India Uses Peer Support for Mental Health

Dr Vikram Patel is on Time magazine’s annual list of 100 most influential people in the world.  He has been revolutionizing the way mental health issues are approached and treated, not just in India but across the world 

 Dr Vikram Patel, a psychiatrist aged 51, is arguably the best known Indian mental health professional in the world today. Patel and his colleagues at Sangath, an organization that he helped set up some 20 years ago, have been revolutionizing the way mental health issues are approached and treated not just in India but across the world.

Through innovative experiments that have withstood scientific scrutiny, Patel’s team has demonstrated that medicines should be the last resort and not seen as the only solution to disorders.

“Most people who suffer from depression, anxiety, suicidal feelings or post-traumatic stress disorders do not see them as a mental health problem but as a social disorder – a disorder caused by social circumstances,” Patel says.

The good doctor, wearing his trademark kurta and blue trousers, speaks with passion – and gestures that are as evocative as his words.

During his research, he found that when there is a mental disorder people go to a priest, faith healer, friend or someone in the community whom they trust. “Approaching a psychiatrist is the last thing on their minds,” he observes. He used this insight to find out if trained but non-medical counselors drawn from the community could provide effective psychosocial services to people who needed help.

Today, Sangath’s presence is felt in most parts of Goa. “Almost 95 per cent of the people who seek our assistance are provided this at a place where they are comfortable, be it village halls or schools. Only five per cent need to visit our clinics,” he says.

Today, Patel wears many hats. Apart from spearheading Sangath, he is a joint director of the Centre for Global Mental Health in London and co-director of the Delhi-based Centre for Control of Chronic Conditions that Sangath jointly set up with the Public Health Foundation of India (PHFI), New Delhi.

And, as you’d expect, he leads quite a peripatetic life. “These days, I spend about four months in Delhi, two months in Goa and one month in London.” The rest of the year is spent in places where he has ongoing projects – in India and abroad.

Over the years, Sangath has expanded its horizons. In addition to Goa, it has footprints in Assam, Bihar, Haryana, Madhya Pradesh and Maharashtra. In terms of scope, it covers a vast area starting right from early brain development disorders to mental health issues related to adolescence and those that crop up in old age. “We cover the entire spectrum of mental health disorders,” he says.

It was his experience in Zimbabwe that “opened” his eyes. “In 1993, when I landed in Zimbabwe, there were just 10 psychiatrists in that country of 10 million people. Nine of the 10 were foreigners who spoke no regional language,” he recalls.

He really had to “unlearn” what he’d learnt at King’s – widely perceived as one of the best psychiatry schools in the world. It prompted him to look for an alternative mental healthcare strategy which would be inclusive and more affordable.

“The current approach that psychiatry takes almost ignores social worlds in which mental health problems arise and tries to become highly biomedical like other branches of medicine such as cardiology or oncology. But psychiatry has to be far more embedded in people’s personal and social worlds,” he holds.

Even in Western countries, where the number of psychiatrists far exceeds that in India, only 50 per cent of the needy get psychiatric care, he says. “In countries like ours, nearly 90 per cent of the affected are neglected.”

Which is why, after his PhD, he spurned lucrative job offers in London and headed back to Goa, with a fellowship grant from the British Wellcome Trust. Midway through the program, when the fellowship suddenly stopped, he did private practice for a year to fend for himself. “But I was determined not to go back to London,” he says.

In the larger world of psychiatry, Sangath stands out. His peers from across the world seek to collaborate with it. “They have a fine infrastructure to do mental health research in low-resource settings,” says Charles F. Reynolds, professor of geriatric psychiatry at the University of Pittsburgh in the US. Reynolds and his team are already working with Sangath and the Goa Medical College on a project that would help monitor and screen older people for depression.

What sets Sangath apart from other bodies is that it evaluates its work using robust scientific methods. “If you do something new and out of the box, it could be wrong – that could be useless, or dangerous. So there is a need for an objective evaluation,” he stresses.

Mental health, he adds, is “too precious” to be left to psychiatrists alone. “We believe that mental health is everybody’s business. And there is no health without mental health.”

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The above article was adapted from a longer article by T.V. Jayan

posted at http://www.telegraphindia.com/1150426/jsp/7days/story_16667.jsp

Sunday, April 26, 2015 in the newspaper: The Telegraph, Calcutta, India