Valuing Community Workers in Global Mental Health: Critical Ethnography of a Psychosocial Intervention in Post-Earthquake Nepal

Chase, Liana; Shrestha, Sujan; Sidgel, Kripa; Rumba, Sunita; Shrestha, Parbati; Gurung, Dristy

Abstract

There is growing consensus that aspects of mental healthcare can be effectively delivered by lay community members with as little as a few days to a few months of training. In the field of Global Mental Health, the deployment of such “community workers” has been embraced as a way of tackling inequities by expanding access to care in low-resource settings. Yet there is a dearth of research on how this practice is experienced by community workers themselves, many of whom are women working for low or no pay. This article develops a critical ethnography of a psychosocial intervention delivered by women community workers in post-earthquake Nepal. Our analysis makes use of anthropological theories of value and feminist scholarship on care labor to shed light on the stakes of decisions about whether and how to remunerate community workers. Drawing on fourteen months of ethnographic fieldwork, we trace how the expectation that community workers volunteer their time ultimately led to distress and disengagement for one woman and the consequent closure of the community psychosocial support center she led. Although community health volunteerism is often described as a pathway to women’s empowerment, our findings suggest it can have different and sometimes adverse effects for women from disadvantaged social backgrounds. Greater attention to the way community workers’ care labor is valued is needed to ensure that psychosocial interventions do not reproduce some of the social dynamics fuelling mental health inequities. We reflect on how value-oriented analyses which consider the intersections of class, gender, and caste/ethnic identity can advance critical Global Mental Health work.

Citation

Chase, L., Shrestha, S., Sidgel, K., Rumba, S., Shrestha, P., & Gurung, D. (2022). Valuing Community Workers in Global Mental Health: Critical Ethnography of a Psychosocial Intervention in Post-Earthquake Nepal. Studies in Nepali history and society, 27(2), 317-352

• Journal Article Type: Article
• Acceptance Date: Mar 9, 2022
• Online Publication Date: Jan 27, 2023
• Publication Date: 2022-12
• Deposit Date: Nov 8, 2022
• Publicly Available Date: Feb 3, 2023
• Journal: Studies in Nepali History and Society
• Print ISSN: 1025-5109
• Publisher: Mandala Book Point
• Peer Reviewed: Peer Reviewed
• Volume: 27
• Issue: 2
• Pages: 317-352
• Public URL: https://durham-repository.worktribe.com/output/1189419
• Publisher URL: https://www.martinchautari.org.np/mc-publications/sinhas-volume-27-number-2