Blogs by students 2023

Looking back to Earthquake 2015 in relation to mental health and universal human right

The theme of this year’s World Mental Health Day, 2023 is “Mental health is a Universal human right”.  This reflects each individual regardless of their identity, background, religion, socioeconomic status, disability, nationality or any circumstances has an inherent right to have good mental health.

According to WHO, Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community.

Similarly, UN defines human rights as rights inherent to all human beings, regardless of race, sex, nationality, ethnicity, language, religion, or any other status. Human rights include the right to life and liberty, freedom from slavery and torture, freedom of opinion and expression, the right to work and education, and many more.  Everyone is entitled to these rights, without discrimination.

In this writing, I am sharing my reflection in regards to mental health and human right as a part of my experience during the earthquake 2015 in Nepal.

Nepal being one of the low-and middle- income countries, mental health resources are very scarce and the budget is 0.2 % according to FY 2020. The majority of people lacks evidence-based care for mental disorders which lead to chronicity, suffering and increased costs of care (Patel, 2007).

After the earthquake hits Nepal on 2015, the place where we were responsible to support the survivors of earthquake, had just been around 10 days of having electricity in the village. People were in celebrating mood but the mother earth had her own plan. Being raised in the capital city, it was very new thing for me to witness a village that was under the dark till that year. We, in capital city were advocating different human rights and all, the nearby district was lacking to supply electricity to one of the villages. As soon as we reached there, people were expecting more physical relief supports but we were there for emotional support and ventilation. After letting them know about our objective, people gathered together and we initiated our session.

We gathered all age group, gender, ethnic group together which helped to break the resistance, and stigma and shared their fear, emotions which they had after the quake. This encouraged them to seek help and support for their mental health as well.

Here during the lecture, I can reflect as it was my very first experience with the community in big mass, I was nervous, trying to use my all skills to help the community as an expert which I was not. But it was easy for me when we sit in between them on same ground, sharing and listening them. This showed how a togetherness in community helps in healing, how a misconception can spread in a community if proper and right information is not given. The importance of being on same level the both service provider and the service receiver.  How the people were unintendedly harm like raising expectations and dependency, lack of holistic support, and consent. And as we are here to celebrate with the theme of “Mental health is a universal right”, may we enjoy mental health as our basic human rights with full dignity.

Reference:

Patel V. Mental health in low- and middle-income countries. Br Med Bull. 2007;81-82:81-96. doi: 10.1093/bmb/ldm010. Epub 2007 Apr 30. PMID: 17470476.

https://www.icrc.org/en/document/nepal-invisible-wounds-need-healing

Mental Health is a Universal Human Right’-Opportunities and Challenges in Nepal

All people have the right to be protected against mental health risks, to receive quality care that is accessible, acceptable, and affordable, and to be included in their communities. The theme of this year's World Mental Health Day is “Mental Health is a Universal Human Right”. Yet, people with mental health conditions continue to suffer a variety of human rights violations throughout the world. Many people are excluded from society and discriminated against, while many more cannot access mental health care. The same goes for Nepal. In such a situation, World Mental Health Day 2023 could be an opportunity for Nepalese people to improve knowledge, raise awareness and drive actions that promote and protect everyone's mental health as a Universal Human Right. Furthermore, Nepal faces a number of challenges when it comes to establishing mental health as a Universal Human Right.

With the efforts of governmental and non-governmental mental health organizations, advocacy groups and the media, there is increasing awareness of mental health issues in Nepal. This provides an opportunity to address the stigma and misconception surrounding mental health. Nepal has also taken steps in developing policies and legislation related to mental health. The 2017 draft mental health policy, the 2020 mental health strategy and action plan are among a few examples. These legal frameworks provide a foundation for recognizing mental health as a human right. In the same way international partnerships, collaborations and initiations on mental health together with organizations like the World Health Organization (WHO) can lead to resources and expertise for improving mental health services. Nepal has a strong sense of community and community-based health initiatives can be effective in reaching a remote and marginalized population. The mobilization of trained community health workers could identify and support individuals with mental health issues. All of these indicate the positive signs of Nepal being able to take constructive efforts on establishing mental health as a universal human right.

