Spotlight Interview with Prof. Soraya Seedat

“I don't look for equal partnerships, rather I look for equity and parity in other domains in engagement and intellection. I look for the common will among collaborators to invest, to work together, to share passions, and to contribute in a meaningful way.” – Prof. Seedat

Location: Stellenbosch, South Africa

Bio: Prof. Soraya Seedat is a Distinguished Professor of Psychiatry and Executive Head of the Department of Psychiatry at Stellenbosch University. She holds the South African Research Chair in Posttraumatic Stress Disorder and directs the South African Medical Research Council Unit on the Genomics of Brain Disorders. She has more than 20 years of clinical, epidemiological and basic neuroscience research experience as a psychiatrist working in the field of traumatic stress and anxiety and has published over 450 peer-reviewed journal manuscripts and has co-edited four books. She has served 2 terms as the President of the College of Psychiatrists of South Africa and is currently a member of the Board of Directors of the Colleges of Medicine of South Africa. She is also a Board Member of the International Society of Traumatic Stress Studies and Secretary of the Board. She is an Associate Editor of the European Journal of Psychotraumatology and Global Mental Health.

What does your day-to-day usually look like?

My day is variable which makes it interesting and diverse. I have both managerial, clinical, and academic responsibilities. I currently have a joint appointment with both Tygerberg Hospital and Stellenbosch University. My clinical activities extend to supporting and training psychiatry residents while also teaching undergraduate and post-graduate students. I oversee many research projects, supervise postdoctoral and doctoral students, and run laboratory & research meetings. These meetings are great as they are an opportunity for us to meet as a team, and to ensure that we work in a collaborative way. I believe that when you are a researcher in the field of neuroscience and psychiatry, it's important that the research you pursue is done in a holistic way. I have strong interests in neurobiological and genetic factors that contribute to the development of mental illness. At the same time, I recognize that it is important to understand all environmental, cultural, and broader ecological factors that contribute to the onset and persistence of mental illness.

How did you begin your career in global mental health?

I have now been working in psychiatry for more than 25 years. When I completed my medical school degree, I was sitting on the fence between pursuing pediatrics and psychiatry. I had positive experiences in both disciplines mainly due to having great mentors in both specialties. They were passionate and committed to teaching me and my colleagues. In South Africa, it was a requirement at the time to work a year as a medical officer before pursuing specialization. Initially, I decided to pursue a psychiatric route and I thought that if I didn’t enjoy it, I would switch to pediatrics. During this first year, I was exposed to a wide range of mental illnesses and naturally was enthralled by my clinical experiences. By seeing patients’ quality of life improve and witnessing all the major developments and advancements in the field, I knew I was on the right track. In retrospect, the advancements were baby steps in terms of the present-day field of psychiatry. Today we see the power of machine learning and diagnostic prediction and we are working towards more targeted and tailored patient treatments. I don’t think I could have imagined ten years ago that we would be where we are today, but still, we have a lot of work to do. Soon after completing my residency, I began to wonder how I could venture into research. I wanted to be a clinical researcher and not lose sight of building up others as leaders in psychiatry. So, I thought, “How can I marry my interests in children and adolescents with a research career?” In 1999, I established a clinic to assess and provide a referral pathway for children and adolescents exposed to life threatening traumas. Our hope was to assess them in a comprehensive way. We named the clinic “Bathuthuzele,” which translates to “comfort them.” More than 95% of adolescents who have post-traumatic stress disorder (PTSD) and other common mental disorders are not diagnosed. They are symptomatic, expressing distress, and show signs of impairment in day-to-day functioning. This clinic was a start to getting the children to proper treatment and care. Even in South Africa where we are better resourced compared to other African countries, we are still hugely underdeveloped in terms of meeting the needs of the population. Many countries have fairly rudimentary psychiatric services for treating trauma. Still today, much of our practice is extrapolated from what we know from studies that have been conducted in the North.

Why did you want to be a clinician researcher?

My decision to be a clinical researcher has come with sacrifices. One of the sacrifices is being limited time-wise as I have many projects in the realm of clinical research that, while giving me exposure to patients, does not leave me time to see patients directly as I was before. Being a clinical researcher and also engaging in laboratory research means that I am still able to exercise my clinical skills but rather now in a research sphere and conduct research that is translational. This truly requires you to be a good clinician as research in psychiatry is ultimately about optimizing patient care and discovering ways to prevent mental illness from occurring in the first place. Research teaches you to be conscientious, methodical, and reminds you of why you became a clinician in the first place.

Can you describe the status of mental health in South Africa?

