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How to Treat Depression When Psychiatrists Are Scarce

WIRED
by Greg Miller December 3, 2013

Psychiatrist Vikram Patel has a radical idea to make mental health counselling available to people in developing countries.

Mental health doesn’t even rate a mention in most policymakers’ lists of global health priorities. But mental illness and substance abuse disorders rank among the greatest causes of disability worldwide. In poor countries, where there aren’t nearly enough therapists, these conditions cause tremendous suffering and block economic development. Vikram Patel, a psychiatrist at the London School of Hygiene and Tropical Medicine, has a solution: train ordinary people to be coun­selors.

In a rigorous study in Goa, India, Patel found that young women could learn basic psychotherapy skills and go on to help people with depression at least as well as local clinics would have. Now he’s advising the Indian government on incorpor­ating these lay counselors into the national health system. We talked to Patel about why this strategy is necessary for poor countries—and how wealthy countries could benefit too.


Does mental illness get less attention because it doesn’t kill like AIDS and malaria?

PATEL:  Mental illness does kill. Worldwide, suicide is one of the primary causes of death in young ­people, and they are the engine of any economy—especially in the develop­ing world. In India, now that maternal mortality is falling, suicide is theleading cause of death in young women. On average, life expectancy for mentally ill people is 15 to 20 years less.

Then why is the focus always on infectious disease?

Before “global health” became a popular term, there was “tropical medicine.” Colonial administrators and soldiers used to end up in the tropics and get sick from things they never saw at home. Most of the ­people who make decisions about global health are in the US and Western Europe. There, the mental health care sys­tem is dominated by highly trained, expensive professionals in big hospitals, who often see patients over long periods of time. This simply can’t be done in rural Africa or India. Who the hell can afford that kind of care? The real innovation is redefining who is a mental health care provider.

Can you train people off the streets, with little education, to be counselors?

We’re training them to do very specific tasks. It’s a bit like training a community midwife: You’re not training her to be an obstetrician; you’re training her to deliver a baby safely and to know when to refer the mother to a doctor.

The training can be as short as two days or it can be two months, but the classes are the least important part. There’s a much longer period of supervised learning that happens through direct contact with patients. You don’t have much theory. You go directly to the skills you need to actually help people recover.

How do they actually counsel?

Most of our patients are women with depression linked to an unhappy marital relationship. So a counselor would identify the relationship as the reason the patient is feeling withdrawn and not sleeping well….Continue reading→

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