Reflections on doing training for the World Health Organization’s mental health gap action program intervention guide (mhGAP-IG)

The World Health Organization’s (WHO) mhGAP-Intervention Guide (mhGAP-IG), is a tool designed for non-specialists to detect, diagnose and manage common mental disorders. In this paper we specifically focus on how the mhGAP-IG is understood and used in the training of non-specialists – as part of a task-sharing strategy key to scaling up mental health in LMICs. Specifically, this paper is interested in how mhGAP training enacts pedagogic modes of address that invite, enact and circulate particular ways of knowing and doing mental health. Despite being highly scripted, we cannot know from the mhGAP training manuals how training actually takes place in practice, or about whether local contextual epistemologies of distress are able to interrupt or resist universal tools. This is important because while the IG and its training may be designed for expansion and global use, this doesn’t tell us much about how they are actually used, enacted, appropriated, or resisted around the world. The research detailed here draws upon interviews with people involved in designing the mhGAP-IG and/or delivering training, and focuses on moments when training takes off or diverts from the script. The data detailed here shows instances when people’s own philosophies of life and understandings of distress shape the training they deliver. Instead of assuming that universal tools such as mhGAP enact top-down medicalization, we attend to the complex practices engendered by mhGAP and the nuances of local adaptation.