Over tea, I talked to Chris Underhill, a man who is what the non-profit world calls a ‘serial social entrepreneur’. In an email, he joked about the slightly quirky location where “quite a few of the members are even older than me!” He was 65 himself but he worked with the energy and passion of a recent graduate – with the wisdom of a life time in charity around the world thrown in.
Chris has spent almost four decades or his professional life helping society’s most vulnerable. He launched his first organisation before he was 30 and soon dedicated himself to supporting people with disabilities. It ultimately led him to found BasicNeeds, a mental health charity that has already supported more than 630,000 people in developing countries.
I always ask people who work to change the world when they knew that’s what they wanted to do. Chris remembered the exact moment and described it to me: “I was about 19, standing in a field, and I remember thinking: as much as I love farming in Wales, I just don’t think I am cut out for this. I really need to be in a place where I can interact with people.”
I knew Chris’ career path had led him to interact with many thousands of people, often in urgent need of care. Ever since our first meeting, I wondered whether the immense need for mental health treatment ever felt overwhelming.
Luckily I get a chance to ask him. He is 66 now and he has agreed to a follow-up interview, although this time in an office building rather than the club. The venue might not be as exciting, but the conversation certainly is as engaging as the last time.
I always ask people who work to change the world when they knew that’s what they wanted to do.
It turns out that a man like Chris tackles big numbers by firstly fully understanding them, and then choosing a strategy to maximise impact. In the field of mental health, that means first of all accepting that there is a proportionate relationship between a population and the number of people that are likely to be mentally ill within that population. Experts say it is about 10 percent – anywhere in the world. Chris warns that in reality, that number can be even higher: “If there are other factors like overcrowding, extreme poverty or a previously war torn area, then it would be safer to go on 15 percent, so that says something about the size of the field.”
In fact, the World Health Organisation (WHO) puts the total number of people with mental disorders at around 450 million. The added complication in developing countries is that up to 85 percent of then have no access to treatment.
After opening offices in twelve countries, Chris was convinced that his Model for Mental Health and Development was tried and tested enough to take it to the next level: the BasicNeeds franchise: “It is not like McDonalds, which is franchising itself. What we are franchising is only the model for mental health and development, which existing organisations embed within their own structures locally.”
So far, five non-profits in Kenya, Ghana, Nigeria, India and Nepal have become franchisees. Each will work with at least 1000 people within the first four years. Chris explains that the model works because it is very recognisable for both development and health workers: “It uses field skills and techniques that they already recognise, like community organising skills, but also skills around livelihoods and the introduction of a new technology.”
He gives the example of the creation of self-help groups of mentally ill people and their carers. Over 500 groups are run by BasicNeeds organisations, and some groups have over 500 members. The creation of these groups allows the local aid workers to move quickly through the community and identify people suitable for group activity. The next step is to provide treatment and accepting that this treatment might be lifelong. And ultimately, it is the mind shift that follows that matters the most: “It is about recognising that these people – if properly treated both medically and in a human sense – can make an enormous contribution to society.”
“The progress is not automatically made in first world countries.”
Throughout our conversation, Chris is keen to highlight that mental health is an issue that should concern us all. “The progress is not automatically made in first world countries,” he says. “With support from a foundation, we are doing tests to see whether the model will work in the USA. In some of the poorer states, the number of psychiatrists in a local population is not that different from some developing countries.”
Just as I am packing up my note book we start talking about dementia, which Chris calls “a whole new crossover issue between mental health and gerontology.” His friendly eyes look stern for a brief moment, as he recalls an item he heard on the radio that morning. “It revealed that elderly patients suffering from dementia were handled by security guards in UK hospitals. If your only treatment is restraint, you don’t really have much right to compare yourself favourably to the developing world.”
How societies deal with their ageing population is a big question added to the long list of the world’s mental health needs. Perhaps unsurprisingly, Chris has already started to think about possible answers. He has been invited to a WHO conference by the Centre for Excellence in Ageing to talk about his model. Ultimately, he wants to wake up political leaders around the world and work with them. “Governments have to recognise that they haven’t found major solutions. They have to look at organisations like ours at demonstrators of models and replicate them at scale. We know there is a gap, which the franchise model will help to bridge.”
When the interview eventually comes to an end, we quickly agree to meet again next year. Chris’ story is one of those that I thoroughly enjoy to see unfold.