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Mar 29, 2016

Research Project Report on Mental Wellbeing

An investigation into the socioeconomic factors impacting on mental wellbeing in Kumbeshwor and Imukhel area (Lalitpur, Nepal).

This report shares the findings of a three-month research project into the idiosyncratic realities and socioeconomic factors that might make certain populations more vulnerable to mental distress and mental illness. The location of our research was the Kumbeshwor and Imukhel area in Lalitpur(Kathmandu, Nepal), which was identified by Chhahari Nepal for Mental Health (CNMH) as being of concern due to the magnitude of mental health issues seen in the area.

In Nepal mental health issues have not been adequately addressed, either by the government, private sector or non-governmental organisations (NGO). It is estimated that around 20% of the country’s population of around 30 million people are affected by mental health problems in some form, yet only 0.14%of the national health budget is currently spent on mental health. On the positive side, in recent years there have been increasing efforts on the part of NGOs to work on mental health issues, including the establishment of a national level Mental Health Network, of which CNMH is an active member.

This work was commissioned by CNMH during the two volunteers who prepared this report worked. CMNH is a secular local NGO that has been working for over five years in the district of Lalitpur in the Kathmandu Valley  , with the aim of establishing a more just and equitable society where the mental health needs and wellbeing of all people, women, children and men alike, are addressed.

Within Lalitpur, the focus of research was narrowed to the smaller area of Kumbeshwor and Imukhel, where CNMH identified a larger than average number of people suffering from mental illness and/or distress. Interestingly, narrowing geographical focus simultaneously led to a particular ethnic group, as the majority of people living in Kumbeshwor and Imukhel are Podes (or Deulas), who belong to the Newar lowest occupational caste, the so-called ‘untouchables’.

This report narrates and analyses the data collected, seeking to function as a bridge between the realities in the field and the professional lens on these issues, revealing several common themes but also some discrepancies between the two. Finally, informed recommendations is also provided for mental health service providers in Nepal with more specific recommendations tailored to CNMH.

Both the professionals and most of the clients' families and neighbours acknowledged the huge reliance on traditional healers, especially when there is no sign of physical injury or illness. In fact, it was said that several informants believed mental illness is caused by someone casting a spell to ‘ruin you’ due to jealousy or hatred.

Here is an example, Shyam’s neighbours thought that his mental distress was caused by a stranger having ‘ruined him’ by giving him some milk to drink. However, they admitted they didnot see him drink anything offered by anyone else and Shyam himself does not hold that belief. His neighbours also confessed that they were afraid of Shyam during full moon nights because they thought his behaviour would become erratic and violent. When inquired whether they were referring to the mythical story of a man turning into a werewolf on a full moon night, they agreed this was so.

A social development practitioner reiterated the popularity of traditional healing beliefs when there is no sign of a physical wound. The reductionist association of all illnesses to a physical injury causes people to believe that those who become mentally ill or are mentally distressed must have been ‘ruined’. Hence, they are taken repeatedly to traditional healers. The social worker mentioned that people only acknowledge the one person who is 'cured' by a traditional healer; which in his words ‘could be a coincidence’ rather than the many who are not cured. Hence, according to him, sufferers and their families have no faith in recovery through medication and hospital visits but continue to visit faith healers, despite inconsistent results, posing a challenge to modern health care.

Poverty was one of the first factors thought was impacting on the capacity of individuals and families to respond to mental health problems and indeed found it to be a fundamental contributing factor. However, it is important not to impose a label and let it stand as a full explanation for a circumstance or behaviour. It would be overly simplistic to conclude that the families of the Pode community do not seek out treatment or follow through with it purely because of a lack of financial resources. Although it undoubtedly does play a role, there are other more subtle dynamics that unfold in particular ways within unique circumstances that could explain behaviours

The same problem of resources present in the families of informants applies more generally to the health care services in Nepal. The specific vulnerabilities that the Pode community might face in responding to mental illness and distress are exacerbated by the general lack of government resources allocated to these societal issues. Indeed, caring for the mentally ill and distressed is generally considered the responsibility of the families or communities of the distressed.

 We are in the final process of editing this research project report. The full version of the report will be shared upon request. Contact or email us for more details on this report.

Dec 29, 2015

CNMH earthquake response project report 2015

Chhahari Nepal for Mental Health

Earthquake Response Project Report

Chhahari Nepal for Mental Health (CNMH) initiated immediate relief measures in response to the destruction and damages caused by the earthquakes in the months of April and May, 2015. The first priority has been to locate and access the safety of CNMH's clients and their families. CNMH is now widening its scope to initiate a rapid assessment of other people on the streets who may be suffering from trauma, stress and/or mental health problems as a direct consequence of the earthquakes. The objective of this Earthquake Response Project is to identify these individuals, re-connect them with their families and provide psycho-social and treatment support where necessary.

This report summarizes the findings of a project that focused on locating, and offering support to, mentally distressed men and womenafter the earthquakes in Nepal in April and May 2015. The location of this project was in the areas around Lalitpur (Lubhu, Bugmati, Khokana and Bagdole) as these areas were adversely affected by the earthquakes, but were not areas in which Chhahari Nepal for Mental Health (CNMH) had previously worked. The project lasted for one month

Three days after the first earthquake, CNMH began to locate clients, ensure their safety, then investigate and address their wider needs. The main task was to find individuals who were living on the streets in areas that had been devastated by the earthquakes who had not yet gained access to Chhahari's services, and build positive working relationships with them. While locating these new clients and their carers the focus has been on areas in the Lalitpur district that were not previously covered by CNMH.

