Paper short abstract:

This paper examines how CHWs in north India address social dimensions of mental health. CHWs displayed culturally nuanced relationship skills and contextual knowledge. They deployed relationships and knowledge to social analysis of their client's lives and to implement bespoke micro-innovations.

Paper long abstract:

Community-based workers promote mental health in communities yet little attention has been given to the ways they operate and the strategies used. For example, how do they translate biomedical concepts into frameworks that are acceptable and accessible to communities? How do micro-innovations lead to positive mental health outcomes, including social inclusion and recovery? The aim of this study was to examine the types of skills and strategies to address social dimensions of mental health used by community health workers (CHWs) working together with people with mental health problems. We interviewed CHWs (n=46) about clients with psychosocial disability who were randomly selected from 1000 people registered with a local non-profit community mental health provider. Notes taken during interviews were cross checked with audio recordings and then coded and analysed thematically. CHWs displayed culturally nuanced skills in forming trusting relationships and in-depth knowledge of the context of their client's lives and family dynamics. They used this information to analyse political, social and economic factors influencing mental health for the client and their family members. The diverse range of analysis and intervention skills of CHWs built on contextual knowledge to implement micro-innovations in a be-spoke way, applying these to the local ecology of people with mental health problems to address social determinants that shaped the mental health of clients.