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Dec 21, 2016

Vulnerability and Resistance in Lubhu, Nepal

This report provides a qualitative assessment of a rural/urban community for the protection and promotion of mental health and well being following the 2015 earthquake.

The report seeks to assess the impacts that the 2015 Nepal earthquake had on the mental health and psychosocial wellbeing of Lubhu residents, a semi rural town in the Kathmandu Valley. We had a Masters student from Edinburgh University doing her intern with us who carried out the full research with Chhahari staff. 

The investigation into how mental distress is expressed within a Nepali context and what formal and informal support sources exist for those experiencing mental distress – at a micro and macro level was carried out during this research.  Through a culturally grounded, qualitative assessment, conducted via semi structured interviews and observations, we explored the immediate and mid term effects the earthquake had on psychological wellbeing from social determinants of health perspective. The overall objectives of the study into post-earthquake mental health and psychosocial support are as follows:

1.Using interviews and observations, identify the impacts of the 2015 earthquake on the residents of Lubhu in terms of: Overall mental health and wellbeing.The social determinants of mental health and wellbeing (including housing, livelihoods, social relationships and roles) in this community.

2. Using interviews and observation identify the positive, desirable sources of support available to residents of Lubhu in the 12 months following the 2015 earthquakes.

3. Critically assess any ongoing gaps or areas of unfulfilled need regarding mental health and wellbeing support in this community.

We spent time with community members, conducting semi-structured interviews. This allowed for the progressive development of early research questions through the lived experiences of participants and enabled the narrative data collected, to be directed by the participants’ perspectives. We were able to extrapolate trends from the emerging data and explore these within a wider narrative of post disaster mental health issues and existing psychosocial challenges in contemporary Nepal.  We also interviewed mental health and social work NGOs as well as mental health professionals working in the greater Kathmandu with whom to speak with-in more detail- about specific themes emerging.

Our  findings show that social support is fundamental in facilitating mental wellbeing and community resilience in the face of a disaster. The networks of social capital that exist at a community level can compound the negative effects of trauma and provide psychosocial strength to those that utilise them.There is however no single approach to promoting mental wellbeing and it must be understood as part of a larger and complex sociocultural phenomenon. Factors such as stigma, lack of understanding of mental distress and lack of funding to health services can all act to mitigate support sources.The impacts and suffering arising from the trauma of the earthquake have generated an increased need to establish and deliver effective mental health and psychosocial support to those who have been affected. This can be viewed as both a challenge and an opportunity: immediate assistance was needed as a matter of priority, but the need for longer term support for those suffering from the effects of trauma related to the earthquake, and mental distress in general, was clearly highlighted.Thus too was the need to restructure and develop the existing mental health care systems to create a more effective and encompassing structure, as well as need to de-stigmatise mental distress and encourage those experiencing mental distress to access support services.

Understanding the socio-cultural factors that impact on the attitudes towards mental health is inherently important in understanding the patterns of existence and utilisation of support systems and services.

The full version of this report can be provided upon request.

Sep 22, 2016

Report on the Importance of Including Mental Health Carers in Policy

This report highlights our experience of working with mental health carers, focusing the importance of widening the global mental health agenda to include local carers’ voices, greater government investment in mental health with social protection schemes for carers, flexible paid employment arrangements, and innovative mental health care actions.

Chhahari Nepal for Mental Health promotes a holistic person-centered approach to support men and women mentally distressed found on the street and disconnected from their family. Through establishing relationships with the mentally distressed person and their carers, this opens up the opportunity to support stigmatized families to regain confidence and dignity to negotiate through complex relationships amid economic constraint.

We have been building up on providing support to mentally ill people and their carers. From our experience we have realized that it is essential to have a carers support group for awareness and guidance whilst they themselves support mentally ill person/s. We have been providing a monthly carer’s workshop sessions. These workshops allow friends, family members and other carers the opportunity to meet others. The carers have found it comforting to know that other people have had similar experiences

We are gathering evidence from the day-to-day realities of mental health carers,  with very low income (between 39 Dollars and 49 Dollars). The financial and social challenges that carers face in the absence of government mental health services and social protection provisions is huge. They struggle to manage the complex dynamics within the family and community together with the irregular behaviour that can arise as a consequence of mental illness. Also there is a perspective of men and women as mental health carers, including societal gender expectations, discrimination and stigma.

