Revisiting therapeutic governance: the politics of mental health and psychosocial programmes in humanitarian settings

Over the last several decades, humanitarian programmes have increasingly sought to preserve not only physical life and health, but also to address psychological needs and to promote the social well-being of conflict-affected populations. This growing prioritisation of psychological issues in humanitarian settings can be seen in the development and widespread use of mental health and psychosocial support (MHPSS) programmes. Such programmes have taken many forms, including the deployment of psychiatrists to emergencies, promotion of trauma counselling, establishment of supportive spaces for children, and longer-term community development and peace-building initiatives. Despite this proliferation, MHPSS programmes have been widely criticised, and the field marked by intense debate. In this paper, the author discusses the evolution of MHPSS programmes and the associated debates by analysing Vanessa Pupavac’s critique of psychosocial programming as constituting 'therapeutic governance', or the homogenisation, pathologisation, controlling and depoliticisation of affected communities. She then mobilises this framework to analyse current practice as represented by the 2007 IASC Guidelines on Mental Health and Psychosocial Support. She argues that the field has made significant progress toward a culturally-appropriate and empowering model of psychosocial programming within humanitarian interventions, but that individual programmes would still benefit from situation-specific evaluation. Though the critiques of homogenisation and pathologisation have been addressed by the IASC guidelines, she argues that there remains the potential for MHPSS programmes to contribute to the controlling and depoliticising nature of broader humanitarian programming.