A lifetime for patients with mental illness

Chris, we are excited to be welcoming you at the Making More Health Together 2022. You will be one of the panelists for the session on “Wellbeing in Changemaking & Changemaking for Wellbeing". What are you looking for at the event in Ingelheim, Germany?

Chris Underhill: I have known people from Boehringer Ingelheim in the United Kingdom for years, and I am a Senior Fellow of Ashoka, so I am very familiar with your company and particularly with your engagement via the Making More Health initiative. I am excited to be part of the convention and to meet in person with many colleagues that I admire. I will participate this panel discussion on mental health and I am looking forward to what will be a very interesting and insightful discussion.

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Mental health is a topic that has accompanied you throughout your life – professionally and private. As a teenager, you struggled with mental problems yourself. 

I was a boy, ten years old, when my parents decided to send me to England. They lived in Corsica but believed that it would be better for me to grow up with family in London and to go to school there. Unfortunately, I found myself in a situation where I wasn’t being fed. I literally had to go on the streets to look for food. It was a stressful time and it ended up with me having a mental breakdown and finding myself in a hospital. 

You were a traumatized child.

I felt bad. I felt lonely. To make things worse, there was a lot of stigma at that time towards people with mental health illness. The doctors didn’t like the idea of me playing with other children. They were good at the basics, and not so good at the empathy. It was an unsuitable situation for a little boy. Eventually, my parents were contacted, and they took me back home. It took me over a year to recover.

Sympathy for people with mental health conditions

You later became what you call a “serial social entrepreneur”. You founded and led several organizations that are working with disabled people and patients with mental health conditions. How did your own experiences as a child help you in your job? 

It is not possible for me to draw a simple line between the events that happened in my childhood and my career. I do think though, that I certainly have an understanding of what it’s like to be caught up in a confusing situation, a mental haleth condition or breakdown. I certainly have this empathy.

The first organization that you founded, back in 1978, was Thrive. You worked with people with dementia - and the core idea was to encourage them to take up gardening. 

It sounds a little bit funny given the rainy weather in Great Britain, but it is actually true: We love gardening. As a former agriculturist, who also taught agriculture science, I realized that gardening has a huge effect on people with dementia. If you have them gardening, they are not sitting at home, being lonely. They have a hobby, they are outside, they meet other people, and they talk to them. Secondly, gardening for older people is also about memory recall. You use techniques that you have trained in the past. You have that muscle memory – and you will be supported by Mother Nature. You instantly see a result: You plant seeds, and you get seedling. Nature is backing you up and does part of the job. Our program has proven to be very successful. 

After seven years in the lead at Thrive, you turned your attention to people with disabilities and patients with mental health conditions in Africa and beyond?

That is correct. I knew that Thrive was in a great shape and that the organization would continue to work successfully without me. I wanted to do something different, and I felt that I could do more. Firstly in 1985 I started ADD (Action on Disability and Development) and we worked together with people with disabilities in 13 developing countries. Later we reached more than 800.000 people with mental health conditions in 15 countries with the organization BasicNeeds that I started in 2000. What is quite interesting: There are a number of similarities between patients with mental health conditions in Great Britain and in countries like India, Sri Lanka or Ghana, i.e. they are subject to stigma. One of the main differences is that resources are limited. Patients in developing countries have very little opportunity to seek medical advice and to get a diagnosis. 

Organizing gatherings for patients

How did you help these people?

It was clear to us: We did not want to provide medical support rather we wanted to support people with mental health conditions and their families to access medical help from their government and, where possible, to get back into the social economy. If, as a charity, you deliver medicine it can create dependencies, which is very hard to withdraw from. So, we encouraged and supported the health service and their staff. We organized gatherings for people with mental health conditions. We asked them: What is your situation? How do you feel? What are your main challenges? For most of the participants it was the first time that they could talk about themselves. It was therapeutic. We also registered them to medical authorities to provide access and opportunities to get a diagnosis. Finally, we created work opportunities for them which was most appreciated. 

How can global pharmaceutical companies like Boehringer Ingelheim help patients in developing countries best? 

Pharmaceutical companies historically do not have the best reputation in developing countries. But numbers of companies, with Boehringer Ingelheim at the forefront, have done a lot of great work to get much closer to the communities and better understand what their needs are. This is the right way and I would encourage Boehringer Ingelheim to continue doing so and to build on these deep relationships. Plus: The medications from global pharma companies are really valued. The medicine – particularly in the field of mental health – has upgraded through the years. The issue now is that governments in developing countries have to buy the newest generations of medicine for their people. It makes quite a difference if patients get the first, the second or the third generation of a certain medicine. To point out these benefits, to discuss and to explain, is also a main task for pharma companies. With the right relationship to government companies can stay in-country for many years in contrast to NGOs, who are typically time restricted.