Reverse Innovation: Adapting the Basicneeds Model for Mental Health and Development In

REVERSE INNOVATION: ADAPTING THE BASICNEEDS MODEL FOR MENTAL HEALTH AND DEVELOPMENT IN THE UNITED STATES

The BasicNeeds Model has the potential to enhance community collaborations and empower those affected by mental illness in fragmented, resource-poor

systems of care throughout the U.S.

BasicNeeds is excited to share our plans to adapt and implement the BasicNeeds Model for Mental Health and Development to address mental health and community development needs in the United States. In partnership with Innovations in Healthcare at Duke University, BasicNeeds is nearing completion of a 15-month feasibility and implementation planning study funded by the Charities Aid Foundation of America Donor-Advised Fund of the Robert Wood Johnson Foundation. The study has laid a solid foundation for U.S. implementation – one that not only demonstrates a clear need, but also embodies an articulate and realistic plan, strong partnerships, and highly qualified and committed leaders.

Like many nations around the world, the U.S. struggles with the cost, access, and effectiveness of mental health care. According to the Substance Abuse and Mental Health Services Association (SAMHSA), in 2014, 18 percent of adults (42.5 million individuals) reported experiencing any mental illness, and 4.2 percent (10 million individuals) reported having serious mental illness.[1] It is estimated that less than half of individuals living with serious mental illness in the U.S. access the care they need.[2] The U.S. mental health delivery system, its workforce, and the funding that supports it are insufficient to resolve this gap.[3],[4] The situation calls for a comprehensive, coordinated and cost-effective approach that builds on the skills and resources already existing in communities – placing empowerment, expansion of capabilities, opportunities and choice at its core. BasicNeeds’ innovative, community-based solution has significantly improved the lives of people living with mental illnesses and their families in 12 low- and middle-income countries in Africa and Asia. Many mental health professionals in the U.S. are keenly interested in applying the approach to address similar issues in the U.S.

BasicNeeds’ U.S. Implementation Plan features the development of a network of partner organizations with the capacity and commitment to deliver the BasicNeeds Model for Mental Health and Development at the community level. As a first step to developing the network envisioned, BasicNeeds will pilot implementation in urban a rural sites. The experience acquired and lessons learned through the pilots will support the development of the training curriculum and materials for a network of BasicNeeds members across the U.S.

Detroit, Michigan has been selected as the first pilot site. The City of Detroit faces significant challenges in addressing the mental health needs of its residents, many of whom are poor and/or unemployed. The population of Southwest Detroit is 44,000 with an estimated five percent living with serious mental illness. BasicNeeds’ community development approach is well suited to Detroit because officials there are progressive, sensitive to the need to address the social determinants of health, and understand that community organizing is necessary for community development. Detroit also has many other assets that indicate an environment ripe for the BasicNeeds Model.

BasicNeeds US is based in Lexington, Massachusetts and is taking the lead in identifying, developing and training local community organizations in implementing the BasicNeeds Model in Detroit and other U.S. communities. To accomplish this, BasicNeeds US is working with BasicNeeds UK and will draw on the skills and experience of BasicNeeds’ international partners to deliver trainings enriched by the field experience from other countries.

Southwest Solutions (SWS), a mental health care provider in Southwest Detroit, is taking the lead role in implementing the BasicNeeds Model in their community as the local member organization for the Detroit pilot. Southwest Solutions is a well-established community development organization dedicated to addressing a full range of social determinants of health for its constituents in Southwest Detroit. SWS has committed to becoming a flagship member of the BasicNeeds network in the U.S., participating in development, training, and implementation activities, and enlisting support from other local partners and stakeholders.

The plan for the Detroit implementation calls for heavy involvement of BasicNeeds early in the development and training of SWS. Over the course of 3 to 5 years, BasicNeeds’ role diminishes and becomes limited to quality assurance, periodic training, and mentoring, as SWS builds capacity and applies its training to implementing the Model. At that time, SWS will have adopted the approach and absorbed implementation costs into their ongoing operations, making implementation sustainable without continued philanthropic funding.

Based on planned partnerships for Detroit, we expect the approach to be cost-effective. During the pilot phase, we intend to measure the impacts and develop a more comprehensive business plan that addresses scale up, which will include another pilot site, as well as bringing more sites into the U.S. network of BasicNeeds member organizations. Initial funding for the Detroit Pilot will focus on grants, philanthropy, and government agencies. Once the approach demonstrates effectiveness and begins scaling up, other reimbursement and revenue sources will likely come into play. We believe that we can attract interest from hospital systems and health plans.

In addition to addressing funding needs related to implementation of the BasicNeeds Model in Detroit, the effort will involve coordinating an array of service providers, government agencies, and consumer groups - organizations that do not have a strong track record of collaboration. This process is underway in Detroit with positive responses and support from government partners, private hospitals, consumer organizations, and other stakeholders.

BasicNeeds is knowledgeable about existing U.S. systems of mental health care and how they differ from the fundamentals of BasicNeeds’ approach. We are sensitive to the challenges of bringing a collective empowerment process to an individual service-oriented system of care, but we are finding that the approach resonates with many stakeholders. In particular, SWS and other potential partners in Detroit understand the importance of this distinction, and the team will build on its strengths in working with other stakeholders in making this shift in thinking.

With a realistic understanding of the challenges ahead, a thoughtful plan in place, strong partnerships, and highly qualified leaders, replication of the BasicNeeds Model for Mental Health and Development is well positioned for implementation in the U.S.

Members of the Steering Committee and Advisory Board in Washington, DC, April 2016

[1] Substance Abuse and Mental Health Services Administration. Behavioral Health Barometer: United States, 2014.

[2] Parity or Disparity: The State of Mental Health in America, Mental Health America, 2015.

[3] Mechanic, David, Removing barriers to care among persons with psychiatric symptoms, Health Affairs vol. 21 no. 2 p. 137-147, May 2002.

[4] Sundararaman, Ramya. The US Mental Health Delivery System Infrastructure: A Primer, Congressional Research Service, 2009.