'Built for expansion': conditions of possibility and sites of performance for the WHO's mhGAP diagnostic algorithm
Eva Hilberg (University of Sheffield)
China Mills (University of Sheffield)
Paper short abstract:
This paper traces how the WHO's mhGAP diagnostic algorithm is the product of strategic collaborations, historical epistemological alignments, and ongoing performative enactments of a particular 'movement' for global mental health that overlooks alternative epistemologies in relation to distress.
Paper long abstract:
Quantifications of mental health and the 'treatment gap' (as conceptualized from a biomedical perspective) have been central in making visible mental health as a global health priority, now named in the UN Sustainable Development Goals. Digital tools support further measurement of both burden and treatment gap, and facilitate task-sharing in countries where there are few mental health professionals. The focus of the paper is the WHO's mhGAP Intervention Guide 2.0 (2016), an algorithmic clinical decision-making tool with protocols for diagnosis and condition management that is currently being implemented in various low- and middle-income countries. We explore how this tool is the product of strategic collaborations, historical epistemological alignments, and ongoing performative enactments of a particular 'movement' for global mental health. In tracing the 'social lives' (the performance and conditions of possibility) of mhGAP, this paper illuminates how its explicit design for global expansion positions mhGAP as only open to questioning from those who are technical 'insiders' (black-boxing mhGAP), and furthermore, sets the epistemological parameters of its own critique. This excludes critiques from different worldviews of distress and promotes a particular techno-scientific imaginary of mental health that also extends to its conception of processes of local adaptation. The paper ends by encouraging the WHO to open the 'black box' of mhGAP development and to be open to alternative epistemological understandings, particularly user/survivor/Mad epistemologies.
- Confluence, collaboration and intersection