Presentation Information
[P-2-01]Close the talk with Clozapine: Resurgence of the medical in community mental health programmes in India
*Sudarshan R Kottai (Indian Institute of Technology Palakkad(India))
Keywords:
community mental health,clinical Eethnography,pharmaceuticalisation,medicalisation,task-shifting
Background: The flagship community mental health programme run by the government of India has been criticized by scholars for failing to deliver on its policy objectives (Jain & Jadhav, 2009; 2012). Responding to the global call to fill the treatment gap (Patel et.al, 2007) community mental health services have been set up by nongovernmental organisations (NGOs) which partner with local homegrown organizations. But after these local organizations began partnering with the government and the NGOs in the field of community mental health, home grown approaches to care have been marginalised.Aims: The community mental health programmes run by mental health NGOs target the poorest of the poor for its services. The power to ‘medicalize’ is expanding from the mental health professionals to the laypersons trained by them pitching for a large tent of ‘patients’ who are ‘ill’ and in need of ‘treatment’. This paper explores how the entry of NGOs in mental health has engulfed the community-led organisations like pain and palliative clinics turning them into agents of the medical.
Method: A clinical ethnographic study of community mental health programmes run by five organizations in India was undertaken for a period of 14 months.Results: The desperation and urgency to somehow ‘treat’ and fill the ‘treatment gap’ through task-shifting have led to employing non-medical professionals to prescribe medicines and laymen to offer psychotherapies all in turn leading to ‘patient communities’ beset by violations of their bodies, minds and spirits.Discussion: The broader notion of community, health and illness which evolved bottom-up using experience as expert knowledge by the community-led organisations have lost its autonomy, freedom in choice of intervention after associating with mental health NGOs which employ and proliferate the biomedical model ripping apart its broad community outlook. Prevention is out of focus; a major departure from policy.
Method: A clinical ethnographic study of community mental health programmes run by five organizations in India was undertaken for a period of 14 months.Results: The desperation and urgency to somehow ‘treat’ and fill the ‘treatment gap’ through task-shifting have led to employing non-medical professionals to prescribe medicines and laymen to offer psychotherapies all in turn leading to ‘patient communities’ beset by violations of their bodies, minds and spirits.Discussion: The broader notion of community, health and illness which evolved bottom-up using experience as expert knowledge by the community-led organisations have lost its autonomy, freedom in choice of intervention after associating with mental health NGOs which employ and proliferate the biomedical model ripping apart its broad community outlook. Prevention is out of focus; a major departure from policy.