British Journal of Social Work (2015) 45, 1242–1258

doi:10.1093/bjsw/bct181
Advance Access publication December 4, 2013

Linking Social Work with Buddhist

Temples: Developing a Model of Mental
Health Service Delivery and Treatment
in Vietnam

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Huong Nguyen*

*
Correspondence to Dr Huong Nguyen, Ph.D., MSW, Assistant Professor, College of Social
Work, University of South Carolina, 1731 College Street, Room 205, Columbia, SC 29208,
USA. E-mail: hnguyen@mailbox.sc.edu

Abstract
As a profession, social work only began developing in Vietnam in the last twenty years.
In 2011, the Vietnamese government approved a national programme aiming at incorpor-
ating social work into formal health settings in Vietnam for the first time in the history of
the country, including mental health care facilities. It is well known, however, that Viet-
namese people stigmatise seeking services from formal mental health settings; yet, they
frequently seek help from Buddhist temples and other informal systems. In this paper,
I will (i) review the systems of mental health service delivery in Vietnam, including
Western-style formal systems and Buddhist temples, and (ii) propose an exploratory model
of service delivery where the emerging social work profession will play the liaison role
between formal and informal systems.

Keywords: Vietnam, mental health, social work, Buddhism, service delivery

Accepted: October 2013

Introduction

Having begun developing only in the last two decades, social work is still in its
infancy in Vietnam (Oanh, 2002; Tran, 2009). On 25 March 2010, Vietnam’s
Deputy Prime Minister Nguyen Sinh Hung signed a landmark decree
(Decree 32) approving the National Social Work Development Program
with the budget of 2437.4 billion dong (US$120 million) for the next ten

# The Author 2013. Published by Oxford University Press on behalf of

The British Association of Social Workers. All rights reserved.
 Linking Social Work with Buddhist Temples 1243

years. This programme aims to (i) train 60,000 social workers and (ii) build a
nationwide network of ‘social work centres’ (trung tam cong tac xa hoi) for the
country. In July 2011, the Vietnamese government approved two important
programmes: a national 2011– 20 programme to develop medical social work,
which aims to incorporate social work into nationwide medical settings for
the first time in the history of the country (Vietnam Ministry of Health,
2011a); and a 2011– 20 programme that provides community-based social
support and rehabilitative services to people with mental health issues
(Vietnam Ministry of Health, 2011b). Both programmes demonstrate the Viet-
namese government’s intention to incorporate social workers into treatment
teams at formal health care facilities, where medical doctors, psychiatrists, psy-

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chologists, therapists and nurses have traditionally dominated service provision.
Exciting as it is, the above plan will face a fundamental issue of mental
health service delivery and treatment in Vietnam: Vietnamese people are re-
luctant to seek help from formal mental health systems, yet they have had a
long tradition of seeking help from informal systems, especially Buddhism-
related organisations (Ham et al., 2011; Tran, 2009; Nguyen and Anderson,
2005; Phan, 2000). The success of the plan, as well as the long-term success
of Vietnamese social work, therefore, is contingent upon the ability of the
profession to address Vietnamese people’s help-seeking behaviours in rela-
tion to mental health services. On a larger scale, this issue also poses a critical
question that Vietnamese social work needs to address: How can Vietnamese
social work establish a subfield of mental health that is modern, professional,
effective, and compatible with social work worldwide, while also being sensi-
tive to and appreciative of the Vietnamese culture, where Buddhism, Confu-
cianism, Taoism and indigenous beliefs have an undeniable influence in
people’s perceptions of the root causes of mental health problems and accept-
able methods of treatment?
This article will address the above question by reviewing the two existing
systems of mental health services in Vietnam: the formal, primarily Western-
style mental health systems and the informal mental health systems, of which
Buddhist temples are a key component. I will then review the state of social
work in Vietnam and discuss the Vietnamese government’s current tendency
to incorporate social work only in formal mental health settings. Based on
these discussions, I will present key arguments for why Vietnamese social
work should serve as an organisational liaison between formal and informal
mental health systems, especially the Buddhist temple system. Finally, I will
propose an exploratory model for such organisational linkage.
Materials used for this article come from three primary sources: (i) existing
data and literature about the help-seeking behaviours of Vietnamese people,
mental health policies and programmes in Vietnam, and Vietnamese social
work policies and programmes; (ii) initial observational data about services
provided at formal and informal mental health systems in Vietnam, and
(iii) ‘emic’ knowledge and interpretation of Vietnamese culture and practices
towards mental health as a cultural insider (Harris, 1976; Headland et al.,
1244 Huong Nguyen

