Abstract：
In response to the global call to upscale mental health services in low--income countries, mental health non-governmental organisations (MHNGOs) have sprung up in Kerala to address mental health needs by partnering with pre-existing locally grown, bottom-up, community-led pain and palliative clinics (PPCs) to increase access to mental health care through task-shifting. The MHNGOs mandate filtering only patients with \'severe mental disorders\' from low socioeconomic backgrounds for their free services. This eligibility criterion mandated by the MHNGO is ruffling feathers within the palliative clinics that oppose such -classifications. They believe that suffering cuts across all divisions and should not be discriminated against based on economic background and severity of illnesses. When chronicity and suffering are held universal by the MHNGO and palliative care, respectively, it brings to the fore the enactment of two perspectives of care. Drawing on observations of clinical interactions between patients, MHNGO staff and mental health professionals and interviews with community volunteers of palliative care clinics in Kerala, this paper demonstrates how chronicity narrative promoted by MHNGOs based on biopsychiatric model gains hegemony, whereas the community care model loses traction progressively. The state, caught between these two narratives, frontstages development by submitting its health machinery to the MHNGOs flouting basic medical safety laws in its services to marginalised people like the tribal population. This paper argues that the rising dominance of chronicity narrative in community mental health clinics as well as in popular media discourses evolves out of power relations between the MHNGOs and the palliative clinics.
摘要：
为了响应全球呼吁在低收入国家扩大精神卫生服务的呼吁，心理健康非政府组织（MHNGO）在喀拉拉邦如雨后春笋般涌现，通过与当地已有的合作来满足心理健康需求，自下而上,社区主导的疼痛和姑息诊所（PPC），通过任务转移增加获得精神卫生保健。MHNGOs要求仅过滤来自低社会经济背景的“严重精神障碍”患者，以获得免费服务。MHNGO规定的这一资格标准使反对此类分类的姑息诊所感到不安。他们认为，痛苦贯穿所有部门，不应基于经济背景和疾病的严重程度而受到歧视。当MHNGO和姑息治疗普遍接受慢性和痛苦时，分别,它突出了两种护理观点的制定。根据患者之间临床相互作用的观察结果，MHNGO工作人员和心理健康专业人员，并采访喀拉拉邦姑息治疗诊所的社区志愿者，本文展示了MHNGOs基于生物心理学模型推动的慢性叙事如何获得霸权，而社区护理模式逐渐失去牵引力。国家,夹在这两种叙述之间，通过将其保健机制提交给MHNGOs，在为部落人口等边缘化人群提供服务时藐视基本医疗安全法，从而实现发展。本文认为，社区心理健康诊所以及流行媒体话语中慢性叙事的主导地位逐渐演变为MHNGOs与姑息诊所之间的权力关系。
