Community solutions are key to tackling mental health issues says Vikram Patel

June 27, 2022

“I am Bhanwarlal” is how Vikram Patel titled his opinion piece in The Indian Express last month.

A few days earlier, Bhanwarlal Jain, 65-years-old, died after being assaulted in the state of Madhya Pradesh. “The murder…rattled me deeply,” wrote Patel, a professor at the Harvard Medical School who co-leads the school’s Mental Health for All lab and co-leads the GlobalMentalHealth@Harvard initiative. “Of course, such acts of wanton cruelty are hardly uncommon in…(India.) What broke my heart was that the victim, Bhanwarlal Jain, was described by his family” as being mentally challenged.

A viral video shows a man assaulting Jain, a Hindu, while asking him if his name was Mohammed and demanding his identity card to verify his name. Jain, Patel notes, “…became terrified and disoriented, unable to grasp the nature of the evil he was confronting and respond to his torturer’s questions. Surely, I would not comprehend such mindless violence either. The blows rained down on this bewildered, hapless man until he died.” The assailant, reportedly an activist in Prime Minister Narendra Modi’s Bharatiya Janata Party, was arrested. 

Nearly half a billion “people are affected by mental illness worldwide,” Patel, 58-years-old, noted in a 2012 TED talk. “In wealthy nations, just half receive appropriate care, but in developing countries, close to 90 percent go untreated because psychiatrists are in such short supply.” A video of the talk has gotten more than 1.6 million views on the TED, YouTube and other platforms.

While doing research in Zimbabwe for his Ph.D., Patel “discovered that everything I had ever learned was impossible to apply because there were no mental health professionals,” he told The Crimson, Harvard University’s student newspaper.

In 1996, while a Ph.D. student, Patel founded non-profit Sangath as a modest child development clinic in Goa, India. Since then, with operations in Goa, New Delhi and Bhopal, it has developed path-breaking intervention programs in child development, adolescent and mental health and addictions in India. Its programs empower nurses, community workers as well as ordinary people to deliver affordable, easily accessible psycho-social interventions in their communities, including the welfare of people with autism, mental retardation, cerebral palsy and multiple disabilities.

Sangath’s goal is to bridge the treatment gap for mental health problems in India and other low- and middle-income countries. Its funding comes from a variety of foundations and government agencies including the Wellcome Trust, United Kingdom, Department for International Development, UK, National Institute of Mental Health, United States, and the Tata Trusts in India.

Patel also leads a team that developed Empower, an online-based curriculum for healthcare and community workers, as well as anyone else, to learn how to alleviate mental health issues. The team includes staff from the Harvard Medical School, Sangath, and partners around the world.

Empower’s first offering is a six-session treatment for depression in India and the US, consisting of videos with short quizzes. In just a few videos, one learns “how to demonstrate acceptance, listen effectively, identify signs of suicide, and put patients in contact with the right resources,” a report in The Crimson noted. Future Empower modules will cover emotional disorders in school-going adolescents, young children with autism and other issues.

Vikram H. Patel leads the Lancet Citizens’ Commission set up by the Lakshmi Mittal and Family South Asia Institute at Harvard University. It is working on formulating a path whose implementation can provide universal health coverage in India. Earlier, he served on the Committee which drafted India’s first National Mental Health Policy and was a co-editor of the 2011 Lancet series on promoting universal health care in India.

Patel co-founded the Movement for Global Mental Health, the Centre for Global Mental Health at the London School of Hygiene & Tropical Medicine, and the Mental Health Innovations Network. He is a Fellow of the UK's Academy of Medical Sciences and an adjunct professor at the Public Health Foundation of India.

His 2003 book Where There Is No Psychiatrist: A Mental Health Care Manual, published by the Cambridge University Press and translated into eighteen languages, has become a widely used manual for community mental health in developing countries. In 2018 he published an extensively revised second edition with co-author Charlotte Hanlon of Addis Ababa University, Ethiopia. He has published more than 250 peer reviewed scientific articles. He also offers himself as a keynote speaker for which he charges a fee of between $10,000 to $20,000 for a live event.  

In 1987, Patel earned his Bachelor of Medicine, Bachelor of Surgery from Bombay University; in 1989, an MS from the University of Oxford on a Rhodes Scholarship; and in 1997 a Ph.D. from the University of London. His thesis was based on research on mental disorders in Harare, Zimbabwe, where he and his wife Gauri lived for three years.

While at the University of Bombay, to the displeasure of his mother, Patel moved from studying neurology to psychiatry since he was interested in blending medicine and personal care from a social perspective. At that time psychiatry had a stigma, Patel told an online publication of the Mittal Institute at Harvard. “The overwhelming majority of mental health professionals in India lived and worked in just a few urban areas. And almost all in-patient care was in asylums that had been built during the British era.”

As a child Patel had severe bouts of asthma and on three occasions the doctors had given up hope of his surviving, his mother Bharti Patel told Rediff.com. He was in and out of hospitals and his paternal grandfather, a former Indian ambassador to Belgium, feared he would not finish high school. While Vikram Patel always wanted to be a doctor, “seeing his physical condition everyone would laugh at his dream,” his mother noted.

Through his research and community work, Patel seeks to convince policy makers of the need to integrate tackling mental health issues as part of broader social policies since it is often linked with other health, poverty alleviation and development priorities.

Patel demonstrated that community members, using low-cost resources, can help deal with autism, emotional disorders in adolescents, depression and substance-use problems. “Let’s not ask what we don’t have; let’s ask what we can do with what we do have,’” he told the Mittal Institute.

While advocating community-based solutions, Patel does not see it as a replacement for the specialized mental health care system. His goal, he added, is to expand “the footprint and reach of the existing mental health care system deep into the community to reduce the large disparities in access to quality care.”

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