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Paper short abstract:

Focusing on the network of mental health services available in an urban context in Sri Lanka, this paper highlights practitioners’ perspectives on the intersecting challenges and structural barriers they face in providing care for patients and families.

Paper long abstract:

At stake in the debates over Global Mental Health are critical questions about the ways in which socio-economic and cultural realities shape illness experiences and the degree to which proposed strategies for expanding mental health services globally address not only the diversity of lived experiences of illness but also the structural barriers to wellbeing. I draw on 22 months of ethnographic research with mental health practitioners and individuals and families seeking treatment in an urban setting in Sri Lanka to highlight how practitioners and patients relate to and shape available psychiatric services in meaningful ways. In highlighting practitioners’ perspectives on the challenges they face in treating patients, I further show how questions of cultural meaning are inextricably tied to political and material dimensions of care such as economic and social marginalization and lack of institutional resources. Observations in an outpatient clinic and interviews with doctors, counselors and patients illustrate that despite relatively robust mental health services in this context, systemic issues such as lack of long-term care facilities, high patient loads, and persistent economic inequality make it very difficult to implement services that are truly responsive to people’s diverse and intertwining needs—material, social, cultural, and spiritual. This paper thus stresses a focus on the cross sections of identities and socio-cultural and material realities within any given setting in order to examine the complex ways that practitioners and people experiencing mental illness or distress orient themselves to existing modalities of healing and strive to alleviate distress amidst structural barriers to wellbeing.