There are high levels of stigma in South Africa that have consistently been documented through research. We have empirical evidence on the prevalence and correlates of mental illness in South African and other African countries, and specifically regarding our approaches and attitudes towards the mentally ill. At the same time, I think that some stigmatizing attitudes have shifted over time, which have gone hand in hand with more information, education, and social media awareness. One could say that this has been one of the few positive offshoots of the global pandemic with a lot more awareness about mental health issues and the importance of early detection and appropriate management of individuals with mental illness.

Across a myriad of African countries, approximately 2% of the health budget is dedicated to mental health. This points to a lack of will on part of governments to take mental health as seriously as they do other diseases, both infectious and other noncommunicable diseases (NCDs). As most know, on our continent we have a high burden of infectious diseases, a growing burden of NCDs, and a high comorbidity burden. In South Africa specifically, the budget allocation is slightly better than 2%. Currently it is just under 5%, which is still hugely insufficient. Only 25% of patients receive proper treatment; this means that there is a 75% treatment gap. Other population-based studies have shown a treatment gap even closer to 90% in low- and middle- income countries. It’s concerning that we have so few people in communities able to access services. There are also huge inequities in terms of public sector versus private sector services. It's a complicated and long-winded path to get care for most patients. Only 15% of the population is medically insured and many pay out of pocket for specialized private services while the other 85% of the population only has access to public (government funded) health services. Right now, 80% of psychiatrists work in the private sector. Clearly, we have economic constraints. It’s as simple as not having sufficient personnel and bed capacity to meet the population’s needs. Many factors contribute to the treatment gap, and it requires a multipronged approach to fix that issue. It obviously starts with the need to invest in prevention and promotion of mental health strategies, especially in our youth. If we are going to change the landscape over the next few decades, we need to invest in our youth. To reduce the incidence of mental health issues, all health professionals need to take concerted action and work together. Bettering our mental health system will be a multifaceted, multilevel challenge. In South Africa, as in most other African countries, the call to action is even more dire due to the high levels of poverty, abuse, neglect, and interpersonal violence. This cycle of violence is also the cycle that perpetuates mental illness intergenerationally. Ultimately, it is difficult to approach these issues when you don’t have the resources available to address the root cases of such pervasive violence.

How does this affect your research?

I am often frustrated because I am not able to do the type of “blue sky research” across the lifespan that I would like to as it requires huge financial and human resource investments such as large, collaborative, interdisciplinary teams to perform longitudinal research. We really need our government to join the party and, together with private funders, invest in large-scale local and African mental health research projects.

What do you look for in potential collaborations?

I don't look for equal partnerships, rather I look for equity and parity in other domains in engagement and intellectual contribution. I look for the common will among collaborators to invest, to work together, to share our passion, and together contribute in a meaningful way. The reason I say not equal is that there are many factors and layers to a relationship. I believe there is a natural course in a collaboration. You can't make any early assumptions about forming long term relationships. Realistically, sometimes in a collaboration there is a lack of synergy. We have to find goodness of fit and that really comes from complementary strengths. I look for a lack of dominance whether from the North or South because it should not be led by one single partner. Everyone deserves to be heard. Everyone needs to be given a voice and given space. I’ve been fortunate with finding many successes in my partnerships. I like to think that successful collaborators communicate in an organic way and work together in an environment of mutual respect and common understanding. An analogy that I use to think about collaborations between individuals is that collaborations are a “dating dance” – or at least they start off that way. Some of these partnerships end up in a marriage, which can be smooth or bumpy along the way. Others may end abruptly and can also teach you lessons about how to approach future collaborations differently and enable personal growth.

What is a project that you are currently working on?

One project that I am proud to share was initiated by one of my postdoctoral students, Dr. Stefanie Malan-Muller and is currently led by another one of my students Dr. Patricia Swart. Our group has been interested in the gut microbiome and understanding how it may contribute to PTSD and other mental disorders. We are currently conducting a population-based study. Our project is called the South African Microbiome Initiative in Neuroscience which is essentially an online platform that allows us to recruit community-based participants for our study. It definitely was a steep learning curve for us. For us, this online platform is an innovative way of accessing research participants and has taught us how we have biases in our expectations of participants. For example, we thought South African participants would not be willing to give consent to volunteering stool samples unless they were approached in person, but we have had no real issues with online consent. We tend to have these cultural biases, such as the collecting of stool samples potentially being an obstacle, but we have managed to gather data relatively smoothly. By the end of year, we will have our first data to analyze and write up. I am very proud that this initiative was conceptualized, developed, and executed by a postdoc student I have mentored.

Closing Thoughts

My main mission is to ensure that the next generation of neuroscientists that cross my path are equipped to accelerate their career trajectory. We need to focus on growing the next generation of clinician-scientists faster and more efficiently. We need to build up our African neuroscientists that are on the ground throughout the continent, retain them and support, mentor and fast-track them in cementing employment and building their research careers. 

 By Joanne Won, May2022