Deconstructing Autonomy in Mental Healthcare in the Global South: A Case for Tanzania

About this event
The UN Convention on the Rights of Persons with Disabilities (CRPD) has introduced a paradigm shift in mental health law, endorsing autonomy for all, irrespective of mental capacity. However, the conceptualisation of autonomy in this context remains mostly Western-centric, especially regarding expectations for implementation. The policy and legal dilemmas involved in achieving compliance are under-researched, given the resource and institutional constraints affecting healthcare systems in low- and middle-income countries (LMICs) in the Global South.

Drawing on a case study of Tanzania, it is argued that current mental health and legal frameworks do not sufficiently address the social, structural, and power dynamics. These dynamics underpin the embodied experience of mental disability in the context of autonomy. These frameworks inadequately consider the enduring legacies of coloniality, which have fostered medical elitism, unequal power relations between patients and healthcare professionals, and the predominance of Western practices in the provision of mental healthcare. Further, they overlook the operationalisation of fundamental pillars of Ubuntu philosophy, such as inclusion, solidarity (Ujamaa), and communal support, failing to consider the importance of relational aspects of autonomy within the Tanzanian socio-cultural environment.

Therefore, I argue for a more holistic and inclusive approach to the design of mental healthcare policy and law that recognises a decolonial and relational understanding of autonomy, grounded in the core tenets of Ubuntu philosophy, including communal support, solidarity (Ujamaa), and inclusion. Account should also be taken of feminist socially constitutive accounts of autonomy (SCAs), which highlight the impact of oppression on autonomy, in order to critically address ongoing coloniality in mental healthcare institutions and professional practices. This conceptual framework offers a more nuanced and comprehensive understanding of how to promote autonomy in the design and regulation of mental healthcare in LMICs in the Global South, such as Tanzania.

Speaker
Hilda Tizeba is a PhD candidate in Health, Medical Law and Ethics at the University of Edinburgh. Drawing on Tanzania as a case study, Hilda's research uses socio-legal inquiry to explore anti-colonial and feminist approaches for the promotion of autonomy in mental healthcare in the Global South.

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