Mental health is something we often think of as a “western” issue, but in countries like Nepal, where suicide is the leading cause of death for women of child-bearing age, it’s also a serious concern. TEAR’s Paul Hansen recently visited one of TEAR’s partners in Nepal, the Centre for Mental Health and Counselling (CMC), who is taking an innovative approach to working with those struggling with mental health.
There are some things I expected when travelling in Nepal, like creative approaches to electrical wiring in hotel rooms and having your vehicle equipped with a red and green flashing figurine of the Hindu god Ganesh on the dashboard (a notable safety feature). As I visited TEAR’s partner, the Centre for Mental Health and Counselling (CMC), I probably should have also expected that some of my less-well-thought-through assumptions – like that depression is a “western” illness which the poor couldn’t afford to spend time on – would be shattered.
Staff trained by TEAR's partner the Centre for Mental Health and Counselling help to spread the word about mental illness in their communities.
I was so surprised to hear that suicide is the leading cause of death for Nepali women of child-bearing age, that I didn’t believe it until I heard it from several sources and then tracked down the research to prove it1. In a way, this statistic is the result of the enormous effort by many people put into improving maternal health in Nepal, which has seen what was the leading cause of death, childbearing, fall from 770 per 100,000 births to 170 over the past 20 years. It helped me realise that mental health is a significant issue not just in Australia, but in developing countries such as Nepal as well.
Visiting some of the communities that CMC is working in, I had the privilege of listening to Nepali people talk about their struggles with mental illnesses. They talked of their difficulty to know what was wrong, failed attempts at healing (often trying animal sacrifices and other traditional approaches) and then joy at finding help at last.
Of course, getting mental health services out to the millions of people in rural Nepal is a fairly daunting task, and this is where CMC’s approach is very clever. CMC connect into the existing Nepali Government health system by training health workers at primary health posts. With a combination of intensive courses and coaching over a period of several years, these workers are able to correctly diagnose and treat about 85% of the people they see with mental health issues such as depression and psychosis. This way, a relatively small amount of money, provided by TEAR’s supporters, is making a big difference to many people.
Mental health is a significant issue not just in Australia, but in developing countries such as Nepal as well.
The challenge now is to make sure this important work keeps going as CMC finishes in one district and moves to a new one. And that was why we were bouncing around in a vehicle protected by a flashing Ganesh dashboard ornament. We were looking at CMC’s efforts to form groups of people who have found they can have a normal life and want to see mental health continue and grow as part of the government health service. Groups that will be able to speak up when medicines are not available, support each other, and be a voice in the community against the stigma often associated with mental illness. I saw a lot of enthusiasm for this next step in CMC’s work, with no shortage of volunteers coming forward to join the new groups.
What the best ways for these groups to work in practice remains to be seen, but TEAR has appreciated partnering with CMC because they try new approaches, learn from things that don’t work and persist in their efforts to see people with mental health problem in Nepal living dignified lives.
Paul Hansen is TEAR’s International Program Officer for Nepal.
This project has received funding from the Australian Government Department of Foreign Affairs and Trade (DFAT), responsible for Australia's overseas aid program.
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