Guest Post: We Are Not Alone (Vikram Patel and Global Mental Health)
Here’s another in a series of guest posts by our friend/mentor/intern Jill Seidenstein.
The issues that arise within Shanta’s story are complicated and difficult to disentangle from each other. Attempting to detangle mental health from global development from cultural shifts makes me dizzy. I start to follow one thread and find myself hopping to another, wondering about various factors that could or could not be making things better or worse.
I’m going to focus on mental health for a moment, though. Amy and Scott are shedding light on a variety of serious issues, through the lens of a single person. We come to care about her and wonder what if? They are not the only ones asking that question, and there are other people working on answering it.
Vikram Patel is one of those people. He’s a psychiatrist from India who trained in the UK and is now based back in India, in Goa. He spoke at a TED event about his experience and where he’s going with it. He observed a radical disconnect between how he had been trained to deliver care in highly resourced countries and the need that was present in developing nations. For countries in Europe, perhaps 50% of those with mental illnesses don’t get the treatment they need; in developing nations, that rises to 90%, due primarily to the model that relies on highly trained, specialized professionals to treat individuals in combination with the severe lack of those professionals.
Patel learned about “task shifting” in health care, which is a sort of distributed model for dispensing health care. Individuals are trained in their communities to take on certain tasks with minimal training, taking the burden off a specialized expert and locating the knowledge and expertise within the community. He identified a 5-step recipe to implement task shifting for any type of health care being provided, captured with the acronym SUNDAR, which means “attractive” in Hindi.
Here are the five steps:
- Simplify the message (strip medical jargon that’s been invented)
- UNpack the treatment – break down complex treatments into smaller components that can be easily transferred to less-trained providers
- Deliver it where people are – not in large, centrally located institutions but in people’s homes
- Affordable and available human resources – people who are available in our local communities
- Reallocate specialists to train and supervise, rather than deliver the care themselves
At the beginning of his talk, he asked the audience to think of someone they knew who had a mental health issue or mental illness. He pointed out that the person was probably someone intimate in their social network. I think the reason we are all touched by Shanta’s story is that each of us has known someone whose life has been affected by suicide, a very real and palpable measure of depression and mental illness.
As more light is brought to the issue, awareness will increase which in turn increases support for programs like Patel’s. His model brings a lot of hope, because it doesn’t rely on labor-intensive model that would take decades to implement. Instead, it is lightweight and portable, and can be culturally sensitive since the trainers are working with people within their communities, instead of imposing care from the outside or forcing people to be removed from their context for treatment. For countries with few resources, a small amount of effort will have a large and lasting impact.
(Scott here again) I’d like to add here that, while we are discussing Shanta’s life and death in light of mental illness, we do not know if her suicide was the result of mental illness. We suspect it was, but we are certainly not qualified to make that diagnosis! For the purposes of our film, we are exploring that connection mainly because Shanta’s death brought us to awareness that there is a crisis in mental health support in Nepal.
The comments we receive from people familiar with the landscape of mental health there convince us that we’re onto something. But ultimately we are a lot more about finding questions than giving out answers.