Paper short abstract:

To understand the politics and materiality of technological innovations in healthcare systems, the paper examines the accessibility and care at a small telepsychiatry clinic in Tharparkar, Pakistan.

Paper long abstract:

The rising numbers of suicides in Tharparkar district in the last decade has led to numerous psy-interventions by public, private and development actors in Pakistan. One often-cited intervention is the telepsychiatry clinic. Operated within a private hospital (considering internet connectivity and smartphones are not common in the district) through a partnership between various public and private-sector organisations, the clinic is praised by these stakeholders as a novel solution to the problem of access to mental healthcare in Tharparkar, where, otherwise, a single government-appointed psychiatrist caters to the entire district’s two million population.

Previous works have shown how clinicians and policymakers have presented telepsychiatry as a way to ‘enhance access’ to therapeutic services (Pickersgill, 2019). The clinic’s management and funders also market the telepsychiatry service as a dynamic solution to the district’s rising suicide numbers. However, preliminary findings from my fieldwork–including observations and interviews with mental health actors in Tharparkar district–reveal that the telepsychiatry clinic is not thriving. The patient attendance is nominal and decreasing with time, and the quality of service is hindered by three infrastructural barriers: 1) the majority of the Thari people cannot afford travelling to the clinic; 2) the power supply and internet connection in the district is insufficiently stable; 3) people cannot afford to continue buying psychiatric medicines which are often prescribed via telepsychiatry services.

The paper highlights the material and political dimensions of telepsychiatry’s claim of ‘enhancing access’ and offer insights into the everyday workings of tech-led mental healthcare in southern Pakistan.