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Pills that swallow policy: Clinical ethnography of a community mental health program in northern India

Jain, S; Jadhav, S; (2009) Pills that swallow policy: Clinical ethnography of a community mental health program in northern India. Transcultural Psychiatry , 46 (1) 60 - 85. 10.1177/1363461509102287. Green open access

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Abstract

India’s National Mental Health Program (NMHP) was initiated in 1982 with objectives of promoting community participation and accessible mental health services. A key component involves Central government calculation and funding for psycho-tropic medication. Based on clinical ethnography of a community psychiatry program in north India, this paper traces the biosocial journey of psycho-tropic pills from the Centre to the Periphery. As the pill journeys from the Ministry of Health to the clinic, its symbolic meaning transforms from an emphasis on accessibility and participation to administration of ‘treatment’. At its final destination of delivery in the rural health centre, the pill becomes central to professional monologues on compliance that mute the voices of patients and families. Additionally, popular perceptions of government medication as weak and unreliable create an ambivalent public attitude towards psychiatric services. Instead of embodying participation and access, the pill achieves the opposite: silencing community voices, re-enforcing existing barriers to care, and relying on pharmacological solutions for psycho-social problems. The symbolic inscription of NMHP policies on the pill fail because these are contested by more powerful meanings generated from local social and cultural contexts. The authors argue this understanding is critical for development of training and policy that can more effectively address local mental health concerns in rural India. The paper concludes with an outline of potential areas and approaches to interrogate well meaning mental health programs that alienate the very people it is meant to serve.

Type: Article
Title: Pills that swallow policy: Clinical ethnography of a community mental health program in northern India
Open access status: An open access version is available from UCL Discovery
DOI: 10.1177/1363461509102287
Publisher version: http://dx.doi.org/10.1177/1363461509102287
Language: English
Keywords: Community Psychiatry, India, Psycho-tropic medication, Mental Health Policy, Clinical Ethnography.
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Division of Psychiatry
URI: https://discovery.ucl.ac.uk/id/eprint/136523
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