Rethinking approaches to mental health in poor rural areas of the developing world.

by Michaela McDonald

Vikram Patel delivered a TED Talk recently, titled “Mental Health for All by Involving All”.  He spoke about the treatment of mental illness in areas of the developing world lacking trained therapists to treat depression. Almost 450 million people worldwide are affected by mental illness. There is a staggering difference in the life expectancies of people with and without mental illness. In the developed world, those with mental illness die up to 20 years before those without mental illness. And the disparity in the developing world is even larger. Close to 90% of people with mental illness in the developing world remain untreated, which can have significant impacts on their quality of life. One of Patel’s solutions to this unmet need for mental health care is a practice called “task shifting”. Essentially, Patel believes that we can meet the unmet need for mental health care by training community members in proven therapeutic techniques. The research on the topic is encouraging, with a 70-90% effectiveness in different settings. His ideas of task shifting provide an encouraging mechanism for those whose mental illness can be improved through talk therapy.

But what are people in rural areas of the developing world supposed to do if their mental illness does not respond to talk therapy? A non-profit in India is trying to help those who need a different type of intervention. The Schizophrenia Research Foundation (SCARF) operates a mobile telepsychiatry unit where patients can have an appointment with a psychiatrist in a far-away city via Skype and get medication from a pharmacy at the back of the RV. SCARF currently reaches 800 villages, giving a huge number of people access to mental health care that would otherwise be completely inaccessible. To read more about SCARF, click here.

There are those who criticize efforts to expand access to this type of mental health care, saying that using a Western model of disease and medication is inappropriate in India and other areas. However, there is also a benefit to that care being provided by members of the same community, or occurring within the village, eliminating the need for expensive travel. What do you think about these responses to a lack of mental health care practitioners in poor rural areas of developing countries?

(McDonald is a graduate student in the Maternal and Child Health Program at the University of Minnesota.)