Increasing mental health resources imperative to care for mental illness

Maya Adhikari (name changed), 25, of Waling-7 is a single mother to her two children in a means that she has been raising them single-handedly.

Her spouse is currently in foreign job. After her spouse stopped financially supporting the family over a dispute, the responsibility of raising their children has befallen her. The situation has had its implications on her mental status and ultimately in her mental health.

 “I feel I'm split after the person who was supposed to be my lifelong companion is a complete stranger to me."

The situation drove her to receive the help of psycho-social counseling which proved a boon for her amidst the depressed days. "The days were so depressing, but now I am gradually recovering from the situation after getting psychosocial counseling. I have got courage to live a life as I have realised that it does not end in a single point but offers us many alternatives to make it meaningful," she shared.

According to her experiences, psychosocial counseling instead of allopathic medicines has helped her recover. Psychosocial counselors under the safer migration (SaMi) programme reached out and offered psychosocial counseling at her home. “When I get psychosocial counseling, and financial literacy awareness, my lifestyle is getting changed and it is becoming easier for me to live,” she said.

Financial literacy has taught her to save money. She is saving Rs 5,000 per month, which has helped her become economically independent.

Sita, 27, (name changed) of the same municipality has a similar story to share with. Her slide to depression began over a family dispute. Her husband was a foreign migrant employee while she was raising their son back home. She noticed some changes on the part of him when she all of a sudden started receiving lesser phone calls and declined monetary support from him. When he returned home on a holiday, she conceived a baby. When she gave birth to a baby who is a girl, he started ignoring her. He even took their son away from her.

Now, she is taking medicine for depression. She is recovering after getting a combination of psychosocial counseling and medicines, said psychosocial counselor Bimala Thapa.

The number of people suffering from mental illness is going unchecked in Nepal, it is said.

According to the World Health Organisation (WHO), more than 4 percent of 29 million Nepali people are estimated to be currently experiencing mental disorders, with an additional 5.2 percent of 13-18 age group. The situation worsened following COVID-19.

In 2019, one in every eight people (970 million people around the world) were living with a mental disorder, with anxiety and depression the most common. In 2020, the number of people living with anxiety and depression rose significantly due to COVID-19, says the WHO. There is roughly a 26 percent and a 28 percent increase for anxiety and depression respectively. The number of people with mental disorders are said to be increasing due to present adverse economic and political situations.

Suicide is the fourth leading cause of death among the 15-29 age group. People with severe mental health conditions die prematurely, as much as two decades early, due to preventable physical conditions, says the WHO.

In Nepal, many people with mental illness lack a healthcare system either due to stigma attached with it and a lack of awareness or limited mental health resources, say experts.

According to a special initiative of mental health situation assessment by the WHO, there is a lack of qualified mental health professionals in Nepal. The number of psychiatrists in Nepal is as low as 144 and the figure of psychologists in private practice is estimated to be around 30. The gap between the mental health professionals and mentally ill people is widening with 23 percent of Nepali people seeking treatment in 2019 and 2020, according to a study.

Experts blame the government’s least priority to mental health for such an unmanaged system in the sector.

Under the SaMi programme, 58 with mental illness got psychosocial counseling in three years in Syangja. Psychosocial counselor Thapa is providing service. “We are providing counseling after identifying the cause of mental illness. Now, there is a change in their behaviours. Positive messages will flow in the family after mental problems of family members are resolved,” she said.

People between the 25-50 and 14-18 age groups have been affected the most by mental disorders, she said, adding that family disputes and conflicts, particularly among the families where a primary member (either husband or wife) is a abroad job holder are found to be a major cause of problems leading to a mental disorder among the family members. Family conflict affects children in particular in the long-run, she said.

“Family conflicts directly affect children. As a result, children’s morale goes down, and they do not like eating, but feel alone, fearful and startled. Their overall health gets affected as well.”

Psychosocial counseling is proving effective in helping control mental problems. Classes on financial literacy and psychosocial counseling are being run targeting the families from where the family heads have gone to foreign countries for jobs, she said. The classes are offered by forming 12 groups in the municipality and they are also offered individually as per need, she added.

Transcultural Psychosocial Organisation Nepal (TPO Nepal), a psychosocial organisation, has been providing psychosocial counseling to people with mental issues in the district. It collaborates with health institutions and health workers or individually as per need, said Janani Magar, TPO Nepal, Syangja coordinator, adding that during COVID-19, it provided psychosocial counseling to the affected people at their doorsteps within the municipality.

 “We are providing counseling depending on the severity of the problem of patients,” she said. Nurses offering psychosocial counseling get a five-day training course. But the five-day class is not sufficient. The training period should be extended, Magar argued.

“In the beginning, staff nurses provide counseling. It is difficult, our counselors reach and provide counseling in hospitals,” she said. She stressed the need for focusing on the monitoring to succeed the psychosocial counseling. Some patients get relieved after receiving counseling. But some others need the combination of counseling and medication, she said, calling on the government for the management and smooth supply of medicines for mental disorders.

(Tolakanta Bagale)