Two Earthquake Response Officers (EROs) were assigned to complete this essential work. Both EROs had been volunteering for Chhahari prior to the earthquake, so were familiar with the organisation's work and approach. While visiting many different locations around the Lalitpur area many mentally distressed women and men were found to be living in a miserable state with various mental, as well as physical, health problems. In the field visits 21 vulnerable people were located who had not yet accessed CNMH's services (14 men and 8 women) in the areas around Lalitpur. Estimated ages ranged from 16 to 50 with most of them falling in the 20-40 age range. The EROs focused more on the areas such as Lubhu, Bungmati, Khokana and Bagdole as these were new areas for CNMH and had been badly affected by the earthquakes.

Of the 21 mentally distressed women and men who were identified during our field visits, only 4 had family support while 17 were mentally distressed women and men who live on the street.

CNMH's two EROs received extensive training relating to post-earthquake trauma counselling. This training was very helpful during the project, but also helped greatly in their own personal lives.

Initial support for individuals focuses on assessing their current living conditions, assessing needs and setting priorities for support work. The next step is tracking down their families and, where necessary, reuniting individuals with their families. Reconnecting mentally distressed people with their families/carers is essential for ensuring that basic needs for food, shelter and clothing are met, but also for meeting social, medical, educational and economic needs. CNMH often finds this partnership approach with carers and family members to be extremely effective in supporting individuals with mental health issues.

Through the undertakings of this project, it is identified that the community is provided with training courses related to trauma counselling and mental health support.Likewise, it is also noted essential that after building positive relationships and rapport with new clients, it is necessary to provide them with medical treatment. Similarly, to encourage new clients and their carers to attend the day-care centre (Welcome Centre) and to allow individuals to express themselves through creative tasks (music, arts, cooking), build self-esteem (using meditation and field excursions) and support increased interaction with others. Previous experience has demonstrated the huge contribution Chhahari's Welcome Centre makes to helping people to improve their mental health.

During the implementation of this project, the urgent need is identified to locate individuals with mental health issues who are living on the street and their carers and reunite them.

case study:  

Rita is a 35 year old woman from Khokana who lives with her family. She is married and has two children. During the earthquake Rita was working in the field alone, away from friends and family members. According to her father-in-law, Rita did not return to her work for weeks after the earthquake and was showing signs of shock, mood swings and helplessness. She was traumatized by what had happened, and had refused to enter her house for several days after the earthquake due to her fear of aftershocks.

It was suggested that CNMH could provide local people with information on mental health issues and how to deal with trauma.

The most pressing need for this client is for psycho-social trauma counselling to help her to come to terms with what happened. Also there needs to be increased awareness, as well as acceptance, in this area regarding mental health issues and mental distress.

Sep 28, 2015

CNMH Earthquake Response Progress Report - Phase III


Chhahari Nepal for Mental Health (CNMH)
Earthquake Response Progress Report – Phase III

After the completion of two phases of Post-Earthquake Response Activity project, we now process towards the phase III. This is the final phase of this project and mainly focuses on the completion and some ongoing activities of phase I and phase II. In phase I, we emphasized on assessing our clients living condition and to what extent earthquake affected them be it physically, mentally, financially and socially. As we worked upon phase I, we identified the need of the development of another phase; and in phase II, we worked on locating new clients and re-connecting them with their family/relatives. Under all phases we work in co-ordination with the community and other likeminded organizations. CNMH is also participating in the UN Mental Health Cluster meetings led by UN and MoHP(Ministry of Health and Population).

Under phase III, CNMH is providing monetary support to help clients and carers continue with their medication, treatment and temporary shelter with regular follow-up. We are in the process of providing monetary fund to the clients for their monthly medical cost; and covering 50% of treatment cost of the carers. These carers are undergoing certain medical treatment like cataract treatment, hemorrhoids, and bed sore. This monetary fund is provided only for a period of 5 months. And for this we have signed an agreement letter between the carers, clients and organization. This agreement letter is considered to be of importance; as for the clients and carers to understand that this support is for a certain time period.The bills provided by the hospitals, clearly mentioning the patients name and amount; are collected as for our record.

Likewise, the client's families who have lost their houses or who have suffered from damaged houses are provided with monetary support.

We continue to work and proceed with one of the activities of phase II; that is to locate new clients and re-connect with their family/relatives. For this activity to be carried out, we have employed two EROs (Earthquake Response Officers) who actively participate to identify and investigate people suffering from mental health problems, majorly affected due to the earthquake. The EROs shall also seek to locate and reconnect these individuals with their families. Until date, we have located 21 new clients post- earthquake period. And under phase III, we continue to work with these clients and support them.

After, the assessment and evaluation was done by the EROs during phase II, a report was prepared by them which highlighted the findings and experiences focusing on locating mentally distressed men and women as a post-earthquake response. This report can be found in our website.

Similarly, the clients and carers are also supported through our weekly Welcome Center sessions and Carers Workshop Sessions. Carers Workshop Sessions takes place once in every 2 months in collaboration with ECTC (Elijah Counselling and Training Cenre) specially designed for the carers only who care for the mentally ill .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.

There are some aftershocks felt across Nepal until date. And a sense of fear and stress still exists amongst the people. Therefore, under this phase CNMH is participating in various psycho-social trainings on stress management, peer support; counseling and community based psychosocial support; to continue to develop in post-earthquake response activities with mentally distressed group.



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