The social, the biomedical, and the side effects of care: an ethnographic study of mental health interventions in a refugee settlement in northern Uganda
(London School of Economics and Political Science)
Paper short abstract:
This paper is an ethnographic study of mental health interventions in a refugee settlement in Uganda.In this context, the integration of mental health services into primary care has led to an active disengagement of the humanitarian system with the socio-economic difficulties of their beneficiaries.
Paper long abstract:
This paper is an ethnographic study of mental health interventions in a refugee settlement in Uganda. Uganda currently hosts more than a million South Sudanese refugees fleeing a brutal and ongoing conflict. The emergency response to this crisis has recently included the integration of mental health services into primary care ones. This strategy, consistent with one of the main pillars of the movement for global mental health, is being piloted by the UNHCR in Ugandan refugee settlements, and is the focus of this study. Drawing on 6 months of in-depth ethnographic fieldwork in the refugee settlement of Palabek, northern Uganda,
this paper argues that mental health and psychosocial services in Palabek are largely incapable of addressing the widespread suffering and needs of their beneficiaries. This is due to two different reasons. Firstly, the heavy reliance of psychotropic medication leads to psychosocial dimensions of suffering to be overlooked, while "social interventions" are understood merely as efforts directed at ensuring compliance with the medication; on a similar note, the consequences of the side-effects of such medications on patients' social and economic environment are heavily overlooked. Secondly, the lack of thorough follow-ups leads to the concept of recovery being flattened down to continuous and virtually never-ending compliance with medication. In the context of Palabek refugee settlement, the prescription of psychotropic medication ultimately becomes a way for the humanitarian apparatus to actively disengage with the ongoing socio-economic difficulties that are in the best case precipitating, if not directly causing, the suffering of the refugees.
Problematising 'social interventions' in global mental health: what can ethnography offer?