Anthropology, brokerage, and collaboration in the development of a Tongan public psychiatry: Local lessons for global mental health.

Abstract

The Global Mental Health (GMH) movement has raised questions of the translatability of psychiatric concepts and the challenges of community engagement. In Tonga, the local psychiatrist Dr Puloka successfully established a publicly accessible psychiatry that has improved admission rates for serious mental illnesses and addressed some of the stigma attached to diagnosis. On the basis of historical analysis and ethnographic fieldwork with healers, doctors, and patients since 1998, this article offers an ethnographic contextualization of the development and reception of Puloka's three key interventions during the 1990s: (a) collaboration with traditional healers; (b) translation of psychiatric diagnoses into local cultural concepts; and (c) encouraging freedom of movement and legal appeal to involuntary admission. Dr Puloka's use of medical anthropological and transcultural psychiatry research informed a community-engaged brokerage between the implications of psychiatric nosologies and local needs that can address some of the challenges of the Global Mental Health movement.