The Psychology Department motivated for an honorary doctorate to be awarded to Professor Vikram Patel. This honorary doctorate will be awarded to him at the graduation ceremonies of December 2019.

Vikram Patel, psychiatrist and global mental health expert. is without doubt the leading figure in the Global Mental Health movement, and a key contributor to the promotion of mental health and prevention of mental disorders in low and middle-income countries. His on-going willingness to critique this movement is also of crucial importance. Named as one of TIME magazine’s 100 most influential people of the year in 2015, he not only has made substantial contributions to improving the health and wellbeing of populations, he has also been the key leader in convincing governments and a wide range of international agencies and bodies that paying attention to mental health should form a cornerstone of all global development efforts.

We are recommending Professor Vikram Patel for an honorary doctorate at Stellenbosch University. We think our reasons for nominating him are in line with the requirements for an honorary doctorate, as set out by Stellenbosch University. He meets the following requirements:

  • His outstanding contribution to the fields of psychiatry and psychology in the developing world;
  • His outstanding contribution to community service in the developing world;
  • His national and international recognition as a researcher and academic;
  • His on-going contribution to the fields of psychiatry and psychology and the critical relevance of his current work, also specifically for South Africa;
  • The profound ways in which the candidate’s contribution to society can be linked to the vision and objectives of Stellenbosch University;
  • The ways in which his work has directly and indirectly impacted on research and practice of practitioners and researchers at the Department of Psychology, Department of Psychiatry and the Centre for Public Mental Health of Stellenbosch University; and
  • The fact that his work also is of interest and importance to various other departments in different faculties at our university.

Outstanding contribution to the fields of psychiatry and psychology in the developing world

There is no question that Patel is a leading scholar, with over 20000 citations on Web of Science. His work has addressed four major themes: (1) generating policy relevant evidence on the burden and impact of mental disorders; (2) developing and evaluating mental health interventions for delivery by non-specialist and lay health workers; (3) developing training programs to build research capacity and leadership in global mental health; and (4) communicating research to diverse audiences to act on this evidence.

Among his scientific contributions are:

  1. Generating key evidence of the burden of mental health problems in low- and middle-income countries. This has laid the foundation for advocacy on why action is needed to address these problems. Key findings included the demonstration of the strong association of mental disorders with social disadvantage, the first nationally representative survey of suicide mortality in India, population-based surveys carried out in 60 countries examining the association of depression with other chronic conditions; and the identification of a strong association of mental health issues with child under-nutrition and delayed cognitive development (as PI).
  2. Providing evidence on the effectiveness of task-sharing of psychosocial interventions, which has been the foundation for demonstrating how action can be taken to address mental disorders even in low-resource settings. Key findings include: the demonstration of cost-effectiveness of contextually adapted brief psychological treatments delivered by lay counsellors for depression in primary care, the demonstration of the cost-effectiveness of collaborative care led by a lay health worker for depression and anxiety disorders in primary care in the largest RCT in psychiatry from the developing world; the first trial of task-sharing for supporting caregivers of persons with dementia from a LMIC, which won the Alzheimer’s Disease Society Prize for psychosocial interventions in 2010; and the first evaluation of a community based intervention to enhance demand for care for depression.
  3. Designing the methodology for the development of scalable psychological treatments, i.e. which can be delivered by non-specialist workers in routine health care settings for culturally diverse populations. Key findings include the development of two new treatments, the Healthy Activity Program for severe depression and the Counselling for Alcohol Problems for harmful drinking; the development of novel measures and strategies for evaluating the quality of psychological treatments delivered by non-specialist workers; and the demonstration of the effectiveness of peer supervision for assessment of therapy quality by non-specialist workers.
  4. Demonstrating the great paucity and inequitable distribution of global mental health research resources and outputs and setting the research agenda for global mental health which has led to over 100M US$ in funding (for example from the United States National Institutes for Mental Health [NIMH] and Grand Challenges Canada) since 2011. Key findings include: bibliometric research demonstrating that low and middle-income countries (LMIC) contributed just 6% of the published output in leading psychiatric journals; setting research priorities for mental health in LMIC and for psychosocial interventions in humanitarian settings; and establishing the research priorities for global mental health through the Grand Challenges in Global Mental Health initiative of the NIMH (of which he was the co-chair of the Scientific Advisory Board).
  5. Synthesis of research in global mental health for effective communication and uptake by a variety of stakeholders. Major examples of this synthesis include his role as lead editor of major series of articles on global mental health published in The Lancet in 2007 (six article series) and 2011 (five article series) and PLoS Medicine in 2009 (six article series) and 2012 onwards (an open series, now with over seven articles published to date). These syntheses have informed: global and national policies for improving access to mental disorders including the WHO’s flagship program on mental health (mhGAP) on which he served on the guidelines development group and India’s first national mental health policy in 2014 drafted by the Mental Health Policy Group on which he served; the funding of the PRIME consortium leading implementation research to integrate mental health into routine health care programs in countries in sub-Saharan Africa and South Asia (he served as research director); the publication of guidelines for decision makers on the packaging and delivery of interventions for mental disorders using a platforms based approach (from the Disease Control Priorities group on mental disorders which he led); and the first Lancet Commission in Mental Health and Sustainable Development, (which he led).

