New light: Mental health in Vietnam focus of new program

topics: Communities, Psychology and Human Development

Spring 2007, Melanie Moran, Ideas In Action

It’s a fortunate person who is able to combine both his personal and professional passions. Vanderbilt Peabody psychologist Bahr Weiss is one such man. Weiss is in the midst of creating the first clinical psychology program in Vietnam, a country and culture that has shaped his life at home and in the laboratory. Weiss and his former wife are the parents of two daughters, Nina and Lila, whom they adopted in Vietnam in 1993 and 1997.

“I became fascinated with the culture after visiting Vietnam for a conference and after adopting my daughters,” Weiss, associate professor in the Peabody Department of Psychology and Human Development, said. “I wanted to combine my personal and professional interests, and the need for research-based mental health services in Vietnam gave me the perfect opportunity.”

With Peabody’s support, Weiss won two grants totaling more than $1 million from the National Institutes of Health in 2001 and 2006 to develop Vietnamese mental health research capacity.

“Our ultimate goal is to permanently increase research capacity in Vietnam to develop culturally appropriate research-based treatments for children’s mental health problems,” Weiss said. “Our work with our Vietnamese colleagues will increase their ability to plan, design and conduct intervention trials to evaluate these treatments, and to share their results to improve mental health services.”

Mental health awareness and treatment are limited in Vietnam, in part because the psychological underpinnings of problems such as drug abuse and depression are not widely recognized.

“The stigma associated with mental health concerns in Vietnam is even greater than in Western countries,” Weiss said. “We are hoping to help people understand that mental health problems can result from one’s life circumstances, and that the habits you develop about what you think affects what you do and feel. We’re also starting a dialogue that moves away from characterizing issues such as drug abuse as ‘social evils’ and frames them more as mental health problems.”

While awareness is growing, the lack of research-based training and treatment is resulting in services that can do more harm than good.

“Most clinicians in Vietnam have little or no training. People have good intentions–they’re trying to address a social need–but they are setting up clinics with no training and no basis for judging their effectiveness,” Weiss said. “As a result, some treatments likely are completely lacking in efficacy. The governmental drug addiction treatment system, for example, has been estimated to have a 90 to 100 percent failure rate.”

After four years of surveying professionals and testing training strategies, Weiss and his colleagues in Vietnam and in the United States decided the most sustainable way to increase Vietnamese mental health services research capacity was to develop a Ph.D. program to train students to develop and evaluate research-based methods for treating mental health concerns.

The program will get fully under way in fall 2008, when two doctoral candidates and four post-doctoral Vietnamese researchers will come to Nashville to study at Peabody in the Vanderbilt Clinical Sciences program. The Vietnamese researchers then will return to Vietnam to serve as core faculty in the new clinical psychology program at Vietnam National University in Hanoi.

Weiss and his colleagues also will provide training to approximately 10 Vietnamese fellows via two-week summer seminars in Vietnam.

“The people we train will be remembered one day as the forefathers and mothers of Vietnamese clinical psychology,” Weiss said. “It is a tremendous opportunity for these individuals and for Vanderbilt to have a lasting positive impact on global health.”

In addition to this program, with support from Peabody College, Weiss is developing a National Institute on Drug Abuse grant proposal to establish and evaluate a research-based drug treatment program in Vietnam, where heroin is a gateway drug. Addiction treatment in Vietnam has largely consisted of sending addicts for up to two years to “rehabilitation camps.” Weiss, one of the first Westerners to receive permission to visit the camps, said, “With their barbed wire-topped walls, these ‘camps’ bear an uncanny resemblance to prisons.” However, he has been assured by his Vietnamese colleagues that they are not.

“We were approached by local authorities to set up a drug treatment program in collaboration with the Danang Psychiatric Hospital,” Weiss said. “Almost all of the research on drug abuse and prevention has been conducted in Western countries, yet much of the world’s drug addiction problem exists in collectivist countries where there are quite different challenges.

“In Vietnam, young adults stay with their parents until they marry, usually around age 25, and they are still under their parents’ authority. Culturally, one of the discipline techniques parents use is shame and the threat of humiliation, which can inadvertently lead to an increase in drug use,” he continued. “Young people also often have unrealistic expectations; they come back from the camps expecting their families to unconditionally welcome and trust them, which is not realistic given the cultural embarrassment the family has experienced. Both sides need help balancing their expectations, and that is one of the things our program is working to do.”

Weiss believes both projects will benefit their American partners as much as they will the Vietnamese.

“The collaborative relationships with the Vietnamese researchers will give us long-term opportunities to share and learn perspective on human behavior from a significantly different culture,” he said.

“As members of the most affluent and most privileged country in history, we feel we have a moral imperative to assist in reversing the ‘brain drain’ in mental health resources,” Weiss said. “The World Health Organization has reported the inequity in the distribution of mental health resources in the world is ‘unfathomably large,’ and as a faculty member at Vanderbilt, it is both an honor and a moral imperative to try to help address this inequity.”

In addition to being a Peabody faculty member, Weiss is an investigator in the Vanderbilt Kennedy Center for Research on Human Development and a member of the Vanderbilt Institute for Public Policy Studies.