. (Interestingly, Grand Challenges selected our project in a peer-reviewed global competition, implicitly recognizing that mindfulness-based therapies are becoming solidly mainstream.)
A sound intervention is one thing; now you need an organization to deploy it through. What do you do if there is no mental health care in the formal health system, as is the case in the Philippines — in the typical community health centre there is no mental health expertise, and no ability to prescribe psychoactive drugs. This is, in fact, an opportunity. There is no a priori reason to associate the treatment of mood disorders (for example) with a medical system that is not equipped to help. An alternative is to create a new specialist organization.
So, the shape of our project, which we are executing with our excellent partners in Manila, the Bulatao Center for Psychology Services at Ateneo de Manila University, is as follows. First, re-shape our standard MBCT course to fit with local cultural norms and practices, and translate the materials into Tagalog. Second, create a training capability at the Bulatao Center (this already started with the training team from the “Bu Center” attending Zindel Segal’s 5-day intensive at the Centre last month, and continues next year when our project team travels to Manila). Third, train a cadre of paraprofessionals, and run a randomized clinical trial of MBCT involving 200 kids drawn from a relatively depressed area of Manila, screened for some level of psychological stress.
But this is just Stage One. The idea, in Stage Two, is to create a country-wide social enterprise, a franchise operation, with maybe 1,000 community-based clinics, ultimately, serving the population of 100 million. This gives us the opportunity to shape public awareness and opinion around mental illness, through the creation of a strong brand identity for the new organization. We will need investors for this, and they will have to be convinced that it is a sound business proposition. We will therefore run a model clinic, similar in its offerings to the Centre for Mindfulness Studies, where we can find out whether demand exists for such services (where the price depends on ability to pay), and this will give us the data we need to create a business prospectus, laying out the opportunity in a clear dollar-and-cents way.
It may seem a stretch for an organization like ours to concern itself with building a mental health care organization in a faraway country. It is, of course, but the payoff for us is the way it forces us to re-think what we do, and to build more rigour into our courses and treatment protocols.
We will post more in our blog as the project unfolds.
– Tita Ang-angco, Executive Director
Centre for Mindfulness Studies