1990; Morris et al., 1999), supported by literature about Vietnamese culture

and the Buddhist influence in Vietnamese culture. With regard to the first
source of data, I primarily reviewed laws, national strategies, policies and pro-
gramme documents, as well as survey analyses, statistics and books or journal
articles discussing mental health and social work in Vietnam. With regard to
observational data, I visited Vietnam multiple times between 2010 and 2013;
each visit lasted from two weeks to three months. During this time, I stayed at
a Buddhist temple in Hanoi to observe why people seek help at Buddhist
temples and what kinds of help are being offered at Buddhist temples in
Vietnam (Nguyen, in press). With permission from the head-monk, I sat in
session treatments where the monks at the temple treated people with

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mental problems, either through counselling them, performing rituals
similar to exorcism, lecturing on Buddhist sutras or meditation. Parallel to
this investigation, I conducted exploratory interviews with patients of a
mental health hospital in Hanoi about the pathways through which they
reached formal mental health services. From these data, I developed initial
themes about help-seeking pathways of Vietnamese people and the role of
Buddhist temples in helping people with mental illnesses.
Even though these observations and analyses were preliminary, they reso-
nated with my scientific inquiry and insights as a native Vietnamese about
Vietnamese people’s established beliefs, attitudes and behaviours towards
seeking help. They also resonated with cultural studies and writings about
Vietnamese culture, especially about the influence of Buddhism on Vietnam-
ese people’s help-seeking behaviours. These critical reviews of literature and
‘emic’ analyses help me ‘generate native judgments’ about organisational
problems with existing mental health systems and the ways to address these
problems (Harris, 1976, p. 336).

Conceptualising ‘mental health’ in Vietnamese culture

Due to the strong influence of Buddhism, Taoism and indigenous beliefs,
Vietnamese people generally believe that a person essentially has physical
and non-physical parts, which are interdependent. ‘Mental’ is the umbrella
concept representing the non-physical part and has been translated into
several Vietnamese versions: tam than (‘heart’ and ‘spirit’), tinh than
(‘essence/nectar’ and ‘spirit’) or tam tri (‘heart’ and ‘intellect/mind/cogni-
tive’). As these terms indicate, in Vietnamese culture, the concept
of ‘mental’ comprises at least four interconnected categories: heart (emo-
tions, feelings), mind (cognition, logical thinking), essence and spirit.
A person in good mental health will be able to control his or her emotions,
express his or her emotions and thoughts properly, process and make deci-
sions, possess a good aura/vibe/energy/chi about him or her, and cope
with emotionally and intellectually challenging situations within culturally
accepted boundaries.
 Linking Social Work with Buddhist Temples 1245

Most Vietnamese people believe mental health issues are caused by imbal-
ance or disharmony between different non-physical and physical parts of a
person. For example, traditional Vietnamese doctors explained schizophre-
nia as being caused by the imbalance of yin and yang in such a way that there is
an abundance of fire-like chi flowing in the body, which leads to an individual
‘going crazy’ (Tran Van Ky, 2004, p. 54). In addition, since many Vietnamese
people believe in the Buddhist ideas of karma and reincarnation (i.e. people’s
problems are the karmic fruit of previous bad deeds), they also regularly use
the colloquial word hanh (meaning ‘being tortured/tormented’) to describe
people having mental health problems, implying that these people might be
‘tortured/tormented’ for the bad deeds that they had done in the past

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(Nguyen, in press). Spirit possession is frequently cited as a cause of mental
illnesses (Nguyen, in press; Gustafsson, 2009). Treatment for mental health
issues, therefore, frequently incorporates a spiritual/religious element, pri-
marily through seeking forgiveness and release from the karmic debt, and
is best completed with the help of Buddhist monks.

