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Jun 14, 2018

Mental Health Carers Advocacy

Daily Life
Daily Life


Seventy-year-old Narayan lives in a small house around Patan Durbar square, a UNESCO world heritage site. He takes care of his son Naresh who has been suffering from a mental health problem for the last few years.

A few months ago, Narayan wife died because of physical violence inflicted by their son. She suffered multiple bone fractures and severe hemorrhages. Narayan and their daughters tried to save her by admitting her to an expensive private hospital for treatment, at a cost of more than NRs.150, 000 (around US$1500) but this was in vain.

Subsequently Narayan was also diagnosed with colon cancer, which required extensive surgery. Now he is at home looking after his son and still convalescent from the surgery. Poor, old, sick and vulnerable, Narayan cries every time Chhahari Team visits him, saying he is helpless and does not know what to do. He does not have the money to pay for the expensive medicine prescribed by the doctors, yet is afraid he will die if he does not have it. He cries as he carries water to cook food and in some ways he hopes to die soon to end his suffering.

The Chhahari outreach team visits Narayan on a weekly basis to provide moral support and encouragement, as well as practical help in accessing the services he needs. Coordination with other mental health organizations has enabled him to get few free medication for  himself and his son, which has considerably improved his condition and made life easier for Narayan.

One recurring issue in mental health carer advocacy has been that mental health carers feel confused, unsupported, overwhelmed and/or excluded by the very mental health system that treats the person they care for. 

Mar 16, 2018

Gaps of care created through Gendered Caring Roles.


Gaps of care created through intricate gendered caring roles: Challenge for mentally distressed

When a Nepali woman marries, she is not only marrying her husband but his entire family. In fact, the wedding day is regarded as being a ‘sad’ day for the bride because she leaves her home behind, becoming part of her husband’s family (traditionally moving into his house with his entire family). In theory the wife’s caring responsibilities are mainly towards her husband and his parents. If her parents fall ill, it is the responsibility of her brother and his wife to take care of them. In much the same way, the in-laws take on some responsibility towards their son’s wife. Thus, it could be argued that the responsibility roles are dictated by gender.

An example from our field experience might help elucidate this point further: Chhahari has a female client whose mental distress started after her wedding. Frustrated with the fact that her condition impaired her daily life and role within the household, her in-laws decided to take her back to her parental home to be taken care of by her own family, giving up the responsibility themselves. Further, once they realised that her brother also had a mental illness they blamed her side of the family for it (as being genetic) and refused any further responsibility for her.

Furthermore, we have found that instead of there being a shared sense of responsibility across all family members there was in fact an underlying understanding of what sort of responsibility different members of the family have, and this seems to be dictated according by gender. Men felt responsible for providing the family with monetary support while the women were in charge of care.

This is very apparent in the case of one of CNMH’s clients, who lives with his father and two brothers (the mother had passed away). We regularly visit their house and the father continuously repeats that he provides shelter for his son and thus does more than others, who just leave their mentally ill children on the streets. Although he buys the medication, he told us he cannot afford to stay at home and give the medication to his son because he has to go to work. If he cannot work he is unable to bring food to the house and pay the bills. He also mentioned the fact that there was no woman in the household to take care of his son. It seems he felt he was fulfilling his duty and that the extra steps needed for his son to get timely medication (i.e. giving him the medicine) should be carried out by someone else, ideally a woman.

These examples drawn from the field illustrate unspoken societal rules and expectations with regard to care that are influenced by cultural understandings of gender roles. When these ‘norms’ are abandoned (e.g. in the case where in-laws give up their responsibility) or the conditions cannot be fulfilled (e.g. in the case where the mother has passed away and the father is alone in taking care of his son) gaps of care that are created leaving the mentally distressed/ill on shaky grounds for support.

Dec 18, 2017

Towards Developing a Helpful Social Model Approach

Rupak is a 33-year-old male who has been diagnosed with paranoid schizophrenia. True to gender expectations, his mother provides the majority of his care and his father is the main breadwinner of the family. According to his family Rupak’s mental health deteriorated following the end of a serious relationship. His parents were unaware of how to deal with their son’s condition.

Blaming his family for not providing proper care, Rupak began frequenting the streets and many nights his family, unsure of his whereabouts, worried for his well-being. The family explored curative options through spiritual healers, witch doctors and rehabilitation centers and all proved ineffective.

Rupak’s violent history with his family and members of the community has resulted in his stigmatization and exclusion from the community. Following his diagnosis, he was prescribed medication which he has been taking regularly with the support of his family and Chhahari. According to his family, the medication has resulted in less violence and this is a key reason his family considers him on the path to recovery.

However, Rupak’s father persistently expressed his desire for Rupak to work at the family vegetable shop, indicating that he does not perceive Rupak as fully recovered. When discussing about the topic of the family’s livelihood Rupak’s father expresses his desire for Rupak to partake in the running of the shop – a desire he expresses multiple times. He compares Rupak to his nephews who at similar ages own their own shops and contribute to the economic improvement of their families.

Rupak’s father is happy about Rupak’s improvement over the past year. He highlights that Rupak is no longer violent with his family or community and he has independently taken on new responsibilities regarding his personal hygiene.This case study also highlights the newfound willingness of Rupak’s father to participate in the social treatment of Rupak. As previously his father was unsupportive, uncommunicative and a demanding head of the household.

Rupak’s father spoke of his son’s improved condition, hinting at the multi-dimensional concept of recovery .His perception of recovery falls into line with reference to recovery as complex, multidimensional and subjective process of growth, healing and transformation. Moreover, his participation and cooperation with Chhahari is representative of the positive effect that a ‘person centered approach’ can yield, demonstrating the wider social process of recovery. His participation is celebrated as a positive success by Chhahari.

In this way the social process of recovery is interrelated with the facilitation of ‘supportive relationships’ at the family, professional and peer level .Chhahari Nepal for Mental Health’s Social Model approach to Mental Health care extends the objectives of a ‘person centered approach’ beyond the individual client to include to collective unit of the family by realizing that you cannot simply force supportive relationships with family members. Rather, Chhahari works to facilitate these supportive relationships over time by engaging families in discussions that enable them to realize their full potential in terms of creating a supportive home environment for the client.

Interestingly, Rupak’s improvement has given his father the ability to spend more time and energy on the family’s livelihood. And this has resulted in a greater earning capacity for the family. In this way the experience of Rupak and his family demonstrates a combined instance of coping and recovering.

Rupak and his family regularly attends weekly support meetings at Chhahari and we are witnessing a great improvement. Also, with the support of his family, and the services provided by Chhahari we see encouraging signs.  

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