Close the Talk with Clozapine: Resurgence of the Medical in Community Mental Health Programmes in India

Background: Mental health care has gained currency in contemporary India. 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 in mental illness (Patel et.al, 2007) community mental health services have been set up by NGOs which partner with local home grown organizations to deliver the services. But after these local organizations began partnering with the government and the NGOs in the field of community mental health, local,home grown approaches to care have got relegated to the margins.

Issues in Focus: The power to ‘medicalize’ is expanding from the mental health professionals to the laymen trained by them pitching for a large tent of ‘patients’ who are ‘ill’ and in need of ‘treatment’.

Methods: A clinical ethnographic study of community mental health programmes run by five organizations in India was undertaken for a period of 14 months.

Potential Outcomes: 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.

Implications: The broader notion and the holistic approach to community, health and illness which evolved bottom up using experience as expert knowledge by the community led organisations have lost its autonomy, freedom of choice of intervention after associating with the NGOs in mental health which employ and proliferate the medical model ripping apart its broad community outlook. Prevention is out of focus; a major departure from policy posing critical questions in regard to theory and praxis of community mental health programmers in India.