Mental health services in Vietnam

Brief history of mental health services in Vietnam

Mental health problems have been diagnosed and treated in Vietnam for cen-
turies using traditional medicines. In Hai Thuong Y Tong Tam Linh, pub-
lished in the eighteenth century and considered to be one of the most
important publications in the history of Vietnamese medicines, Le Huu
Trac identified symptoms of disorders of internal chi which manifested exter-
nally in the form of insomnia, anxiety, depression, lack of livelihood, tan-
trums or unexplainable melancholy, all of which could be treated with
herbs that can restore a healthy flow of chi (Le, 2008).
After Vietnam gained independence from the French in 1945, the first
mental health hospitals of the Socialist Republic of Vietnam, all named Psy-
chiatric Hospitals, were established in the early 1960s, mostly to treat veter-
ans and civilians suffering from brain injuries and/or severe mental disorders
associated with the wars (Psychiatric Hospital I, 2012a; Psychiatric
Hospital II, 2012). These hospitals followed the Western-style conceptualisa-
tion of mental illness. During the next few decades, mental health services in
Vietnam largely followed an institutional model where only severe, visible
cases of schizophrenia and epilepsy were classified and eligible for treatment
and, subsequently, benefits from the government.
Starting in the 1990s, mental health services in Vietnam gradually shifted
from an institutional model to a community-based model. In 1998, the Viet-
namese government approved a national Target Program on Protection of
Community Mental Health aiming at early detection, prevention and treat-
ment for mental health patients in their own communities (Government,
1246 Huong Nguyen

1999). In 2007, the Prime Minister of Vietnam approved another target pro-
gramme aiming at providing community-based mental health services in
100 per cent of cities and provinces and to detect and treat 50 per cent of
mental health patients in their own community (Government, 2001, 2007b).
By 2011, most local authorities in Vietnam declared that the community-based
mental health model had been successfully implemented in accordance with
the government’s plan; however, scattered initial evaluations showed that
‘community-based’ programmes were largely meant to deliver medicines to
mental health patients at their local clinics and were limited only to patients
with schizophrenia or epilepsy who had been diagnosed and treated at
central psychiatric hospitals (Tran, 2009). The ‘community-based’ concept

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was mostly understood as adding an element of mental health services to the
existing system of health care clinics that traditionally specialised in physical
health.

Prevalence and services for mental health issues

While reliable, updated, nationally representative information on the preva-

lence of mental health problems in Vietnam is rare, a few scattered studies
give a glimpse of the magnitude of the problem. A survey of ten common
mental health disorders (as defined by Diagnostic and Statistical Manual of
Mental Disorder—IV) conducted in 2001 suggested that approximately
14.9 per cent of Vietnamese had one or more disorders, of which alcohol
abuse (5.3 per cent), depression (2.8 per cent) and anxiety (2.8 per cent)
were the most common (Vuong et al., 2011). A more recent survey of 4,981
Vietnamese adults using a self-reporting questionnaire (SRQ-20) found
19.2 per cent of the sample to be probable sufferers of mental health disorders,
with females having a higher prevalence than men (Richardson et al., 2010).
Amstadter and colleagues examined 1,368 Vietnamese adolescents between
ages eleven and eighteen and found 9.1 per cent of the adolescents to have
mental health problems (Amstadter et al., 2011). Among elderly people,
Leggett and colleagues found 47 per cent scoring above the cut-off for clinical
depression and anxiety, with women having a higher prevalence. Less educa-
tion and poverty as well as a lack of emotional support were key factors asso-
ciated with depression and anxiety among this population (Leggett et al., 2012).
Vietnamese people in need of mental health services have two options:
(i) seeking services from the formal mental health system that includes pri-
marily psychiatric hospitals, outpatient facilities, primary care clinics and
social protection centres; or (ii) seeking help from informal help systems, in-
cluding yoga, acupuncture, tai chi, qigong, folk medicine, and the spiritual
counselling and treatment offered at Buddhist temples. The two systems
function separately without organised efforts from either systems or the gov-
ernment to coordinate their activities (Figure 1). Moreover, social work has
never been a part of either system.
 Linking Social Work with Buddhist Temples 1247

