Mentally Distressed Care

by Chhahari Nepal for Mental Health
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Mentally Distressed Care
Mentally Distressed Care
Mentally Distressed Care
Mentally Distressed Care
Mentally Distressed Care
Mentally Distressed Care
Mentally Distressed Care
Mentally Distressed Care
Mentally Distressed Care
Mentally Distressed Care
Mentally Distressed Care
Mentally Distressed Care
Mentally Distressed Care
Mentally Distressed Care
Mentally Distressed Care
Mentally Distressed Care
Mentally Distressed Care
Mentally Distressed Care
Mentally Distressed Care

It was interesting to learn that our clients and carers thought-provoking interpretation of transformative participation, for eg: they saw it as a process of bringing about positive changes in their lives through their participation rather than the bigger systems. However, there are many barriers throughout the process. During one Welcome center workshop session, our clients and carers shared  the main barriers to participation was poor economic conditions and lack of time due to the primary need to work as they need money to maintain their homes and also need time to take care of house chores. This was relevant for both clients and carers: 

  • Clients who are working cannot leave their job to attend the programs and those who are dependent on carers to attend programs cannot come if their carers are busy.  
  • Some clients had problems in clearly expressing and communicating due to their health condition and probably due to the effects of medication. 
  • There is a considerable lack of support from family members for female clients due to social norms of treating daughters as ones who would eventually be married off. 
  • They try to make it to the weekly program in the welcome center as much as possible but some clients miss it due to work or inability to come without assistance. In that case, carers try to attend to maintain contact and seek support with the organization. 
  •  Some clients fear that due to their mental health problems they see others react negatively to them. 
  • It is physically and mentally difficult to attend at times for the clients since their illness and medication makes them drowsy and they cannot think clearly.

Ganga said:  ”Because of having mental illness I am neglected by my own family and society.I am excluded from employment opportunities, participation in social functions too” 

Tara said “My husband often comments that there is too much work to do at home and says I should not go anywhere. There are children who also need to be looked after, so I cannot go anywhere even if I want to go. I cannot leave our children and house because of fear of comments and abuse from husband and in-laws.” 

Muna said: " Due to our poor economic condition I am not even able to attend all the interesting programmes, workshop etc happening in my own community and also at Chhahari. I have to go an work to make 40 dollars a month, without which I cannot purchase food or medication" 


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Sita,  Ram’s mother, is also his sole carer feels that her son loves CNMH’s weekly welcome center programs. “He loves playing board games with other people”. “Only here” according to her “does he have game partners and opponents to play with or to play against”. “He loves playing board game and here he is a champion”. “No one can defeat my son here” she said calmly and added “but of course sometimes he loses”. The games however are not only attraction for him. According her “he loves being around the social workers from CNMH”. “Even during his worst phase, a mere presence of CNMH’s social worker in the house used to calm him”. She added “everything he likes is here”. she said:

“He loves me very much and I am always with him every Wednesday in this CNMH office. Apart from me he loves being around social workers here who are also present here during the welcome center programs. He has two other friends here with whom he smokes and play games. He meets his friends only once a week and only here. He loves playing games here. I think he is most happy when he is here. I love seeing him happy. I wish every day in his life will be like this” 

Ram’s mother also finds welcome center very important. According to her, Ram always ask her “when is the time to go to CNMH ?”. On Tuesdays (a day before the welcome center) he regularly asks her “if his formal clothes are clean”. She adds “Wednesday morning is the only time when he washes himself and combs his hair”. “It is also the only day when he wakes up slightly early than before and spend time in front of the mirror”. According to her, what Ram likes about welcome center are “social workers”, “friends”, “food” and above all “acceptance”. 

“ My son is simple minded and quiet, but he knows if someone loves him or not. He knows I love him (smiles) and he knows sathi haru (friends at the center and social workers from CNMH) love him. They comb his hair, cut his nails, and arrange doctors and therapists check his condition.  He likes coming here and he also enjoys meeting his friends. Whenever I bring him here, I feel I have brought him back to home from school when he was a child. He used to get so excited to come back home and I see the same excitement when he comes here. He also loves receiving transportation money from CNMH. He loves giving a small portion of this money to me (with tears in her eyes)”  

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Chhahari Nepal for Mental Health participants ( clients: an individual with mental health problems and carers: family member looking after their loved ones with mental health problems )  expressed interest in different types of participation which was something new to our clients and their family members categorically. It was interesting to learn that they had their interpretation of transformative participation, for eg: they saw it as a process of bringing about positive changes in their lives through their participation rather than the bigger systems. 

