From 1999 to the present, the mental health care (MHC) program has undergone significant changes in direction: from focusing on severe mental disorders to expanding to other types of mental disturbances, from drug-based treatments to the development of psychotherapeutic methods, and from a treatment-oriented approach to a comprehensive MHC program. With the goal of providing an overview of the developmental trends of the community-based MHC program, the emergence of the Social Work and Psychology sectors in Vietnam, this article is divided into three developmental stages and reviews the policies that contributed to the changes in each stage according to the author’s perspective and opinions.
Stage 1999 – 2010: The Ministry of Health (MOH) played a leading role in managing MHC, focusing on hospital-based treatment models without interdisciplinary cooperation with other ministries, including the Ministry of Labor, Invalids, and Social Affairs (MOLISA). The primary treatment method was medication-based. Psychological therapeutic methods and community-based interventions/support using non-pharmacological approaches were scarcely implemented nationwide.
• The initiative began in 1999 with the MHC Project initiated by the MOH and launched in 2001 for two target groups: schizophrenic and epileptic patients. The program focused on developing a network of community-based treatment through the commune health system (including health stations and village health workers). By the end of 2010, it achieved a coverage rate of 70% of communes nationwide. The program aimed to significantly reduce the percentage of psychiatric patients receiving inpatient treatment and hospitalization duration, thereby alleviating the burden on psychiatric hospitals and psychiatric departments within general hospitals. Starting from 2006, the program expanded by piloting treatment for patients with depression in selected communes [1].
• The Non-Communicable Disease Prevention Program (2002 – 2010), proposed by MOH, focused on four disease groups, including mental disorders (epilepsy and depression). However, by 2010, the components of MHC were still not fully implemented [1] due to various reasons, including shortages of personnel and resources and a lack of inter-agency coordination.
• The Healthcare Examination and Treatment Law in 2009 [2] mandated compulsory treatment for individuals with “agitated or depressed mental conditions with suicidal ideation or behavior harmful to others, as stipulated by law.” For patients with stabilized mental disorders but without caretakers, medical facilities were required to notify social welfare institutions to take them in. In this period, the role of social welfare institutions primarily focused on managing psychiatric patients transferred from medical facilities to the community.
• MOLISA proposed social support policies for single, homeless individuals with mental disorders, providing a monthly allowance of 45,000 VND per person managed by the commune authorities, and 100,000 VND per person in state-owned social welfare institutions, as indicated in Decree 07/2000/NĐ-CP [3]. Subsequently, Decree 67/2007/NĐ-CP [4] and 13/2010/NĐ-CP [5] on policies supporting social welfare beneficiaries, also proposed by MOLISA, increased the social assistance allowance for psychiatric patients in communes to 270,000 VND per person per month and to 450,000 VND per person per month in state-owned social welfare institutions.
Stage 2011-2020: Establishing the Social Work profession in Vietnam, including “Social Work in Healthcare,” as the foundation for human resources in community-based MHC. MOLISA played a key role in developing plans and implementing activities related to the prevention of mental disorders, care, treatment, and functional recovery for psychiatric patients and expanding the target group for community-based MHC. In the author’s perspective, the concept of “mental disturbances” refers to mild mental disorders that can be prevented/intervened in the community, and it is introduced to differentiate them from severe mental disorders (schizophrenia, depression), which require concentrated interventions/treatments in hospitals.
• Resolution 32/2010/QD-TTG [6] approved the plan for developing the Social Work profession during the 2010-2020 period, as proposed by MOLISA, recognizing, and standardizing the profession of Social Work, focusing on developing specialized skills and expertise for the workforce. During this stage, MOH played a professional role in “guiding healthcare practices in treatment and functional recovery for psychiatric patients in the community and in social welfare institutions; enhancing the capacity of healthcare staff and collaborators in MHC.”
• Decision 1215/QD-TTG [7] approved the Community-Based Social Assistance and Functional Recovery Project for People with Mental Disorders and Mental Disturbances during the 2011-2020 period, specifying the primary role of MOLISA in “developing plans for project implementation,” raising public awareness, and enhancing the capacity of the workforce. In addition to the social welfare institutions, the goal was to develop a network of prevention and therapy facilities for mental disturbances to provide psychological therapy services and functional recovery for individuals with mental disorders and mental disturbances. However, up until now, the availability of psychological therapy services has been limited, and there are no specific standards for quality and services.
• Decision 376/QD-TTG [8] approved the National Strategy for Prevention and Control of Non-Communicable Diseases during the 2015-2025 period, proposed by the Ministry of Health (MOH), but no longer directly addressed mental disorders as in previous stage.
• In Decision 3556/QD-BYT [9] regarding the “Guidelines for diagnosis and treatment of common mental disorders due to the use of synthetic Amphetamine-type stimulants,” psychological counseling is mentioned as a treatment principle, but specific guidelines for psychological counseling methods are not yet available.
• In 2017, UNICEF collaborated with MOLISA to release the “Practical Guide for Social Work in MHC” focusing on common mental disorders in the community: depression, anxiety, epilepsy, schizophrenia, and dementia in the elderly. This was an important step in standardizing training for the social work team in healthcare.
