Paper short abstract:

Ethnographic research with community mental health workers in Ghana shows how globalised norms of clinical practice and audit render invisible forms of support enacted within relationships between clinicians and families which draw on socially embedded moral values and resist global replication.

Paper long abstract:

Critics of global mental health have often pointed to the dangers of biomedical reductionism and the pharmaceuticalisation of mental distress. In this paper I draw on long-term ethnographic fieldwork in Ghana to argue that, despite the prominence of psychotropic medication within clinical practice, the social is deeply embedded in interactions between community mental health practitioners, patients and caregivers. However it is rendered invisible since it is not accounted for within globalised formulations of the 'psychosocial' - often conceived as adaptable and portable technologies such as cash transfers, brief therapies and peer support - institutionalised social work, nor clinical audit. Nonetheless in Ghana the enactment of the social is an essential adjunct to clinical practice not only due to the need to work around the restrictions of resource scarcity, but to the social embeddedness of encounters between health workers, families and patients, particularly where these take place within family homes. Such encounters draw on a moral praxis of relatedness, social and religious values, philanthropy and obligation to address basic needs such as shelter, food, clothing and employment. Undocumented in clinical records and thus invisible within 'the clinic', they are rather shared informally through social media and local networks extending beyond the clinical. These forms of praxis resist global replication or standardisation, addressing social needs through small scale personalised support. They arise not only from the virtual absence of formal social services, but also enact longstanding practices of social redistribution which render life and care possible in the face of extreme poverty.