Paper short abstract:

This ethnographic case study draws on 20 hours of observations and participant interviews (n=24) to highlight the role of counsellors in delivering social interventions for mental health in primary care settings.

Paper long abstract:

Increasing attention has been placed on the importance of addressing 'big' determinants of common mental disorders, such as poverty, gender inequality - within treatment spaces. However, the current battery of mental health interventions available in the Global South - home to the greatest burden of CMD- prioritise socio-relational dynamics of distress, leaving the long-wave stressors created by social adversity largely unmediated. Much work is needed to identify routes to providing patients and communities opportunities to respond to the full gamut of social conditions that shape poor mental health outcomes.

Is it possible for mental health interventions delivered in primary care settings to be sites for tackling structural determinants of mental health? Our research provides an ethnographic case study of clinic in Klerksdorp, South Africa, where group problem solving therapy sessions modified to promote collective action in response to social determinants of depression were delivered with some success.

Analysis of interview and observational data highlights a series of communicative and practical strategies that enable shifts in psychological and normative framings in patients lives that serve as bridges to wider change in the lives of service users. It also highlights the pivotal role of the counsellor as 'change agent' in enabling the successful delivery of this modified group therapy. Implications for future 'socially informed' interventions delivered in primary care in LMIC settings are discussed.