Figure 1 Mental health services in Vietnam before the introduction of social work

At present, the formal system of mental health services consists of two

separate subsystems, and both are structured into four tiers corresponding

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to the administrative tiers in the Vietnamese governmental system: central,
province, district and commune. The main system is managed by the Ministry
of Health (MOH), with major goals being prevention and treatment of
mental health problems through a system of hospitals. The MOH system cur-
rently includes a national institute of mental health, two central psychiatric
hospitals, thirty-two mental health hospitals at provincial levels, thirty-three
mental health departments at provincial primary health care hospitals and
thirty-three mental health departments of provincial centres for disease
control. In addition, there is a nationwide network of primary care clinics
that have now incorporated mental health treatment into their activities in
compliance with the National Target Program on Community-Based
Mental Health; however, the magnitude of care and treatment at these clinics
is unknown.
The second subsystem of formal mental health treatment is supervised by
the Ministry of Labor, Invalids, and Social Affairs (MOLISA), which
manages seventeen social protection centres and multiple rehabilitation
agencies (Tran, 2009). However, these MOLISA centres receive only
those classified as ‘social protection target groups’ in government policy,
which include people with schizophrenia or mental disorders who were
diagnosed and treated at specialised mental health clinics without success
as well as mental health patients without a family or from poor families
(Government, 2007a). At present, approximately 6,000 people with
severe mental health problems are being treated at seventeen MOLISA
centres (Tran, 2009).
Within the formal system, services are limited (Tran, 2009; Vuong
et al., 2011). The mental health professionals in this system are mostly psy-
chiatrists, medical doctors, psychologists, therapists and nurses (Maramis
et al., 2011; Psychiatric Hospital I, 2012b). The rate of mental health pro-
fessionals in the population is among the lowest in South East Asia: 0.63 psy-
chiatrists, 0.3 psychiatric nurses, 0.06 psychologists per 100,000 people
(Maramis et al., 2011). Treatment at formal mental health settings follows
the Western model of mental health, with the DSM-IV and the ICD-10 as the
basis for diagnosis and medication. Unlike Western mental health systems,
the formal mental health system in Vietnam still focuses only on severe,
1248 Huong Nguyen

visible mental health issues such as schizophrenia, while issues like depression
are often marginalised.

Buddhist temples and the Buddhist approach to mental

health
Buddhism entered Vietnam around the second century (AD) and soon
became integral in Vietnamese life. At present, there are nearly 40,000
monks practising at more than 14,000 Buddhist temples and monasteries in

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Vietnam (Thich, 2004). With regard to mental health services, Buddhist
temples in Vietnam have three groups of activities; all of them are offered vol-
untarily and free of charge on the principle of Buddhist compassion. The first
group includes activities to alleviate stress, anxiety, fear or grievance of the
local community or the whole society when faced with natural disasters,
special accidents in the community, war and social chaos. Buddhist temples
also help boost community health by serving as informal cultural centres
where local people meet during holidays (mid-autumn festival, New Year)
to celebrate and bond.
The second group of activities offered by Buddhist temples involves direct
services to individuals and families going through disruptions or changes in
life, such as the death of a family member, the birth of a new child, wedding,
divorce, illness, bankruptcy, relocation, starting a new business, building a
new house and unemployment (Gustafsson, 2009; Hoang, 2004). Many Bud-
dhist temples in Vietnam also care for children and elderly people who have
been abandoned by their families. The third group of activities offered by Bud-
dhist temples involves direct therapy and healing for people showing various
symptoms of mental illness believed to be result of being ‘possessed’ or ‘tor-
tured’ by spirits, ghosts or devils (Nguyen, in press). Gustafsson (2009) docu-
mented many cases of people being ‘possessed’ by family members who died
during the Vietnam War without having their graves marked; thus, the ‘angry
ghosts’ of these war martyrs came back to haunt their family and to guide them,
with the help of Buddhist monks, to the location of their graves so that they
could be buried properly and reincarnated into the next life. These people
were described as suffering from repeated episodes of ‘seeing visions’, experi-
encing insomnia due to nightmares involving ghosts or losing control of their
behaviours as if being ‘controlled’ by another. In such a case, Buddhist thera-
peutic sessions could be offered that include activities that might be described
by outside people as ‘exorcisms’. During my visits to Vietnam in the past few
years, I documented the Buddhist monks’ successful treatment of multiple
people suffering from symptoms similar to hallucinations, schizophrenia and
severe depression (Nguyen, in press).
Unlike the formal Western-style mental health system in Vietnam, treat-
ment and counselling activities offered by Buddhist temples are grounded
 Linking Social Work with Buddhist Temples 1249

