Building system capacity to deliver youth-targeted mental health services in Vietnam and Cambodia

Background: Rising rates of mental illness are an urgent global health problem. As mental health problems often start in youth intervening early is crucial in mitigating long-term personal and economic cost. In countries such as Vietnam and Cambodia, there is appetite for delivering early mental health interventions but there are also system-level limitations, especially outside major cities, that constrain delivery and accessibility.

Aims and objectives: The overall objective of this project is to address these structural barriers by building capacity and strengthening systems that underlie the provision of youth-targeted mental health services in Cambodia and Vietnam. Our specific aims are to: a) train potential service providers across different sectors (health, education, social) on mental health literacy and then co-design and co-adapt with them and youth an intervention for youth (aged ~14-19) that we developed and pilot-tested in previous projects; b) measure the feasibility, acceptability and potential effects of these interventions in promoting good mental health; and c) co-design referral pathways for the scale-up of these interventions.

Research question: How can we build capacity in mental health care systems in Vietnam and Cambodia to co-develop and implement a feasible, acceptable, beneficial and sustainable youth-targeted mental health intervention?

Methods: This project, building on previous work of the interdisciplinary team members including a multi-level framework for conceptualising systems strengthening, has 4 overlapping phases. Phase 1 will identify and map youth-targeted interventions and services in Vietnam and Cambodia. In Phase 2, we will use this knowledge to identify 40 people in each country who work with young people and train them on youth mental health, increasing their mental health literacy.

This capacity building will end with the co-design of the youth targeted intervention. In Phase 3, the intervention will be implemented by the trainees in schools and community centres in Kampong Chhnang and Siem Reap in Cambodia and Khanh Hoa and Thai Binh in Vietnam. We will deliver this intervention to 175 young people in each country, with another 175 being allocated to a wait-list control condition.

Data will be collected on the mental health literacy of trainees (in Phase 2) as well as observation of their delivery in Phase 3. Using mixed methods, we will evaluate the feasibility, acceptability, and potential range of effects on reductions in anxiety and depression symptoms and other relevant secondary outcomes e.g., well-being among youth. Finally, in Phase 4, we will co-develop mechanisms for embedding, scaling up and strengthening youth mental health systems including considering intersectoral communication and referral pathways.

Anticipated impact and dissemination: Our project will lead to an increased ability to address youth mental health in Cambodia and Vietnam through an increased number of youth mental health services providers and through a strengthened and integrated system of provision. We will disseminate findings through: publishing articles in local language journals; sharing our manuals for building capacity to provide mental health care to youth and for delivering co-produced youth-focused interventions; and through developing strategies to sustain the approach beyond the project.

Timelines for delivery: End-points for phases 1-4 are: 6 months, 10 months, 27 months and 36 months.