On the contrary, there are lots of obstacles as well. Stigma around mental health is still prevalent in Nepal. People with mental health issues often face discrimination and social isolation, which may challenge for establishing mental health as a Universal Human Right. Cultural beliefs and practices significantly influence their attitude towards mental health. Some traditional beliefs may stigmatize mental health issues or lead to alternative treatments that may not be effective. Shortages of mental health professionals, facilities and funding may hamper the delivery of mental health services. Further, access to mental health services is concentrated in urban areas, leaving rural populations with limited options for care. In the same way lack of sustained funding and investment in mental health services are the signs of difficulties in the path.

Despite the challenges in recognizing mental health as a Universal Human Rights, Nepal should utilize the opportunity prevail for improving awareness, increasing access to the mental health services and take steps in ensuring it as a Universal Human Right.. To ensure that mental health is recognized as a universal human right in Nepal, it will require a multiple actions involving government policies, civil society engagement, education, and the allocation of resources. Collaborative efforts at both the national and international levels are crucial to overcoming the challenges and seizing the opportunities to improve mental health in Nepal.

Umesh Shrestha

Resident, MPhil. Clinical Psychology

Tribhuvan University Teaching Hospital, Nepal

Exchange Student, University of Bergen, Norway

Psycho-social Support: Unintended consequences and side effects

Psychosocial support can be understood as the processes and actions that promote the holistic wellbeing of people in their social world that includes support provided by family and friends to facilitate resilience within individuals, families and community and recover after a crisis has disrupted their lives and to enhance their ability to return to normality after experiencing adverse situations. Psychosocial support can be provided in every stage of life and development. In time of crisis and emergencies its significance increases. The crisis either natural disaster, manmade, or ongoing life stressors cause a potential psychological and social suffering to the direct or indirect victims. The impact of such crisis could be short term affecting larger population as well subside sooner. But in long term may affect mental health and psychosocial wellbeing of the affected population; with vulnerability to threaten peace, human right and development. Further emphasizes the psychosocial support.

Psychosocial support provided in any situation intended to promote mental health and wellbeing. These services designed in various situations are so planned to reach out the every needs of the sufferer and prevent them worsening mentally, socially, physically and economically. Most often there are few matters of consideration, which come up unintended. I will be talking some of them on the basis of my experience and observation as a psychosocial service intern during massive earthquake in Nepal in April 25, 2015.       

The psychosocial service along with specific targeted services can generate secondary benefits. Unintended positive consequences of psychosocial services: first, protection of basic human rights of food and shelter. Second, collection and use of data of the population and its variants as to reach out the effected the service provider involves in identification of real victims and their degree of impact. Third there may be discovery of new needs and uncovered problems apart from the current crisis, example- medication of chronic disorders, violence, early marriages, marital rapes and more. Fourth, the increased concern and sensitivity towards available resources and support system- as the methodology of service providing people gather together at a place tend to increase communication and care by each other. Fifth, awareness and preparedness for future crisis- purpose and change of policies, production of man power, involvement and ownership of local authority and society.

As saying “along with rain you will get slippery road”, with greater consequence and need, the psychosocial services have some side effects, and matter of concern. First, the religious and cultural consideration of the targeted population- the aids from other religion and group of people who are not acceptable to the population, many examples of aid as weapon to religion change can be seen, better not to foreground religion and other group identity during such humanitarian services. Second, to and back flooding of the manpower- during the crisis lots of employees of aid organization, volunteers and government get into flow to help for short term only, and flood out with no hands, creating negative concept towards service and also dependence and increased expectations. Third over resourcing- tend people to be less active and neglect available local resource, example- during the time of earthquake in Nepal, it was the season for harvesting wheat, but due to over aid of food and rice people had stock for a year, leading to rote the wheat in field and people decreased involvement in daily livings. Fourth, over involvement with children- volunteers involving in recreational and educational activity may increase children’s attachment towards them, which cannot be continued for long term, more effective if parents and teachers are involved. Fifth, added problem to old age and people with disability- for recognition, registration, and receiving of psychosocial service they are high prone to missed, have to travel with difficulty, example a old person of 72 years travels an hour to receive food for his family that lasts only for a week, a person with walking difficulty crosses a hill with crutches and can’t carry back the items.

Along with many researches and practices we get more to improvise.       

Piyush Gautam

Resident, MPhil. Clinical Psychology

Tribhuvan University, Teaching Hospital, Nepal.