Improving access to mental health care in low and middle-income countries

The work of Vikram Patel, professor of international mental health, and his colleagues has influenced other researchers, policy makers and donors, and made a singular contribution to the emergence of global mental health as a vibrant academic discipline.

Patel and colleagues have carried out pioneering research on the burden of mental health problems, their social determinants and their treatment in low and middle-income countries, working with partners including Sangath, the Public Health Foundation of India and CBM International.

Their most notable research has been in demonstrating that non-specialist workers can deliver treatments for mental health problems in low-income countries. An example of such a project is the MANAS randomised controlled trial, the largest trial in mental health care in the developing world, which evaluated the effectiveness of primary care based lay health counsellors for depression and anxiety.

Patel led the development of a landmark six-article series in the Lancet in 2007, the first in the journal to focus on global mental health. This series reviewed the burden, treatments and health system responses to mental disorders in low and middle income countries and ended with a call to action to scale up mental health services.  The call to action was the catalyst for the launch of the Movement for Global Mental Health in 2008, a coalition of individuals and institutions aiming to improve services for people with mental disorders and whose members come from more than 100 countries.

In 2008 WHO launched a flagship action plan to scale-up services for mental disorders, which cited Patel’s Lancet series. This eventually led to a Comprehensive Mental Health Action Plan in 2013. A further series in the Lancet in 2011 and two in PLoS Medicine, all led by Patel, have built on this evidence base and contributed to the continuing growth of the discipline and attention given to mental health in global policy.

The research has also galvanised donors. Grand Challenges Canada has committed C$30m (£16.5m) and the US National Institute of Mental Health has pledged US$15m (£9.9m) to mental health projects in the developing world, in response to the publication of the Grand Challenges in Global Mental Health, a research priority setting initiative which was co-led by Patel.

Patel’s manual, Where There is No Psychiatrist, published in 2003 has been translated into more than a dozen languages and is a core text for mental health nurse training in Liberia, as well as the key mental health manual for Médecins sans Frontières programme staff. The International Red Cross has also adapted this for agencies working in emergency situations.

Patel has been involved in the establishment institutions to promote mental health research in low and middle income countries, particularly in India where he founded the Centre for Mental Health at the Public Health Foundation of India, and Sangath, a community based non-profit organization which has become one of India’s leading mental health research institutions.