Task-Shifting in Community Mental Health in Kerala: Tensions and Ruptures.

Based on an ethnography of community mental health programs run by two NGOs in Kerala which have associated themselves with preexisting, locally grown, community-based palliative clinics, this article explores how professional NGOs bring a new culture to volunteer-based programs. Professionalizing volunteers through task-shifting results in the transformation of their philosophy of community care, which constrains and narrows understandings of mental health care. The state, in alliance with psychiatric NGOs, front-stages development through aggressive task-shifting which we argue is a socio-politico-moral process, disrupting the shared consciousness between volunteers and their own communities with fatal consequences for their most vulnerable citizens.