Each year, one out of every four people worldwide experiences at least one diagnosable mental health problem and an estimated 450 million people already suffer from mental health disorders. It’s numbers like these that lead experts to agree that mental illness and neurological disorders have become the leading cause of disabilities and suffering around the globe. And in Vietnam, with so few mental health professionals, most mental illnesses are mishandled, if they’re handled at all. Cultural stigmas, misperceptions, and poor management leave many mental health professionals and their patients in Vietnam fighting an uphill battle. By Chris Mueller. Photos by Fred Wissink.

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It didn’t take long for Le Thi Phuong Nga to realise something was wrong with her son. He was sick, that was clear, but it wasn’t like anything she had seen before. In desperation she brought him to a Swiss doctor working in Ho Chi Minh City at the time.

“He told me straight away that my son was autistic,” Nga says. “I asked him, ‘What is autism?’ And he pointed to my son and said, ‘That is autism.’”

The doctor warned Nga that if she stayed in Vietnam her son, Nicky, would have a very difficult life, suffering from a disorder that made it nearly impossible for him to communicate or even do simple tasks like eating.

This was in the late 1990s, when few in Vietnam knew what autism was, and even fewer knew how to treat it.

Nga had already lived in the United States before Nicky was born and she feared he couldn’t handle the move. So instead, she packed her bags and headed to Pennsylvania on her own for the first of many courses she would take over the next six years that would teach her how to care for her son properly.

Now Nicky is 15 years old. He still has communication problems, but is almost entirely independent. The experience has changed his mother, too. Over the past 13 years, she has been teaching Vietnamese parents how to take care of their autistic children’s needs at home. Many of these parents are referred to Nga because they don’t know where else to go and doctors have let them down.

She says it used to take months to convince parents their children weren’t afflicted by some curse, but had a problem that with time and work could be treated. Most people who come to her now are very open and willing to learn.

“Parents are starting to have the right attitude and understand that this is a sickness that can be improved, not a punishment from some god or bad luck,” she says.

Mental Health Care in Vietnam Cultural stigmas, and poor management leave many mental health professionals and patients fighting an uphill battle‘Parents are starting to have the right attitude and understand that this is a sickness that can be improved, not a punishment from some god or bad luck’

Le Thi Phuong Nga, mother of an autistic child

Nga, Nicky and the workshops have been featured in dozens of local newspapers and magazines, something she says has started to change the way people view mental illnesses and developmental disorders in Vietnam.

Nga says that many of the parents who come to her workshops do not understand the disorder at all. Either they have stigmatised their own children already for fear of losing face, or their neighbours have done it for them.

“A lot of parents feel ashamed of their own children,” she says. “Very few can overcome it and they try to hide their kids, making it worse.”

While some argue that autism is not actually a mental illness, but a developmental disorder, most agree that it is still a mental health issue. People with autism also tend to be vulnerable to other problems like anxiety and depression.

Either way, autism illustrates the problem Vietnam faces: Stigma and misconceptions still plague the mentally ill.

The hidden burden
In any given year, an estimated 15 percent of the Vietnamese population has a diagnosable mental disorder, and about 2.7 million Vietnamese have severe disorders, according to the Vietnam Veterans of America Foundation (VVAF), which develops community-based mental health projects in Vietnam.

There are very few thorough studies about the state of mental health care in Vietnam, and those that are available paint a grim picture. In one of only two studies published about maternal health in Vietnam, 33 percent of women at general health clinics in Ho Chi Minh City were found to be depressed and of them, 19 percent had suicidal tendencies, according to Thao Griffiths, the Vietnam country representative of VVAF.

Vietnam certainly isn’t the only country to suffer from high rates of depression. The World Health Organisation ranks it as the most burdensome health condition globally, more so than AIDS and cancer. It is the leading cause of disability worldwide, affecting 350 million people.

But Vietnam is a complicated place for treating and understanding depression, says Bente Sternberg, a psychotherapist who has been working in Vietnam for 10 years. War, famine and poverty left many in the older generation scarred, choosing to deal with depression or post-traumatic stress the same way Vietnamese always have: with support from family. Of course, that didn’t always work.

