Discussions on lack of specialist medical healthcare services, including mental healthcare in rural areas, often lead to poor doctor-patient ratio. However, Vikram Patel, the Perishing Square Professor of Global Health and Welcome Trust Principal Research Fellow, Harvard Medical School, opines that training frontline health workers is crucial to addressing the gap in mental health services. In a brief interview with The Hindu during his visit to the city, Dr. Patel, whose work focuses on reducing the gap in the treatment for mental illnesses in low-resource countries, spoke on why is it important to address the issue and how mental health service can be improved.
Do you think the availability of psychiatrists in rural areas will improve access to mental health services?
We definitely need more psychiatrists. Our country has not only too few, but they are all concentrated in a few metros. But this is true of all specialists. In the U.S., there are 10,000 times more mental health professionals than in India. Yet, the majority of Americans do not get psychiatric care. Psychiatrists work with complex problems in hospital settings. These professionals are expensive as they undergo a lot of training. They work in hospitals, and not go to people’s houses and give continuing care. Many of the interventions for mental issues are not drugs, they are psychological and social. So we must see this as a problem that needs both the psychiatrists and psychologists. But what’s more important to me is the community health workers, who are trained to deliver psychological and social interventions for mental health issues.
Why the stress on community health workers being trained?
Not just them, even teachers in schools as well as laypeople should be trained. Any person should know how to heal a broken wound. If my leg is bleeding after a cut, you don’t run to the emergency room. You get a band aid and stick it on it. In the same way, each and every one of us should at least have some basic skills on how to help ourselves when we have mental illness, and how to help our neighbours.
Are there any plans of taking up research on any aspect of mental healthcare in Telangana or in India?
I would love to work in Telangana. I have been working in other parts of India for 25 years. We are largely working with the governments of Madhya Pradesh, Goa, Haryana and Bihar. For instance, in Madhya Pradesh, we were working with Accredited Social Health Activists to train them in delivering brief psychological treatment to people for depression in primary care.
What needs to change in mental healthcare services being provided in India?
If I was working in a district in Telangana, I would want a coordinated mental healthcare system that starts from the district hospital where we must have a 10 or 15-bed acute psychiatric unit with a psychiatrist, psychologist and a nurse, who supervise the whole district’s mental health programme.
But the delivery is done through a network of community health workers that could be ASHA workers, who identify cases and support psychosocial interventions.