Outstanding contribution to community service in the developing world

As described above, Patel is an action researcher par excellence. Much of his research focuses on developing psycho-social and pscychological interventions relevant to the developing world. He has a particular interest in South Africa and has co-operated with Stellenbosch University researchers to find interventions appropriate to our context.

Patel is a co-founder of Sangath, an Indian NGO which won the MacArthur Foundation’s International Prize for Creative and Effective Institutions in 2008 and the WHO Public Health Champion of India award in 2016.

National and international recognition as a researcher and academic

Currently The Pershing Square Professor of Global Health in the Blavatnik Institute’s Department of Global Health and Social Medicine at Harvard Medical School, Patel is also an adjunct professor and joint director of the Centre for Chronic Conditions and Injuries at the Public Health Foundation of India, honorary professor at the London School of Hygiene & Tropical Medicine (where he co-founded the Centre for Global Mental Health in 2008). He is a fellow of the UK’s Academy of Medical Sciences and has served on several WHO expert and Government of India committees. His work on the burden of mental disorders, their association with poverty and social disadvantage, and the use of community resources for the delivery of interventions for their prevention and treatment has been recognized by the Chalmers Medal (Royal Society of Tropical Medicine and Hygiene, UK), the Sarnat Medal (US National Academy of Medicine), an honorary doctorate from Georgetown University, the Pardes Humanitarian Prize (the Brain & Behaviour Research Foundation), an honorary OBE from the UK Government and the Posey Leadership Award (Austin College). As mentioned above, Patel is a co-founder of Sangath, an Indian NGO which won the MacArthur Foundation’s International Prize for Creative and Effective Institutions in 2008 and the WHO Public Health Champion of India award in 2016. He received an honorary doctorate from Georgetown University in 2015.

On-going contribution to the fields of psychiatry and psychology and the critical relevance of his current work, also specifically for South Africa

Patel’s contribution is also important in terms of his willingness to consider the fact that western conceptualisations of mental health may not be relevant to the developing world. As such his work is relevant to the Stellenbosch University project of the decolonialization of knowledge, in this case western diagnostic systms and treatment models. In a seminal 2014 article Patel asserts that the biomedical model can be problematic when applied in the developing world. He refers to what he calls a credibility gap, a yawning gap, between “mental health specialist communities and the rest of the world.”. According to him, mental health experts (with their nosology and their treatments) are at risk to loose touch with the lived emotional suffering of real people in the world, especially people in the developing world. Patel problematizes what he calls “the deliberate tilt in the balance between the personal narrative and the biomedical concept, toward the latter,” arguing that “adopting an increasingly arcane jargon of diagnostic categories to communicate with each other…we have lost the ability to communicate with virtually everyone else in our communities”. Patel’s point certainly is not that diagnostic categories are useless or that the neurobiology of emotions is not important, but he suggests that the use of such labels and their associated biomedical explanations may be unnecessary or even counterproductive in certain contexts. He talks about the fact that “certain mental illness categories, such as depression in particular, do not travel well across cultures. The critique is that the use of such labels represents a medicalization of a social condition where the solutions lie not within a medical approach but more likely within the social or political sphere). He advocates for “the replacement of rigid diagnostic systems, which he says are much more suited to psychiatry and the specialized mental healthcare systems you might encounter in developed countries, with broader, more public health-oriented and contextually appropriate labels and diagnostic systems that communicate better to local policymakers, primary care workers and most importantly, to local communities”. Patel’s argument that “diagnostic categories (can) reflect a medicalization of normative phenomena” that may impose “artificial dichotomies imposed on naturally occurring dimensions of psychological responses to common human life experiences”, is not a new one. Very important, however, is that he highlights the danger of adopting this approach in the developing world, where, he says, emotional suffering is perhaps more “inextricably linked to powerful social and cultural determinants and with a person’s own identity of oneself.”

