By Robert van Voren, May 26th 2009
You only have to walk the streets in a city in Vietnam to realize that the country is undergoing massive change. An endless stream of motorbikes encircles you, like bees rushing out of a beehive, honking almost permanently as if disturbed in their laborious activity. It is not only in the streets that they haunt you, threatening to sting you with the everlasting humming of their engines, but even on the sidewalks you are not safe. A woman crouching on her heels while preparing food for the family is angrily disturbed by a swarm of motorbikes that try to find a way out of the traffic jam. It is exhilarating, but after a few days it becomes maddening, and eventually you want to hide your head in the cushion when the honking enters your room through the windows at five o' clock in the morning.

And this is only a transitional phase. The country is booming since the Communist regime adopted market economy principles in the 1990s, mixing communist slogans with capitalist advertisement, and creating an exciting mix of austerity and abundance. In the streets it is hard to see how the regime manages to exercise its control, it seems communism has turned into a façade that all accept because it allows them to mind their own business. However, the Party is still omnipresent, limiting freedom of speech wherever and whenever it sees fit, trying to control society when progress is rocking its very foundations. To be honest, Ho Chi Minh would probably have an imminent heart attack if he saw what came of his communist ideals, yet the Vietnamese seem to revere him as a deity, a modern Buddha, while at the same time enjoying capitalist life he so much despised.

In mental health, though, things are less booming. It is the general picture, almost a boring one: society changes, mental health is lagging behind. It is a combination of the lack of interest in mental health as a priority, the stigma that the field still surrounds, and the detached state of the psychiatric establishment. Somehow it tends to find itself in the most secluded part of the ivory tower: the world changes, and psychiatry seems untouched. When entering the big psychiatric hospitals, it is almost if one returns to traditional psychiatry of thirty years ago, or to Soviet psychiatry, before the disintegration of the Soviet regime made communism a redundant entity. The hospitals are clean, a big difference from what we usually encounter in (post-) Soviet states, yet the over-dosaging of patients with haldol and aminazine, the excessive use of electroshock, the tying of patients to their beds – all these are daily facts of life. They are a disturbing sign, that spoil the imagine of a well-contained psychiatric environment, and show that much of the tranquility is not the result of patient-oriented care but staff-oriented control through medication.

Still the general picture in Vietnam mental health is not only disturbing, it also gives reason for hope. There are many people – actually the majority – who agree that something needs to change, that Vietnamese mental health does not provide adequate services who need it, that community mental health is virtually non-existent and that whenever in place it mainly provides drugs, nothing else. There is no active relative associations yet, but stigma is considered an issue and when awareness starts to develop it is quite possible that within the foreseeable future such organizations will start to appear. Also, there are some very interesting initiatives in the field of child and adolescent mental health, and although these concern usually paid services, they are run by bright and enthusiastic people who are keen to make a change. It is probably the young generation that needs to be targeted, and that will become the motor – or motorbike – of reform.

All in all, GIP is keen to become involved in Vietnamese mental health care development, and the main constraint will not be the number of areas in which work is needed and possible, but the financial limitations. Donors are still quite reluctant to invest in mental health, and mental health in Vietnam is – like elsewhere – not seen as a priority. For GIP this is nothing new, so will not be a deterrent. One step at a time.