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The double-edged sword of ‘community’ in community-based psychosocial care: Reflections on task-shifting in rural Nepal

Chase, Liana

The double-edged sword of ‘community’ in community-based psychosocial care: Reflections on task-shifting in rural Nepal Thumbnail


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Abstract

Research in the field of Global Mental Health has stoked hopes that ‘task-shifting’ to community workers can help fill treatment gaps in low-resource settings. The fact that community workers inhabit the same local moral worlds as their clients is widely framed as a boon, with little consideration of the social and ethical dilemmas this might create in the care of chronic, stigmatized conditions. Drawing on 14 months of ethnographic research focused on psychosocial interventions in Nepal, this paper traces how the multiple roles community workers occupied with respect to their clients – clinician, neighbour, and at times kin – came to bear on the care they provided. In-depth case studies are used to explore two divergent logics of care informing Nepali community workers’ practice. While formal psychosocial care guidelines emphasized clients’ autonomy, calling for non-judgmental and non-directive forms of emotional support, everyday efforts to ‘convince’ neighbours and relatives in distress often involved directive guidance oriented toward the restoration of moral personhood and social relations. These approaches could be mutually supportive, but tensions arose when community workers invoked moral standards linked with mental health stigma. This analysis highlights the challenge of mobilizing communities’ strengths and resources without inadvertently reproducing their exclusions. It suggests the deployment of community workers to address psychosocial care gaps may entail not only leveraging existing relationships within communities, but also reconfiguring the very terms of relatedness.

Citation

Chase, L. (2023). The double-edged sword of ‘community’ in community-based psychosocial care: Reflections on task-shifting in rural Nepal. Anthropology and Medicine, 30(3), 294-309 . https://doi.org/10.1080/13648470.2022.2161765

Journal Article Type Article
Acceptance Date Nov 1, 2022
Online Publication Date Feb 1, 2023
Publication Date 2023-11
Deposit Date Jan 30, 2023
Publicly Available Date Feb 3, 2023
Journal Anthropology and Medicine
Print ISSN 1364-8470
Electronic ISSN 1469-2910
Publisher Taylor and Francis Group
Peer Reviewed Peer Reviewed
Volume 30
Issue 3
Pages 294-309
DOI https://doi.org/10.1080/13648470.2022.2161765
Public URL https://durham-repository.worktribe.com/output/1181664

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http://creativecommons.org/licenses/by-nc-nd/4.0/

Copyright Statement
© 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.





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