This concern of his is even more relevant when it comes to women in the developing world. While the movement for global mental health has identified women as a group of focus, critics have pointed out that the biomedical model adopted by this movement has served to silence women’s voices in various ways. Patel’s work has been very useful in highlighting the ways in which the biomedical model may silence the voices of women in the developing world

Links to the vision and objectives of Stellenbosch University

Patel’s research and clinical work clearly is in line with the strategic theme “Research for impact” as outlined in the Stellenbosch University Vision 2040 (p.21.). Not only is his research compatible with Stellenbosch University values (the values of excellence, compassion, equity, respect, accountability and accountability) (Stellenbosch University Vision 2040, p.16), but his research agenda is also derived from societal needs (p.21). The Stellenbosch University Vision 2010 also states the importance of research of significance focused on strategic research areas (p21). Patel’s research focus on all of the areas identified: Sustainability and the Environment; Health and Well-being; Social Justice, Human Creativity and Innovation; Systems and Technologies for the Future.

Direct and indirect impact of his work on research and practice of practitioners and researchers at the Department of Psychology, Department of Psychiatry and the Centre for Public Mental Health of Stellenbosch University

Patel has strong links with Stellenbosch University and has influenced the work of colleagues in a number of departments, notably psychology, psychiatry, and global mental health. He has co-published and co-researched with some Stellenbosch University researchers, most notably on the PRIME consortium where he is research director.

Most notably Patel has been a key supporter and influential advisor to the Alan J Flisher Centre for Public Mental Health, which is co-hosted by the Department of Psychology at Stellenbosch University (Prof Ashraf Kagee of the Department of Psychology is currently co-director of this centre), and the Department of Psychiatry and Mental Health at University of Cape Town. Patel currently is a member of the Scientific Advisory Board of the Alan Flisher Center for Public Mental Health. This Centre, which is a World Health Organization Collaboration Centre, owes a great deal to the vision and ongoing support offered by Patel. He was specifically approached to be an advisor and member of the board because his stature in the field of public mental health.

His early work on gender, poverty and motherhood has had a huge impact on researchers in the department who are concerned with these issues.

In general, one can say that his most significant impact on Stellenbosch researchers and practioners is his ongoing contribution to supporting his colleagues and developing capacity especially among emerging academics in LMIC. We at Stellenbosch University have benefited in many ways from his exceptional academic and personal generosity, his persistent promotion of the importance of paying attention to emotional problems and mental health care, his interest in developing evidence-based treatments for mental health problems, his willingness to engage critically with western diagnostic and treatment models and his persistent commitment to transformation and the promotion of human rights.

Interdisciplinarity (his work is of interest and importance to various departments in different faculties at our university)

It should be clear that Patel’s stellar scientific contributions and commitment to community service means that his contributition lies far beyond his home discipline of psychiatry and have impacted on many areas of health care and development studies. The interdisciplinary significance of his work also is in line with Stellenbosch University’s stated commitment to “conduct collaborative and interdisciplinary research that addresses the challenges of society” (Stellenbosch University Vision 2010, p. 21).

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Vikram Patel embodies, through his work and interactions with all, the core principles of democracy and global justice.