in complex Buddhist philosophies that cannot be explained in detail in this

article. One central Buddhist philosophy, called the Four Noble Truths,
teaches about the root cause of suffering and the solution to end suffering
(Thich, 1992, 2002). Essentially, Buddhism identifies seven forms of suffer-
ing: birth, aging, illness, death, not getting what one wants, parting with
what one likes, and being in company of things and people one does not
like. These forms of suffering are rooted in human beings’ illusion that we
each have a permanent, cohesive, unique and ‘real’ entity called ‘myself’
that possesses ‘my’ thoughts, attitudes and behaviours along with materialistic
belongings. In other words, most suffering is caused by a person’s illusion about
and attachment to the self (particularly thoughts and emotions derived from

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that self). A person suffering from mental health issues is someone who mis-
takenly equates the emotions that his mind reflects with a concrete ‘self’;
thus, he will suffer tensions, exhaustion and crises caused by these uncontrol-
lable, constant waves of emotions.
Based on the above philosophy and beliefs, many Buddhist temples in
Vietnam have helped mental health patients rid themselves of problems
through multiple activities aiming eventually at ridding a person of his illu-
sions of and attachment to the self. The practices include meditation, physical
exercises, counselling, learning the Buddhist sutras, fasting and retreat.
In some temples, Buddhist monks also perform an array of activities that re-
semble ‘exorcism’ that aim to cleanse people of their feelings of guilt, shame
and fear (Nguyen, in press). These activities will set a person on Eightfold
Noble Paths, which include (i) right understanding about reality, (ii) right
thoughts, (iii) right speech, (iv) right action, (v) right livelihood, (vi) right
effort, (vii) right mindfulness and (viii) right meditation.
Funding for above-mentioned activities comes almost exclusively from
donations of temple-goers and almost never from the government. As a
result, Buddhist temples are instrumental in helping local individuals, fam-
ilies and communities deal with localised issues; however, they do not yet
have resources to help with structural, large-scale social problems, including
mental health, even though they are well positioned in the community. The
profession of social work is currently developed in Vietnam with the expect-
ation that social workers will tackle these structural, large-scale problems.

Social work in mental health in Vietnam

Social work in Vietnam

As a profession, social work only started developing in Vietnam in the last

twenty years, though the French colonial government and Southern Viet-
namese regime had organised scattered social work services to serve the
French, the Americans and those working for them during the nineteenth
and early twentieth centuries (Ngo, 2009; Oanh, 2002). In 2004, the
1250 Huong Nguyen

Vietnamese government approved social work as a profession within the

registry of governmental occupations, thus making social workers part of
governmental staff for the first time. It was also in 2004 that the Vietnam Min-
istry of Education and Training approved social work as an official pro-
gramme of study at higher-education institutions (Ngo, 2009; Oanh, 2002).
At present, the country has about forty BSW programmes and one MSW
programme, with a few thousand BSW graduates, forty people with MSW
degrees and a few people with Ph.D.s in social work (Ngo, 2009). The
country has approximately 500 service agencies with more than 35,000 staff
working in various types of professions that resemble social work
(MOLISA, 2010). The majority of these staff (nearly 90 per cent) has little

