‘Built for expansion’: the ‘social life’ of the WHO's mental health GAP Intervention Guide

Abstract

The focus of this study is the WHO's mhGAP‐Intervention Guide (mhGAP‐IG) 2.0 (2016), an evidence‐based tool and guideline to help detect, diagnose and manage the most common mental disorders, designed for use by non‐specialists globally but particularly in low‐ and middle‐income countries. This research is a starting point in tracing the multiple ‘doings’ of mhGAP‐IG – connecting questions of how it is ‘done’ and what does it ‘do’ – to the living histories and wider global mental health assemblages that make the tool possible and shape its global circulation. We examine the conditions of possibility that produce and legitimate mhGAP‐IG, and the ways these are ‘black boxed’ through casting mhGAP‐IG in technical rather than epistemological terms. The study illuminates how its explicit design for global expansion positions mhGAP‐IG as open to questioning from those who are technical ‘insiders’ and setting the epistemological parameters of its own critique. It analyses mhGAP‐IG as an ‘inscription device’ that inscribes and materialises algorithmic imaginaries of mental health that impact on design and local implementation. This study is one attempt at initiating dialogue with the WHO from perspectives and methodological approaches not usually included in the conversation.

Reflections on doing training for the World Health Organization’s mental health gap action program intervention guide (mhGAP-IG)

“…The paper is part of a larger study documenting the 'social life' of mhGAP-IG, with a focus on the alignments and contrasts in how it is done in multiple sites by different actors. The focus of our research is on both the doing (Mol, 2002) of mhGAP-IGhow it is done, what it does and the ways the mhGAP-IG does mental health (for example, as universal and as 'illness') (Mills & Hilberg, 2019); and on how the prac-tice of mhGAP-IG is narrated by different actors.…”

Considering culture, context and community in mhGAP implementation and training: challenges and recommendations from the field

“…The program is agnostic to health-care providers’ own ethnocultural backgrounds and interpretations. However, it implicitly endorses the framework of biomedical psychiatric and individualistic psychology in its approach to mental health and illness in terms of discrete problems located within the individual [40–42]. There is a substantial body of research highlighting the importance of culturally informed pedagogy and culturally sensitive and responsive mental health programs that build on the experiences and knowledge of communities.…”

Coloniality and Mental Health, Neurological and Substance Abuse (MNS) Disorders in Guyana’s Prisons Today

“…Due to a lack of funds and infrastructure, prisons in the Caribbean, as they were in colonial times, are also used to house those with mental disorders , and those who have often dropped through the limited social safety nets provided by cash strapped Caribbean governments (Smith 2014;. This was the same in the past, when colonial administrators ignored the relationship between colonialism, labour systems and mental health in understanding why some people were violent or engaged in public disorder; or that the physical and mental health of the colonised under the violence, social destruction and dislocation of colonialism was damaged (Hickling 2002, 114;C. Mills and Hilberg 2018).…”