Working with CNMH has allowed the outreach staff access to various perspectives about mental health from different parts of the globe. They believe that they have learned many “helpful ideas about social work” from others which have contributed to their and CNMH’s growth. They believe that “a cordial and sincere relationship” that they and other social workers/staff of CNMH have built with the clients and the carers is the “foundation upon which the support mechanism of the organization(CNMH) is built”. This relationship-centered social work according to her is what other organizations can “learn from CNMH”,
“Our clients are not treated as individuals by society but as unimportant objects due to their mental health-related behaviors. When we reach out to them the very first duty is to build a relationship with them, but our relationship is not between superior and inferior but between those of equals. For this reason, we start by showing them respect and treating them like we treat someone we care about. Once the clients feel respected then it is easy to build a relationship with them” ( CNMH Senior Outreach Worker)
The relationship they argue is not only between clients and social workers but also between their families and social workers. The clients and their families according to them are “not recipients of social workers’ help but are rather partners in their work”. They are very passionate about the relationship-centered model that CNMH has created,
“We are able to help a large number of people with mental health problems. We are focused on individuals and we help each individual by not only providing services to them but also by connecting them with a community that accepts them. We invite them to the community we have created where they have the opportunity to meet, interact and enjoy communal feasts and play games with others. During the initial stage, we (social workers) spent a lot of time thinking about ways to make the relationship of our community members deeper. The idea of going to picnic together or going to a restaurant together are some of the ideas that came up from among us to address this need. We had not anticipated that we would be creating a community. Still, we ended up building a community in which members have deep relationships with one another and they find a sense of meaning in their lives when they are here. It is however not just the clients, carers, and social workers who find a sense of meaning in CNMH activities. There are several national and international volunteers who come here as often as possible in order to participate in the welcome center programs because they claim that they find activities here meaningful and impactful. The community we have created is not like an office-based community but rather a community that is gathering once a week in an office space. Had it been a big community then our relations with one another could have been official and impersonal but because this is a small community hence, we have developed personal attachments with one another” ( CNMH Social Worker)
Regularly visiting the clients in their homes and inviting them to the “welcome center programs” is one of the means they see as creating a positive environment for them. This however is not enough according to them because unless the attitudes and values of society change and become empathetic towards people with mental health problems, the people with mental health problems will continue to experience discrimination and be marginalized in society. “Creating a space where the clients feel safe and loved is important, but we should also try to change the attitude of the society itself”. The attitude of society can be slowly changed according to them by constantly being engaged with people from various sectors in society to create greater awareness among them about mental health issues.
During our regular “ Welcome Center Session “ we asked some of our clients and carers about the factors that facilitate participation and that encourage them to express themselves.
They thought in order for participation to work properly, they need to have a group of likeminded people. Regular communication with organization staff reminded them to participate in the activities, it also provided them with emotional support and a sense of belonging. They also thought the good relations with other group members also motivated them to participate in different activities like community events, rallies, marathons, picnics and other social events.
In order to further stimulate the discussion, we also showed them a set of selected pictures and asked them about participation. Different nine pictures were displayed and they were asked to share their opinions on them. Some pictures for eg: showed Chhahari social workers visiting home to get updates on the client's situation; training of taking/giving medicines to the client; social events like fundraiser concert where a client also performed for the guests and going on a picnic, etc. group of pictures were shown and the interaction was conducted
They said following things were important:
Some carers also shared their experience of finally receiving the social security card for their relatives with chronic mental health problems. It was a long participation process, going from one government office to another with disappointments many times, lack of proper support and facilitation from the government staff who were themselves unaware or apathetic. The intimidating questioning from the government staff taught them to be brave and fight their way to accessing their rights. They are now able to advise others as well if necessary about the process of accessing the card. It took them several years to get the card and ultimately they have started to receive some allowances that have brought them some economic relief.
Some quotes:
“ The government officials looked at my son and said he looked fine, he has no physical disability even though I provided years of his medical history” Female, Carer.
“ I spent years participating in this process with my son, now that he has started to receive his allowances his father goes to collect the funds with him. I wished being a father he could have participated during the process” Female, Carer.
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:
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"
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)”
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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