Stage 2021-2030: The establishment of the profession “Psychologist” in Vietnam as a separate discipline from psychiatry, creating a workforce to meet the needs of research, counseling, and psychological therapy in society. Due to the impact of the COVID-19 pandemic, alongside specialized treatment, MOH actively collaborated with MOLISA to strengthen the prevention and control of mental disorders. There were initial regulations for the title “Clinical Psychologist.”
• According to Decision No. 34/2020/QD-TTG [10], the title “Psychologist” is officially included in the list of recognized professions in Vietnam, marking a significant step forward for the field of Psychology in Vietnam.
• In the “Guidelines for Diagnosis and Treatment of Common Mental Disorders” issued by the MOH in 2020, numbered 2058/QD-BYT [11], in the treatment diagram, besides pharmacological treatment, psychological therapy, and supportive treatment are specifically tailored for each type of mental disorder.
• Decision 1929/QD-TTG in 2020 [12] approved the Social Assistance and Functional Recovery Program for people with mental disorders, autism in children, and individuals with mental disturbances based on the community during the 2021-2030 period, as proposed by MOLISA. It specifically outlined the target groups of the program, including various mental health conditions such as schizophrenia, epilepsy, brain injuries, intellectual disabilities, stimulant use disorders, autism spectrum disorders, attention deficit hyperactivity disorder (ADHD), and post-traumatic stress disorder.
• Decision 155/QD-TTG in 2022 [13] approved the National Plan for the Prevention and Control of Non-communicable Diseases and Mental Disorders during the 2022-2025 period, as proposed by MOH. It focused on mental health disorders, including schizophrenia, epilepsy, dementia, depression, and other mental disorders. The MOH collaborated with MOLISA to implement activities aimed at enhancing mental health, early detection, management, treatment, and functional recovery.
• Circular 17/2022/TT-BYT [14] in 2022 by MOH stipulated the tasks of MOH facilities, including the responsibility to “implement psychotherapeutic therapies, therapeutic activities, language therapy, music therapy, social and functional recovery therapies, and other therapies…” This provided a place for the field of clinical psychology in hospitals.
• According to the regulations in the Healthcare Examination and Treatment Law (Law No. 15/2023/QH15) in 2023 [15], “Clinical Psychology” is a specialized title that requires a professional license. The National Medical Council will be responsible for evaluating the professional competence of individuals practicing clinical psychology starting from January 1, 2029.
Currently, the demand for psychological counseling and mental disturbance therapy in society is increasing, while the capacity to provide services and standardize the quality of psychological services is still low. The following articles will analyze the trends in the field of psychology worldwide and in Vietnam.
Reference list:
- RTCCD-MOLISA, Assessment of the Current Situation of the Mental Health Care System under the management of the Ministry of Labor, Invalids and Social Affairs, WHO in Vietnam, 2011.
- Law No. 40/2009/QH12 on Medical Examination and Treatment passed by the National Assembly on November 23, 2009.
- Decree 07/2000/NĐ-CP on Social Relief Policies dated March 9, 2000.
- Decree 67/2007/NĐ-CP on Policies to Support Social Protection Beneficiaries dated April 13, 2007.
- Decree 13/2010/NĐ-CP amending and supplementing some provisions of Decree 67/2007/NĐ-CP on February 27, 2010.
- Decision 32/2010/QĐ-TTG approving the development program for social work profession from 2010 to 2020 on March 25, 2010.
- Decision 1215/QĐ-TTG Approving the Project on Social Assistance and Functional Recovery for People with Mental Disorders, Mental Disabilities, based on the Community from 2011 to 2020 on July 22, 2011.
- Decision 376/QĐ-TTG Approving the National Strategy for the Prevention and Control of Cancer, Cardiovascular Diseases, Diabetes, Chronic Obstructive Pulmonary Disease, Asthma, and Other Non-communicable Diseases from 2015 to 2025 on March 20, 2015.
- Decision 3556/QĐ-BYT Issuing “Guidelines for Diagnosis and Treatment of Common Mental Disorders Caused by the Use of Amphetamine-Type Synthetic Drugs” on September 10, 2014.
- Decision No. 34/2020/QĐ-TTG Issuing the Vietnam Occupational Classification on November 26, 2020.
- Decision 2058/QĐ-BYT “Guidelines for Diagnosis and Treatment of Common Mental Disorders” on May 14, 2020.
- Decision 1929/QĐ-TTG Approving the Program on Social Assistance and Functional Recovery for People with Mental Disorders, Autistic Children, and Mental Disabilities based on the Community from 2021 to 2030 on November 25, 2020.
- Decision 155/QĐ-TTG Approving the National Plan for the Prevention and Control of Non-communicable Diseases and Mental Disorders from 2022 to 2025 on January 29, 2022.
- Circular 17/2022/TT-BYT Regulating the Tasks of Mental Health Examination and Treatment for Healthcare Facilities on December 30, 2022.
- Law on Medical Examination and Treatment No. 15/2023/QH15 on January 9, 2023.
Linh Bui – Pharmacist, Master of Psychology, Member of British Psychology Society. Currently, I am living in Ho Chi Minh city, Vietnam. My research interest is metacognitive therapy, nature-based therapy, alternative treatments for mental disorder. I love community work and hope to contribute to the development of mental healthcare in Vietnam.