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or no training in social work.
As mentioned earlier, the Vietnamese government approved a National
Social Work Development Program in 2010. In 2011, the MOH also approved
a National Project on Developing Social Work in Health Care between 2011
and 2020. Among the many goals of this project are: (i) for 90 per cent of
health care agencies to develop a plan to implement social work into their activ-
ities by 2020; and (ii) to implement social work into 80 per cent of central-level
hospitals, 60 per cent of provincial-level hospitals and 40 per cent of commune
or district-level hospitals by 2020 (Vietnam Ministry of Health, 2011a).
In these master projects, the Vietnamese government has excluded in-
formal service systems, including the wide network of Buddhist temples.
Because of this exclusion, Vietnamese mental health social work will face a
great cultural challenge: Vietnamese people stigmatise seeking help from
formal mental health systems, while they are comfortable seeking help from
Buddhist temples. An exploratory study with 200 adults and eight focus
groups in Vietnam by Ham and colleagues (2011) found that respondents
were often unable to name specific mental illnesses and described mental
health patients with stereotypes of people with severe mental disorders such
as talking nonsense, talking or laughing alone and wandering. These findings
resonated with a report by Tran Tuan, who found that the majority of Vietnam-
ese people misunderstand, stigmatise or stereotype mental health patients.
Vietnamese people equated mental health problems with severe symptoms
of ‘craziness’ and described mental health patients as people ‘being treated
at [a] mental hospital . . . or at home but you must always keep an eye on
them’ (Tran, 2009, p. 1). My own exploratory research also indicated that the
majority of patients at mental health hospitals sought informal help, especially
spiritual counselling with Buddhist monks or mediums, before seeking formal
services (Nguyen, forthcoming). In most cases, the reluctance to seek help
results from (i) fear of losing face and honour for themselves and their families
if their problems are disclosed; (ii) lack of understanding of the nature and con-
sequences of the problems facing them; (iii) lack of trust in professionals, espe-
cially newly emerged professionals like social workers; (iv) cultural, spiritual
and religious beliefs that stigmatise seeking external help; and (v) lack of
awareness for available help and accessibility to resources.
 Linking Social Work with Buddhist Temples 1251

Linking social work with Buddhist temples

The above discussion suggests that there is a strong need for mental health
services in Vietnam that is not currently being met by formal mental health
systems. To strengthen mental health services, the Vietnamese government
is making great efforts to incorporate social work into mental health services;
however, the efforts only extend thus far to formal mental health settings.
Since Vietnamese people stigmatise seeking help from formal mental health
systems yet they are comfortable in seeking help from Buddhist temples,
I propose a model that actively uses social work as a liaison between Buddhist
temples and the formal mental health system. The first step of this model is

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for social workers to collaborate with Buddhist temples and formal mental
health system to refer, support and educate people in need of mental health
services. In the future, the connection between Buddhist temples, social
work and the formal mental health system can encompass more in-depth activ-
ities such as employing Buddhist principles into mental health treatment and
employing social work skills into helping activities provided at Buddhist
temples (Figure 2).
There are several arguments in favour of the above model besides the fact
that it will fill an organisational gap in mental health services. First, linking
social work centres with Buddhist temples in Vietnam will be consistent
with a model that has had a long tradition in Vietnam and the world: using
existing local faith-based institutions to help people and communities.
Indeed, Buddhist temples and other religious groups (e.g. Catholic missionar-
ies) have been providing services to the Vietnamese for a long time, even
though they have been doing it without formal support from the government
(Oanh, 2002; Nguyen, 1979). Japan, South Korea and China have used selected
Buddhist philosophies as the foundation to develop a body–mind–spirit
model to treat patients with mental disorders (Chan and Chow, 2001). Thai-
land, a Buddhist nation, has two parallel systems of social services: a smaller

Figure 2 New vision for incorporating social work into mental health services
1252 Huong Nguyen

system run by professional social workers and a larger one run by Buddhist
temples (Nye, 2008). In America, most American mental health patients iden-
tify themselves with one or more religions (Corrigan et al., 2003) and confirm
that their faith helps alleviate mental health symptoms in schizophrenia,
depression, suicide and addiction (Fallot, 2001; Koenig and Larson, 2001).
The application of Buddhism-based therapies such as Acceptance and Com-
mitment Therapy has proven effective for mental problems such as PTSD
among veterans (Hayes, 2002).
Second, Buddhist temples in Vietnam have been physically situated in local
communities and deeply engaged in the life of local communities, especially in
rural areas. Therefore, the Buddhist monks have gained trust and respect from