Clients and their family members brought out their perspectives on participation based on their own experiences. They were vocal about their emotions and thoughts on the process of participation including the facilitators and the barriers to it. They felt light-hearted, happy and being invited to events and sessions at CNMH welcome center sessions to share their perception and simply talk which made it meaningful. They can express themselves, speak up and be heard. They were also happy to be part of a learning experience. 

Most family members who look after people with mental health problems are females but this is accepted as normal and not out of the ordinary. Most of the female family members feel that their participation has been transformative or representative because they have been part of the positive changes in their own lives or participated in programs as a representative/ caregiver. The majority of opinions were voiced by the family members who are representatives of clients. This power dynamic seems to exist and is accepted. 

CNMH connection and support is the major key that facilitates participation. Their introduction to CNMH has opened the doorway to many things- proper treatment, support, access to their rights, social support etc. Facilitation is necessary without which they are running around like headless chickens. Due to the ‘sickness’, clients cannot venture out which is the biggest barrier to participation. Without the correct treatment and medication (right dose, right type) the condition of the client would not improve. They may not be able to express themselves or are not participating by themselves in events and are usually accompanied by their carers when participating so clients an individual level of participation is low.

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Sachin hated coming out of his room and was afraid of meeting other people. Social workers from Chhahari started building a relationship with him and now we have been working with him for over 5years.

Whenever Social Workers from Chhahari went to meet him they started building trust and connection. Then slowly they started taking him to a nearby restaurant, parks and places he enjoyed visiting. During a walk to the restaurant, he began opening up and sharing his frustrations. They slowly learned that he sometimes likes to smoke a cigarette and hence they invited him for a walk allowing him to smoke. After a long-continued relationship, Sachin gradually started attending the Welcome Centre Session at Chhahari. Now, he is one of the “regular clients” to attend the session.

We were able to bring him out of isolation and now he has managed to make three friends from the welcome centre session. All three love to go out together and smoke cigarettes and play ludo game, they are the only friends he has and enjoys their company. The friendship that Sachin has built with one another has helped him to have a sense of companionship and belongingness.

The social workers from Chhahari are able to gain the trust of clients and their families because we invest long hours of time and energy building connections. Some of the clients and their families have been interacting with the same social worker for almost 7 years.

For many clients and their family members, the support from Chhahari social workers may not represent the ultimate solution to all their problems, but they nevertheless are people who they can turn to talk about their problems and be comfortable with.

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One of the youngest clients of CNMH is suffering from chronic mental health problem. It has been a struggle for the CNMH social workers to assist her to psychologists/ psychiatrists. Her mother who owns a small restaurant has a serious health condition. According to her doctor and medical reports, she needs heart surgery as soon as possible. The delay in her heart surgery is related to her economic status.

CNMH social worker has identified government provisions through which the cost of her surgery could be reduced by almost one third. It is however not easy to be eligible for it because it needs various government recommendations and certificates. Although this is not related to her mental health, CNMH believes that it will have a positive impact on the mental health of her daughter if her mother gets better.

CNMH is on a mission to help as many clients as possible to have access to Social Security Allowance (SSA) from Nepal Government. At the same time, many of the clients in the streets do not have proper citizenship certificates.

For the past few years, CNMH has been working towards getting a Social Security Identity Card from the government for many of the clients with chronic mental health problems.CNMH have been able to slowly and successfully manage to link clients and carers ( carers refers to the main person responsible for the day-to-day unpaid care of the family member that has a mental disorder) with the government's social support programs.

Few of the clients now have security and some independence. However, the challenges still remain. 

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Organization Information

Chhahari Nepal for Mental Health

Location: Lalitpur, Province 3 - Nepal
Facebook: Facebook Page
Twitter: @chhaharinepalmh
Project Leader:
Bidya Maharjan
Program Manager
Kathmandu Valley, Bagmati Nepal
$37,811 raised of $50,000 goal
507 donations
$12,189 to go
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