Paper short abstract:

This paper explores how frontline psychosocial workers in rural Nepal strategically broker between global and local illness categories to facilitate access to care. Findings highlight a need for greater attention to the role and contributions of frontline workers within global mental health.

Paper long abstract:

Critics have warned that mental health and psychosocial (MHPSS) intervention in low-income post-disaster contexts can undermine local therapeutic knowledge and care systems. Following the 2015 earthquakes in Nepal, MHPSS interventions relying mainly on 'task shifting' to non-specialist health and psychosocial workers proliferated across rural affected areas of the Himalayan foothills. My doctoral research treats this post-disaster MHPSS response as a window onto the processes through which globalized therapeutic discourses and practices are assimilated within diverse local ecologies of care. Over fourteen months of ethnographic fieldwork, I traced the multiple translations and transformations MHPSS care underwent on the journey from international guidelines to implementation in rural earthquake-affected villages. This paper examines the strategies through which frontline psychosocial workers communicated the scope and object of MHPSS care to potential clients and lay people in rural communities. By gathering familiar afflictions and idioms of distress-ranging from headaches to spirit possession-under the loose and flexible heading of 'heart-mind problems', these clinicians were able to establish new explanatory frameworks and pathways to care without undermining or supplanting local ontologies of suffering. In effect, frontline psychosocial workers engaged in a creative act of brokerage that rendered global and local illness categories commensurable in the interest of broadening the repertoire of therapeutic resources to which individuals had recourse. These findings challenge common critiques of MHPSS intervention and highlight a need for greater attention to the role and contributions of frontline clinicians within the field of global mental health.