Integrative Care

Alternative carers can help

avert mental health crisis

While 14 percent of the global disease burden is due to mental ill health, most of those affected lack treatment, a crisis which is getting worse. But there would be more than enough caregivers, if alternative practitioners were included, said professor Vikram Patel in his keynote lecture at the 8th Annual International Congress of Complementary Medicine Research – ICCMR 2013 –  in London recently.

Vikram Patel is professor of international mental health, Wellcome Trust senior research fellow in clinical science at London School of Hygiene and Tropical Medicine, and a world-renowned psychiatrist and activist in the field of mental health, particularly for low-income countries.

He is also author of the book ”Where There Is No Psychiatrist”, a mental health care manual for non-specialist health workers, widely used in developing countries.

Think outside the box
Mental and neurological disorders are virtually the most neglected global health problem in low- and middle income countries, however you measure it, according to professor Patel.

In his keynote speech, titled ”the role of CAM in rethinking mental health care”, he asked the audience to ”think out of the box” about who is a mental health care provider.

He referred to the call in 2008 of the WHO Mental Health Gap Action Programme to step up services in mental health, particularly in low- and middle-income countries. But he disagreed with the premise behind the initiative.

The primary agenda is to reduce the gap, and make treatments more available. But this is based on two flawed assumptions, that the treatments are only going to come from one tradition, the biomedical, and also that the providers are going to come from that tradition.

There simply are not enough biomedical practitioners to go around, and will no be for the foreseeable future.

Huge untapped resource
Instead, he described complementary and alternative practitioners – making up the corps of so called barefoot practitioners – as ”a huge untapped resource” of both biomedical and complementary interventions. They outnumber biomedical providers 20 to 1 and can take care of the bulk of mental health problems, he asserted.

Lack of access is partly because of the growing remoteness of mental health professional providers from the communities they serve, using heavily medicalized interventions. Here there are two key roles for complementary and alternative medicine, to deliver evidence-based interventions, often more intimately embedded in the context of the patients, and to offer different therapeutic modalities which can complement and increase the range of intervention options for these disorders.

Linked to poverty
Patel´s primary focus is on inequalities in mental health, mainly between rich and poor countries. The problems are vast with depression as one of the leading causes and suicide as the leading cause of death in young people.

      The issue of mental ill health cannot be viewed in isolation, Patel explained. It is tied up with poverty through a vicious cycle, and linked to health in general. Factors such as the experience of insecurity and hopelessness, rapid social change and the risks of violence and physical ill-health may explain the greater vulnerability of the poor to common mental disorders.

– There is no health without mental health, Patel said, offering the example of the relationship between maternal depression and infant growth.

Mental health also impacts on the whole issue of human rights.

There is a systematic abuse of basic human rights and discrimination of people with mental ill health. Some of the worst examples of abuse are perpretrated towards these people, many in mental hospitals in the developing world, left over from colonial times, said Patel. 

Collaborative care emerging
There is preliminary evidence of collaborative models of care emerging from some developing countries,  and good evidence that biomedical interventions can be delivered by non-medical providers, Patel said, giving the examples of depression treatment in Uganda and Pakisan.

There is also historical evidence for CAM interventions, in particular related to indigenous or traditional approaches to mental illness as well as clinical trial evidence, weaker in the CAM field, but for example in yoga a growing evidence- base for e.g. yoga as a stand-only or combinded intervention.

Rich source of medicinal herbs
Some of the opportunities for the future include strengthening the evidence base, and the new research money and other resources being allocated by countries such as South Africa, China, Brazil, India, and the US, which  also involving redefining who are health professionals, taking into account culturally appropriate, and traditional systems.

Patel mentioned commitments by the Bill and Melinda Gates Foundation to improve access to care by involving non-biomedical providers in colloboration with biomedical services.

There is also a rich source of medicinal herbs, which have been traditionally used for mental illness, constituting an untapped resource, we have not began to capitalize on yet.


David Finer



I C will report from 8th annual ICCMR congress, 11-13 April 2013, Institute of Education, London WC1H 0AL


Long Term Conditions: developing global, integrative and sustainable solutions.

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