Borderline well-being: Mental health in a development zone

Mental illness contributes hugely to global disease burden. Inadequate resources, limited access to services and pervasive stigma jointly foster its increasing severity, especially in resource-poor countries. Despite recognition that social determinants such as poverty, inequality and marginalization aggravate mental distress, minimal scrutiny has focused on the negative impact of targeted development schemes creating social and economic change that exacerbates mental health risks for poor people. This article examines the rise of mental disorders as an unwanted consequence of a new special economic zone being built in a border district in Northwest Thailand. Ethnographic data from villages surrounding the intended industrial hub was collected during six-months fieldwork in 2017 and 2018. Informants included public health staff in the community and district hospitals, villagers who had lost farming land, health volunteers and spirit healers. Using local narratives and hospital data to show an emergent vulnerability to anxiety, depression and suicide, I argue that global public health approaches seeking to decentralise mental health services and donor-driven mitigation guidelines fail to alleviate stressors for locals caught up in development's slipstream. In turn, distressed by land reclamation, debt, gambling and substance abuse, villagers turn to reinvigorated forms of spirit-healing for assistance in regaining a sense of well-being. In this context, I demonstrate that development schemes potential to affect the epidemiology of behavioral pathologies remains significantly under-addressed within rubrics of ‘border-health’.