The caring role presents competing demands to juggle the unpredictability of the caring role with the responsibility to earn. There is a lot of stigma and exclusion carers may face as they try to balance their unpaid care roles with paid work to make a living.

Example of a young woman’s journey of economic survival and caring:  

Sister, a young woman, cares for her physically disabled mother and brother with severe mental health problems. Father left the family home and has remarried. Brother has lived on the street for seven years, any close contact with him is difficult. Daily, she takes food to a place he knows. Delight comes when she can see him. The challenge remains to initiate brother’s treatment. Sister left education to care for the family then found paid work as a waitress. Juggling her paid work and being a carer is stressful. Sister participates in the carers’ support group and with this support she’s gained confidence and returned to education. A sponsor provides financial assistance for the family and sister’s education. Sister will be the long-term carer for mother and brother and with better education paid work opportunities will improve.

 A briefing paper highlighting our work with the carers is published online on http://www.ids.ac.uk/publication/the-global-importance-of-including-mental-health-carers-in-policy

Jun 24, 2016

RTI (Right to Information) Project Progress Report

Faces
Faces

RTI project has been initiated by Chhahari Nepal for Mental Health and implementation phase was conducted by the St Xaviers Bachelor is Social work students placed in Chhahari for one year work placement. The project was launched by the team as per the purpose of advocacy and for understanding the budget formation in the mental health sector in Nepal.

The Objectives of this project:

  1. To spread the notion that RTI can be used for advocacy by obtaining the desired information.
  2. To obtain information about the budgeting in the mental health sector from Ministry of Health and Population and Ministry of Women, Children and Social Welfare.
  3. To utilize the information for the benefit of the clients of Chhahari Nepal for Mental Health.

Right to Information in Nepal

The Constitution of Kingdom of Nepal 1990 was the first constitution to guarantee the Right to Information as a fundamental right of the citizens. Article 16 of this constitution provided Nepalese citizen the right to demand and receive information on any matter of public importance, except on any matter about which secrecy is to be maintained by law. Similarly, the current Interim Constitution, 2007 has made a similar provision with some expansion on Right to Information in Article 27 as Fundamental Right. The current provision not only provides right to information on matter of public importance but also to the individual information. 

In 2007, Nepal Government enacted Right to Information Act to give effect to the constitutionally protected right to information. Article 3 of this Act provides every citizen right to information and access to the information held in the public agencies. Similarly, this Act has also made a provision of an independent 'National Information Commission' for the protection, promotion and exercise of Right to Information. National Information Commission was constituted on June 14, 2008. Likewise, Right to Information Regulation was enacted on Feb 9, 2009 to implement the Act effectively. Classification Committee under the section 27 of the Right to Information Act, 2007 has classified certain documents for the protection of information.

The formal letters were prepared for submission to be made in the Ministries. The team leaders (St Xaviers Students) after finalization of the questionnaires went to the Ministry of Health and Population for letter submission and finally after a month the trainee received the response of the questionnaire submitted which was about laws, policies and programs for mental health sectors and it’s processing. The response from the ministry was delayed due to some political obstruction however it was then discussed and evaluated within the RTI operational team. The trainee had also visited NIC (National Information Commission) for the further suggestion.

 RTI Questionnaires Response from Health and Population Ministry

1)   Through health and population ministry, including the main management branch and National health training center, orientation program are being conducted, also mental hospital has been conducting treatment programs, related to mental health. Also, 15 wards are to be managed in a compulsory manner, for the treatment of mental health patients in all teaching hospitals. Similarly, even in the central, regional and zonal hospitals, different wards are managed for the mental patient. In many of the nongovernmental organizations, people having problems regarding mental health are being treated.

2)  This ministry has given priority to the three year plan and the budget allocated by NHSP II for the mental health program.

3)   Among the Rs. 36, 72, 95,040 thousand allocated by Health and Population Ministry for running year 2072/73( 2015-2016) Rs.2 crore is allocated for mental hospital and Rs 28 lakh is allocated for the programs to be conducted by main management branch regarding mental health.

4)   To bring solidarity in the subsidy that are provided in order to conduct health related program and nongovernmental health service, as well as to do optimum utilization of resources and to make the report writing process materialistic, for budget indicator preparation related to subsidy available, regulations were made to make the subsidy available for NGO by a committee meeting by various governmental hospital of this ministry.

We are trying to extract more information about mental health agencies that are getting fund from ministry which will be dealt in the coming days.


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