Paper short abstract:

By taking a look at community mental health programmes in Lima where the scaling-up of services agenda is being carried out, I will examine the ways in which this approach, which relies more on technical knowledge than local experience and participation, is disseminating “mental health” in the community.

Paper long abstract:

Peru can be taken as an apt example of an economic wealth / mental health paradox: its impressive record of recent macroeconomic growth is matched by a high prevalence of mental health problems. Encouraged by the auspicious financial situation, some key actors -two psychiatric hospitals and the Pan American Health Organization- are now pushing for a scaling-up of mental healthcare via specific programmes and public investment advocacy. These efforts propel the psychiatrist into the position of a detached expert whose role is to facilitate the diffusion of the technical psychiatric and public health formulas of mental health services reform. A by-product of this expansionist drive is that older community mental health approaches that privilege local experience and community participation -and where the psychiatrist acts as provider of care rather than consultant- are being marginalized due to their limited scope. Based on direct observation of these projects, I aim to examine what effects they have and evaluate psychiatry's possibilities of effectively reducing the "treatment gap" in this particular setting. ¿Would it be possible to combine the expansionist model with culturally sensitive and participative approaches?