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the local people—a feat that social workers in Vietnam will be unable to ac-
complish immediately. Collaborating with Buddhist temples can help social
workers raise awareness in Vietnamese society about the mission, values, activ-
ities and skills of social work. This can be especially effective in rural areas
where farmers learn about services through word of mouth.
Third, due to the strong influence of Buddhism in Vietnamese culture,
social work clients are likely to hold key Buddhist beliefs, particularly in
matters related to personal suffering. As such, Vietnamese social workers
must be aware of the Buddhist influence on their clients’ thoughts, attitudes
and behaviours in order to support them and develop proper treatment plans.
Similarly, Vietnamese social workers themselves are likely to hold some Bud-
dhist beliefs; thus they must be conscious of their religious beliefs in order to
remain professional and ethical in their practice.
Fourth, having lived for centuries in Buddhist, Confucian and Taoist tradi-
tions, Vietnamese people are receptive to services that incorporate Buddhist
principles (Canda and Phaobtong, 1992). The social work profession in
Vietnam should acknowledge the spiritual nature of Vietnamese people
and their increasing religious and spiritual needs (Gustafsson, 2009; Thich,
2008). If the emerging social work profession in Vietnam acknowledges
these realities and takes proactive action to address them, the profession
will be on its way to alleviating many explicit and implicit mental health pro-
blems in Vietnamese society.
In this model, Buddhist temples can collaborate with social work to
perform four major activities: (i) conducting intake, referrals and coordin-
ation of services; (ii) providing selected direct services; (iii) delivering train-
ing, education and information; and (iv) promoting community development
and policy advocacy (Figure 3).

Function 1: Intake, referral and service coordination

When the monks at Buddhist temples are aware of mental health problems
facing temple visitors, they can refer these people to social work centres or
appropriate mental health professionals for help. For example, if a family
 Linking Social Work with Buddhist Temples 1253

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Figure 3 A model for service delivery in Vietnam

asks the monks to perform spiritual rituals for a recently deceased member,
the monks can refer the family to mental health counsellors if they see the
family struggling with grief and trauma. Conversely, if social workers or
other professionals (therapists, psychologists, psychiatrists) realise that
their clients are having spiritual concerns and can benefit from counselling
with Buddhist monks, they can refer these clients to Buddhist temples with
connections to social work centres. For this activity to be effective, Buddhist
monks and social workers should receive basic training in intake and assess-
ment for mental health issues.

Function 2: Direct services

Within this function, Buddhist temples can work with social work centres to
provide selected mental health services to clients in several ways. First, the
monks at the temples can receive training in social work counselling so that
they can also provide clinical counselling to clients with mental health pro-
blems. Second, the monks at temples and social workers at social work
centres can co-case manage certain clients who are referred to social work
centres through the temples and who have close relationships with the
temples. Such coordination can be particularly meaningful for community-
based mental health since the monks are likely to have deep knowledge
about individuals and families in the community.
In selecting mental health services to provide directly to clients, temples
and social work centres should focus on services that are not too clinical,
those that do not violate religious and spiritual principles of the temples,
and those that would not make clients uncomfortable. In addition, Buddhist
monks need to receive basic training on social work ethics and values, espe-
cially the issue of confidentiality. Some of the areas in which Buddhist
temples can provide mental health services include:
† mental health issues related to family functioning, such as domestic violence,
family conflicts, family disruptions and child abuse;
1254 Huong Nguyen

† mild mental health issues related to grief, anxiety, stress, illness, death, birth,
loss and trauma;
† issues related to disability, terminal illnesses or highly stigmatised diseases
(e.g. HIV/AIDS);
† mental health issues related to addiction, particularly alcoholism and gam-
bling—two serious issues in rural Vietnam.

