-Dr. Roshan Neupane, Nepal’s #1 ranked doctor/Myagdi District’s Health Officer/Senior Medical Superintendant
“Alcohol issues and drug related deaths in our community need to be discussed community wide, and we need solutions.”
-Hira Tapa, a Beni District Ward Secretary
Mental health is a significant and pervasive issue in Nepal that has only begun to be addressed by organizations in the major cities of Kathmandu and Pokhara. Although suicide is the number one cause of death for Nepali women ages 15-49, mental health issues and causal factors are not discussed in remote cities and rural Nepali communities (UN Dispatch, https://www.undispatch.com/suicide-is-a-leading-cause-of-death-for-women-in-nepal/). The absence of support and acknowledgement of issues like alcoholism, drug abuse, depression, and suicide is largely due to cultural stigma and lack of education. According to the 2017 World Mental Health Day study conducted in Nepal, at least 10% of government employees are suffering from depression, while only 50% of people of that 10% seek treatment.
In Myagdi district, village leaders and health professionals from two communities and the District Health Officer/Senior Medical Superintendant, Dr. Roshan Neupane, who are determined to challenge cultural norms and educate their communities on topics and resources surrounding mental health, initiated the Mental Health Awareness Program to be held the first two weeks in May of 2018. The goal of this program is to hold sessions that will lead to safe spaces for community members in need of support, increase understanding of what mental health is and related disease/conditions (i.e. alcoholism, depression), and will raise awareness of societal factors that negatively impact a person’s mental health (i.e. caste and gender discrimination).
In order to accomplish such an ambitious program, especially in the two villages where mental health has never been formally discussed as a community issue before, mental health professionals from the Kathmandu based organization Transcultural Psychosocial Organization Nepal (TPO) will be brought in to facilitate the majority of sessions for the program (tponepal.org).
TPO’s mission statement most aptly sums up why this organization is best suited for this program:
“We promote psychosocial well-being and mental health of children and families in conflict affected and other vulnerable communities, through development of sustainable, culturally-appropriate, community-based psychosocial support systems.”
TPO specializes in designing community based programs and mental health support systems and has had great success throughout Nepal. For this particular program, they will design and hold 10 days’ worth of awareness, education, and advocacy sessions in both villages and in Beni District Hospital. The organization Kopila Nepal (http://kopilanepal.org.np/), a non-profit focused on gender/caste awareness/advocacy as well as overall psychosocial well-being, has generously donated books and informational handouts for the communities’ Health Posts and Beni Hospital, while also providing additional content and suggestions for the gender and caste focused sections during the program. In addition, aNutrition Development Representative from Suaahara (a USAid funded initiative with all Nepali staff that conducts grassroots trainings ranging from agriculture, to climate change, to addressing human rights issues in Nepal), is planning to participate in the program at both of the village sites.
The program will begin with mental health awareness/advocacy sessions at all sites for the health professionals and community leaders. This training, among other things, will equip the participants to recognize signs of declining mental health, understand what community factors and internal factors affect mental health, and give them the resources and contact information of external organizations to provide to community members who approach them for help (i.e.: gender/caste support groups, suicide hot lines, rehabilitation centers, etc). Additionally, they will all be given safe space training to learn how to properly/respectfully facilitate uncomfortable and/or previously avoided topics surrounding mental health with community groups and individuals. Following this training, community centers, medical centers, and schools in Beni and the two villages will be equipped with the contact information of support groups and suicide hotlines for community members to access the information privately to get support for themselves or for family members.
In each of the rural communities, several days of sessions will be conducted at schools for students ranging grades 8-10. This program will combine several schools across different villages and is expected to have 400+ students participating. Students will have a 'What is Mental Health' awareness session and an advocacy session focused on what factors negatively and positively affect their peers and their own mental health. Suaahara will give the students a session on the effects and habits of drug/alcohol/food inputs as they relate to mental health. Lastly, students will have a session focused on developing coping skills (i.e.: journaling/yoga) and how to be a support system for their peers. Students will be have access to a Kathmandu counselor during the program and will be shown what resources they can call or reach out to in the future. This is the first of what is expected to be an annual mental health awareness school program that will be given by the mental health professionals in each community.
In addition, both rural communities have community members who have formed groups to proactively address mental health issues and work with the local health posts to initiate programs/community meetings. In one community, a mental health task force with a proportional representation of caste, gender, and health professionals has been formed to meet bi-monthly and discuss how to support alcoholics, porn/drug addics in the community, and to design after school programs that will allow students to have open discussions about their own anxietys and issues with teachers that they trust. In the other community, teachers have formed a group that will raise awareness for depression and suicide to encourage students to talk about and destigmatize mental health issues. During the Mental Health Awareness Program, both of these groups will seek guidance from TPO on how to best go about facilitating these sessions and discussions in their communities.
After the conclusion of this program, health professionals and community leaders in village will have the skills to facilitate conversations community wide to begin addressing mental health issues and will plan what resources/programs their community members/schools need in order to be better supported. Dr. Neupane learned from the 2017 World Mental Health Day study that at least 20% of patients in Nepali hospitals are suffering from some sort of mental health illness. He acknowledges that his employees at Beni Hospital do not currently have the capacity to adequately treat their patients with mental health needs, and, he believes this must change in order to improve and protect the community as a whole. For Beni Hospital, the Mental Health Awareness Program is meant to serve as an introduction to a series of trainings that will ultimately lead to a fully functioning mental health ward in the hospital with trained staff who have the ability to hold counselor sessions and prescribe medicine, and, the formation of mental health related support groups. Specifically, a gender/caste/societal expectations support group that will be implemented under the guidance of TPO, Kopila and other non-profits/NGOs that are already successfully running similar programs. Ultimately, the goal is for Myagdi District to have the mental health resources/programs that were previously only available to Nepali people living in Kathmandu or Pokhara.
Although many community members from all three communities involved in the Mental Health Awareness program are donating their time and money to ensure the success of this program, there is still a significant amount of money that needs to be raised in order to cover the trainers’ fees, overall logistics, and resources that are being designed specifically for every session. Realistically, the program would need to reach its funding goals by the beginning of April as the program is expected to be held during the first two weeks of May. While mental health is an incredibly serious issue world-wide, in Nepal, alcoholism, suicide, and depression, especially in rural communities, are so common that they are beginning to be accepted as normal reactions to the pressures of Nepali society. The community members behind the implementation of this program view this as a necessary and life-saving initiative and have worked tirelessly to see this come to fruition. For these reasons, any financial support that you are able to give to our Mental Health Awareness Program would be immeasurably appreciated.
- stephen siebert
- Nicky Phear
- Renee Van Vechten
- Sherri Chun
- Diane Schwarz
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