Paper short abstract:

The paper explores the creative economic and therapeutic activities of community psychiatric nurses working in conditions of pharmaceutical scarcity in rural southwestern Ghana, by focusing on generally neglected/concealed practices such as informal drug supply and pharmaceutical gifts and debts.

Paper long abstract:

Drawing on ethnographic fieldwork carried out between 2013 and 2022 in Nzemaland (Ghana), this paper proposes a reflection on the ways in which community mental healthcare is performed and reframed by community psychiatric nurses dealing with pharmaceutical scarcity on a daily basis.

Psychopharmaceuticals constitute the main therapeutic solution offered at the district hospital psychiatric unit where I carried out my research. Though in the last few years I could observe considerable improvements in terms of resources as compared to the early days of my fieldwork (i.e. doubling in the number of staff employed at the unit, reduction of drug shortage episodes, higher availability of second generation drugs at more accessible costs), the everyday practice of mental health nurses is still marked by a scarce and ‘erratic’ psychopharmaceutical supply that forces them to invent creative solutions to meet their patients’ needs, but also to continuously face professional and ethical dilemmas.

In dialogue with classic and more recent perspectives in economic anthropology, the paper will focus specifically on the informal economies of mental health care that emerge in the interstices of formal healthcare service provision. By focusing on practices that are often neglected and/or concealed in public health services such as informal drug supply and pharmaceutical gifts and debts, I propose to explore, in their contradictions, the ‘charismatic’ relationships nurses establish with their clients. By doing so I aim to complexify discussions on the ‘commodification’ of health and to interrogate the place of community mental health care in this kind of dynamics.