Paper short abstract:

The notion of the 'credibility gap' has recently been invoked in Global Mental Health to explain why mental health specialists are not resorted to more frequently. This paper explores how well this concept applies within medically pluralist settings such as Peru, asking ‘What happens in the gap?’

Paper long abstract:

A recurring, indeed formulaic, device in the development of Global Mental Health (GMH) is the 'gap': the 'treatment gap,' gaps in research evidence, resource gaps between high- and low-income countries and populations, and more recently the 'credibility gap' (Patel 2014), postulated as the reason why many individuals and families do not seek help for mental disorders. Within the pragmatics of GMH, this device serves useful purposes; the identification of a 'gap' highlights an absence that invites filling. Yet this may be subtly misleading; for example, the 'treatment gap' is in fact - as a number of critics have pointed out - far from empty, only appearing as such because many, officially unacknowledged, forms of treatment are discounted.

Drawing on ethnographic fieldwork from highland Peru and relevant anthropological literature, this paper interrogates what is actually occurring in the space signaled by the notion of the credibility gap and related constructs within GMH. It explores the assumptions made about the reasoning, behaviors and affect of those whom GMH would serve, and where correspondences and mismatches seem to occur between social actors' perceptions of where the gaps lie. It is argued that the credibility gap potentially opens up space for more open and pluralist encounters within global mental health, yet may also act to delimit the boundaries within which these can occur. Equally, it is important to ask too what gaps other approaches and models might be harboring.

Patel, V. (2014) Rethinking mental health care: bridging the credibility gap, Intervention 12(S1): 15-20