Working from the ground up to understand how better care environments look like: An Engaged Ethnography of Mental Health Activism in Uganda

Mental health disorders have been recognised as the third leading cause of the global burden of disease, and disproportionately affect low- and middle-income countries where over 80% of individuals with mental health disorders live. Despite the evidence, mental health remains a low priority on the global health agenda. Alongside a need for prioritisation in this area, the task of envisioning research directions to achieve quality and equity of care is no easy feat. Longstanding debates have warned about simplistic imports of psychiatric solutions across settings as it perpetuates coloniality and lack the necessary contextual insights. The importance of context has been further highlighted in recent years as evidence is increasingly drawing our attention to the social dimensions of mental health, and its political economy, to help understand and address mental health outcomes. 

In light of this, my Uganda-based research proposes a shift in our approaches to Global (Mental) Health by looking at mental health activism. Health activism is generally described as challenging the status quo where it is perceived to negatively affect health outcomes. As complex power relations are often at play to shape, upkeep and disrupt the status quo, we miss a part of the picture if we don’t pay attention to these dyanmics when envisioning better care environments. By looking at mental health activism, we prioritise and embed grassroots voices and their expert knowledge at the core of research. This calls for more diverse methods to pursue this line of research. I notably suggest photovoice and narrative interviews, as part of an engaged ethnography approach. These methods remain under-utilised in the space of Global (Mental) Health, as orientations are often technical and omit in-depth attention to the social complexities of the issues at hand. The proposed approach and focus can complement the existing body of knowledge by uncovering such complexities through listening to local voices about what their needs are and learning from their innovations in terms of how they envision meaningful change.