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Foto: Harvard Medical School
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Honorary doctor Vikram Patel: “View mental health not only from the medical sciences”

Sija van den Beukel,
9 januari 2023 - 08:30

On the occasion of the 391st dies natalis, the UvA today awarded two honorary doctorates, one of which went to Indian professor and psychiatrist Vikram Patel (58). Folia spoke with him about his work in international mental health and the impact of the corona crisis.

As a medical student in India, Vikram Patel already nurtured a deep interest in biology, but always in a social context. Against all advice, he chose to become a psychiatrist. Throughout his life, Patel built not only a scientific but also a social career, a combination ideally suited to an honorary doctorate.

 

In addition to being a famous psychiatrist, Patel is also a mental health scientist and professor of Global Health at Harvard Medical School. His research focuses on the relationship between mental health problems and social disadvantage. Nearly ninety percent of people with mental health problems in developing countries are not treated because of a shortage of psychologists and psychiatrists. Together with fellow researchers, Patel developed an approach to train people from local communities to provide mental health care. In this way, “ordinary” people are empowered to care for others.

Vikram Patel

In addition, Patel is co-founder of Sangath, a community-based Indian non-profit mental health organization for all ages. He also serves on several committees in the government of India and on various World Health Organization (WHO) committees. In 2015, American opinion magazine Time named Patel one of the 100 most influential people in the world.

 

The honorary doctorate at UvA is already his fourth honorary doctorate. Because of postponed ceremonies during the corona pandemic, he was awarded two last year, one at Britain's York University and one at Stellenbosch University in South Africa. He received an honorary doctorate from Georgetown University in the U.S. many years ago. Patel: “And then, of course, I myself am a doctor by profession. My family already jokes about it, that I collect doctor titles.”

 

What does the honorary doctorate from the UvA mean to you?

“An honorary doctorate is an enormous academic honor. Every doctorate is special because every university is unique. The Netherlands is one of the most innovative countries when it comes to international mental health that pays a lot of attention to its social aspects. This goes back decades, when Dutch mental health professionals and psychiatrists conducted research in Africa and other low-income countries on alternative worldviews of mental health. Some of my key colleagues are Dutch, some I know from the UvA, some from the VU. There are also many NGOs in the Netherlands that I worked with, such as TPO and Warchild. Amsterdam is a special place for me.”

 

Where does your interest in mental health come from?

“During my medical training, I became disillusioned with the limited biomedical perspective. As a student, I was very interested in biology, but always in a social context. Medicine therefore seemed ideal to me. But in medical school, the focus was much more on the disease than on the person. Psychiatry was the only field where the doctor still asked human questions such as: who do you live with, what do you do and how was your childhood? Incidentally, everyone advised me against going into psychiatry, even my mentors in medical school. Once I became a psychiatrist, I discovered how much mental illness there was within my family. That was never talked about, but that changed when I became a psychiatrist.”

“My work has always focused on non-specialists such as primary care nurses, midwives, and social workers”

And did that help?

“Yes, it did. My mother had lived with many mental health problems for a long time and was able to talk about them more and more easily. She became the most outspoken advocate for my work.”

 

How would you briefly describe your work?

“My work has always focused on non-specialists such as primary care nurses, midwives, and social workers, mainly because I believe mental health professionals need to play a much more specialized role. On top of that, people often don't approach a professional right away because of the stigma attached to psychological problems. Many problems can be solved by people in the patient's immediate environment or through primary care. That's the philosophy I really stand for.'

“Worldwide, no country has succeeded in reducing mental problems”

In the Netherlands, psychological problems among young people accumulated during the corona crisis. The queues at mental health institutions only increased. Does the method you developed, to train the community to provide help, also offer a solution in the Netherlands?

“I see no reason why this approach would not also be relevant in prosperous countries. Worldwide, no country has succeeded in reducing mental problems, regardless of how prosperous the country is or how many psychiatrists and psychologists there are. This is very different from diseases such as cancer or cardiovascular disease. So why have all countries failed on mental health? I think it is because we view mental health only through the narrow lens of the biomedical sciences. That works for diseases like cancer, but mental health problems require a more diverse, societal approach that includes the psychological, social, spiritual as well as medical sides.”

 

What impact did the corona crisis have on the mental health of young people?

“The risk of developing mental problems is greatest during youth This was true even before the corona crisis: three-quarters of all health problems begin before the age of 24. Between the ages of 10 and 24, you go through the biggest changes you will ever experience in your life. You change from a totally dependent child to a completely independent adult, you make your own financial decisions, you develop your own sexual identity, your own relationships. Not surprisingly, this period of social, physical and psychological change is linked to the onset of mental health problems. The pandemic only increased that likelihood. Young people's need to meet, form relationships and get an education or a job, important developmental tasks of this stage of life, were completely disrupted. While we wanted to protect the entire population, we forgot the needs of young people.”

“In India schools were closed for almost two years during the corona crisis”

What struck you about different countries' approaches to corona policy?

“The approach varied widely in different countries. India had about the worst corona policy. Schools were closed for almost two years. The damage that did to children is catastrophic, but almost no one talks about it. You see it already in school performance, a key predictor of mental health. If you learn well, you do better in life, and that protects you from some of the social disadvantages like low income that are associated with poor mental health. We have a generation of children in India and other developing countries who have experienced significant limitations in their long-term educational outcomes.”

 

Last week in your column in the The Indian Express, you wrote, among other things, about your desire to improve the health industry in India. How would you go about that?

“Medicine in India has become an industry. That is not the medicine I am enthusiastic about and why I wanted to become a doctor. The private hospital industry sees health as a commodity with which to make a profit rather than a fundamental right. Europe regulates health better with universal health care. In India, people pay a lot of money to become doctors. They want to earn that money back. That leads to a lot of unethical practices. I would start by installing an independent regulator with the authority to hold doctors and hospitals accountable if there are complaints about improper use of drugs, irrational treatment, or high bills. Doctors in India seem to be above the law and are rarely punished for unethical or bad practices. That must change. Without enforcement, you can't improve the quality of care.”