Paper short abstract:

Ideas about ‘access to care’ and ‘treatment gap’ are central to ‘global mental health’ discourses. This paper explores the relationship between poverty and mental health by examining how individuals and their families deploy notions of ‘access’ and ‘care’ in everyday life.

Paper long abstract:

Ideas about 'access to care' and 'treatment gap' are central to 'global mental health' discourses. This paper explores the relationship between poverty and mental health by examining how individuals and their families deploy notions of 'access' and 'care' in everyday life. This paper draws on ethnographic research from northern India that examines the nature of engagement (and non-engagement) of rural people with a government community mental health programme. Specifically, I focus on ethnographic interviews with five families identified by the community, family and/or mental health service as having an individual with a 'mental health' problem. Interviews sought to understand the persons' and families' own understanding of the individual's problems, factors that have shaped help-seeking, and how decisions about accessing help are made.

Data suggests that understanding the relationship between wealth/poverty and mental health relationship requires a contextualized understanding of how families make choices at different points within the illness trajectory and how conceptualizations of problems shift over time. The data does not suggest a clear cut relationship between mental health and poverty. Rather, medium term ethnographic engagement with the 'field' permits an unfolding 'picture' of this relationship, particularly consideration of how factors such as caste, gender and 'treatment fatigue' contribute both to 'access to care' and economic impacts of mental health problems. The paper concludes by discussing how notions of 'freedom' play out in relation to 'access' to psychiatric care in this region, particularly in the context of the spread of market forces and neoliberal ideas of 'freedom'.