NextBillion - An Initiative of the William Davidson Institute at the University of Michigan

Thursday, November 16, 2017

It’s 1998. A 34-year-old, soft-spoken but intense Indian psychiatrist named Vikram Patel sits at a table in a conference room at the World Bank in Washington, D.C. Flanking him are several other mental health experts, looking out at a group of economists. Over the course of several hours, Patel and his colleagues carefully build a case supporting World Bank investment in mental health programs in developing countries, where little to no care for the mentally ill is available. People with untreated illnesses are unable to work. They are often rejected by their communities. Sometimes they’re chained up. Treatment programs could return these people to society.

The economists aren’t impressed. Where are the numbers showing the problems are widespread, and that illnesses can be treated? Patel is stunned by the lack of compassion. “It just seemed that all that mattered was the science, the numbers,” he says now. In 1998, there would be no help from World Bank.

But the meeting did accomplish one key thing. It energized Patel and others who were fighting to get mental illnesses recognized as a major global health challenge. The time had come to build an unassailable knowledge base to prove what they believed in their bones — that mental illnesses, like bipolar disease, schizophrenia and depression, are medical issues, not character weaknesses. They take a major toll on the world’s health, and addressing them is a necessity, not a luxury.

Building that base was not going to be an easy task.

For Patel, it all began five years before that fateful World Bank meeting. He’d just finished his medical and psychiatric training at top institutions in India and England. Eager to see the world, he landed a job at a hospital in Harare, Zimbabwe.

Patel expected to see a conventional psychiatric ward, maybe a bit run-down, with beds for patients receiving treatment. What he saw on his first day was much worse. His driver passed the main hospital and pulled up to a compound about 200 yards away, encircled by a nearly 5-foot-high metal fence. Hospital workers called it “the zoo.” Patients were dressed in white sacks with holes cut out for their heads and arms. Some were hanging on the gate or running toward the fence. Some were smiling, some were screaming, some were babbling. In a hospital ward inside the compound, some patients were tied to their beds.

In that moment, Patel realized he had to rethink his plans of practicing the psychiatry he’d been taught. Nothing he had learned was going to be of much use here.

Photo courtesy of Doug.Williams.