“Vietnam had a ‘life is hard, live with it or get over it’, way of dealing with mental illness,” says Dr Carl Sternberg, a psychotherapy consultant, a clinical psychologist and Bente’s husband.

But things are different in modern Vietnam. Younger generations were born into a world free of war and starvation. The economy has slowed in recent years, but its previous boom encouraged many young Vietnamese to migrate to the cities to attend university, find a job, or do both. As more Vietnamese are leaving home, the safety net of the family is disappearing.

Bente says anxiety or stress from work or school while being so far away from that support network is now the leading cause of depression among young Vietnamese.

Living with ambiguity
It’s not just Vietnamese who are struggling with mental health in Vietnam, but expats as well. For many, a new job in a foreign land can lead to a number of problems for a working spouse or his or her family. Carl calls anxiety one of the most common problems among foreigners.

Mental Health Care in Vietnam Cultural stigmas, and poor management leave many mental health professionals and patients fighting an uphill battle‘[Expat] spouses give up friends and comfort. They find themselves in a vacuum, feeling empty and trying to find meaning’

Dr Carl Sternberg, clinical psychologist

He says that spouses sent here by their employers are required to work at such high levels, for so many hours, and in such a state of ambiguity — not understanding the culture or language — that a lot of the time they burn out.

“Stress is cumulative,” he says. “It’s like a water bottle being squeezed until there is no room. Then it blows its top.”

For the non-working spouse, too, problems can arise. Many are thrown into the country without a proper support network, Carl says. “Spouses give up friends and comfort. They find themselves in a vacuum feeling empty and trying to find meaning.”

And in today’s struggling global economy, it’s not easy to give up a good job and relocate the entire family back home. Instead, many expats turn to alcohol or extramarital affairs, which in turn can take its toll on the entire family.

But mental health treatment has come a long way in the western world, and expats are more likely to seek out help than hide their issues.

For Vietnamese, however, it’s not as easy.

Diagnosing the problem
Bahr Weiss, an American psychologist working in Vietnam, recalls once working with a Vietnamese man who had been diagnosed with schizophrenia, one of the more commonly treated mental illnesses in Vietnam.

When the man was 18, the woman he had fallen in love with left, and he became heartbroken and obsessed. He went to a doctor, was quickly diagnosed with schizophrenia, and received a prescription for anti-psychotic medication. He took the drugs for 15 years, causing him to become severely depressed and barely able to function. After a recommendation, the man went to another doctor, who immediately recognised he had been misdiagnosed. He took him off the medication and the man quickly improved.

Overmedication and misdiagnosis is not unique to Vietnam. But, Weiss says, the problem is the number of people in the country who practice mental health, prescribe medicine and give treatment without relevant training.

“One of the reasons mental health is more difficult is because what you do with things like psychotherapy is talk to someone and help them change,” he says. “Then someone sees [the therapy] and thinks all that is being done is talking, and they try to do it. They don’t understand the complexity of it. They wouldn’t think that with other medical fields, like surgery.”

Despite the unlicensed treatment centres that are popping up, especially in Hanoi, Weiss says there are a growing number of well-trained Vietnamese doctors and psychologists who are providing excellent care.

It’s just not enough.

Right now there are only an estimated 0.32 psychologists for every 100,000 people in Vietnam, compared with 13.7 in the United States and 11 in the United Kingdom, according to a 2010 report about mental health in Vietnam.

That’s where organisations like Learning Strategies are trying help. Learning Strategies, in Phu My Hung, Distirct 7, specialises in educational and behavioural support programs for families and schools in Asia. Here they not only focus on tailoring sessions for each client or child, but also run workshops aimed at educating Vietnamese professionals about mental illness and how to treat them.

It’s also not as bad as many think, says Tony Louw, the managing director and founder of Learning Strategies. He says that in his experience Vietnamese have a very open attitude towards disabilities, and he’s seen a huge improvement with mental health care in Vietnam. In Ho Chi Minh City alone, there are now 20 special needs schools and the amount of government investment in them is high.

“I think there is a stigma about the stigma,” he says. “A lot of the time westerners project their ideas on Vietnamese. There needs to be local cultural knowledge built into it.”

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