Care & Support of the Mentally Distressed

Gita is a 20-year-old female, diagnosed with bi-polar disorder. In the past, as a result of her mental distress, she wandered the streets. This is where CNMH came into contact with her. She is currently taking medication for an anxiety disorder, which CNMH funds, reducing the economic stress of the family. Gita lives with her mother who suffers from diagnosed depression, her younger brother who excels academically and her father who works in a small shop. Gita's mother works intermittently as a domestic worker – her depression causes employment insecurity and Gita's father is the breadwinner of the family. However, his income also fluctuates and he earns only approximately 2-3 dollars a day.

Gita has a passion for education, but unfortunately this passion is a source of self-stigmatization, as she cannot perform at par with her peers. Based on her experience of exclusion at school and in society, Gita does not perceive herself as valued member of the community. Based on a ‘person centered approach’ CNMH has focused on assisting Gita with her studies and her English language skills in the past which has visibly increased her confidence and provided a means of empowerment that has helped her overcome her self-stigma. In this way, mental health social care models can benefit from the inclusion of social methods that work to negate harmful effects of stigma at an individual level. Moreover, Gita's expression of her desire to attend CNMH daily reflects the positive effect that community social support networks facilitated by mental health organizations can have on mentally ill/distressed people who are vulnerable to social exclusion on account of stigma.

Given the major connections between poverty and mental health, this case study of Chhahari presents an important example of the positive affects of social inclusion, which is a major theme in development discourse. Given that development policy is predominantly focused on poverty alleviation, this provides an opportunity for Global Mental Health and development alike to feature the voices of the the poor, who Global Mental Health seeks to support.

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.