Function 3: Education, training and information on mental health

This activity is especially important since Vietnamese society lacks knowl-

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edge about mental health. Buddhist temples and social work centres can col-
laborate through the following activities:
† Buddhist temples can display and distribute materials on mental health
issues so that temple visitors can learn about mental health in a non-
threatening environment;
† the monks can communicate with social work centres about mental health
services available in the community so that the monks can introduce and
refer local people to these services;
† social work centres and Buddhist temples can collaborate to organise train-
ing courses in the community about common mental health issues such as
coping with stress, family disruption and disaster.

Function 4: Community development and policy advocacy for mental health

Community development is important in Vietnam and an area in which Bud-

dhist temples can play an essential role. Specifically, Buddhist temples and
social work centres can collaborate to organise community activities (vaccin-
ation day, donation drives, festivals) to strengthen social networking and the
social capital of the community and, therefore, can strengthen the overall
mental health status of community members.

Model implementation and the role of the Vietnamese

government
The above linkage model can be implemented effectively only if the Viet-
namese government supports the model through specific actions and pro-
grammes:
† the government can provide funding to Buddhist temples to provide direct
mental health services and receive social work training;
† the government can provide funding for social work centres to deliver ser-
vices at Buddhist temples, such as providing training to monks or providing
direct services to temple visitors;
 Linking Social Work with Buddhist Temples 1255

† the government can advocate for Buddhist universities, colleges and institu-
tions to include basic social work skills in their curricula;
† the government can advocate for social work education programmes to in-
corporate religious and spiritual social work into their curriculum, especially
Buddhism-based social work;
† the government can conduct research about the roles of Buddhism and Bud-
dhist temples in communities in Vietnam, help-seeking behaviours of Viet-
namese people, needs for social work services and the ways in which social
work and Buddhism can be connected;
† the government can develop pilot programmes to connect Buddhist temples

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and social work centres.
In developing and implementing the model linking Buddhist temples with
social work centres, the social work centres should play a proactive role by
approaching Buddhist temples to initiate collaboration. Then, Buddhist
temples and social work centres can gradually build and implement specific
programmes based on the needs, conditions and characteristics of the local
community as well as the resources available to both sides. Throughout this
process, social work centres need to be flexible and sensitive to the religious
and spiritual nature of Buddhist temples so they do not violate and break
down the status and main function of Buddhist temples in the local commu-
nity. After the initial connection has been established, the two sides need to
develop specific programmes and then experiment and evaluate them in
order to sustain and expand the connection.
The model can also be applied to communities and societies with strong
Buddhist influence such as most Asian countries and Asian communities
living overseas. Extensive literature has found, for example, that even
though roughly 34 per cent of Asian Americans are diagnosed with mental
health problems, only 8.6 per cent of them seek services. This is the lowest
rate of service utilisation among all racial groups in America and only half
of the rate in the general American population. This disparity is due to the
stigma against mental health and formal help-seeking (Abe-Kim et al.,
2007; Spencer et al., 2010). Buddhist beliefs in particular become a consistent
source of help to this community. Early on, Canda and Phaobtong (1992)
found that millions of refugees from Vietnam, Laos, Cambodia and other
South East Asian countries relied on Buddhism to cope with the trauma
they experienced during their journey to America as well as in settling
down in a new culture. In that light, building a Buddhism-based approach
to mental health might be an effective way to approach Asian communities.

Conclusion
In this paper, I have reviewed the formal and informal system of mental
health services in Vietnam in order to argue why the emerging social work
1256 Huong Nguyen

profession in Vietnam should collaborate with both systems in delivering ser-

vices. In essence, I argue that the Vietnamese government should support
Buddhist temples and social work centres to collaborate in four areas of
mental health activities: (i) service intake, referral and coordination; (ii) pro-
vision of direct services in areas appropriate for both sides; (iii) education,
training and information; and (iv) community development and policy advo-
cacy. In order for the collaboration to be meaningful and effective, it must not
violate the religious and spiritual nature of Buddhist temples or the social
work Code of Ethics. Given the strong influence of Buddhism in Vietnam,
the model has the potential to be successful, especially in rural areas where
Buddhist temples are very active and engaged in local life. The model can

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also be used in Vietnamese communities overseas as well as in countries
where Buddhism has a strong influence.

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