Pills that swallow policy: clinical ethnography of a Community Mental Health Program in northern India

Transcult Psychiatry. 2009 Mar;46(1):60-85. doi: 10.1177/1363461509102287.


India's National Mental Health Program (NMHP) was initiated in 1982 with the objective of promoting community participation and accessible mental health services. A key component involves central government calculation and funding for psychotropic medication. Based on clinical ethnography of a community psychiatry program in north India, this article traces the biosocial journey of psychotropic pills from the centre to the periphery. As the pill journeys from the Ministry of Health to the clinic, its symbolic meaning transforms from an emphasis on accessibility and participation to the administration of a discrete ;treatment.' Instead of embodying participation and access, the pill achieves the opposite: silencing community voices, re-enforcing existing barriers to care, and relying on pharmacological solutions for psychosocial problems. The symbolic inscription of NMHP policies on the pill fail because they are undercut by more powerful meanings generated from local cultural contexts. An understanding of this process is critical for the development of training and policy that can more effectively address local mental health concerns in rural India.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Communication
  • Community Mental Health Services / economics*
  • Cost-Benefit Analysis / trends
  • Developing Countries*
  • Drug Costs
  • Female
  • Health Policy / economics*
  • Health Services Accessibility / economics*
  • Humans
  • India
  • Male
  • Medication Adherence
  • Middle Aged
  • National Health Programs / economics*
  • Patient Care Team
  • Physician-Patient Relations
  • Psychotropic Drugs / economics
  • Psychotropic Drugs / therapeutic use*
  • Rural Population
  • Social Conditions


  • Psychotropic Drugs