Jun 19, 2017

CNMH's Social Model approach to Mental Health Care

Raju is a 32-year-old male who has suffered from mental distress for over 10 years and was medically diagnosed with schizophrenia and prescribed medication two years ago. However, he has not taken medication consistently, and as such, his condition has worsened. Raju lives with his mother and older brother. Raju’s 72-year-old mother is his sole carer and both Raju and his brother are entirely dependent on her for their basic everyday needs, including bathing and eating. Raju’s mother is also in charge of administering and monitoring his medication intake.  Raju’s mother is greatly distressed by the situation, but continues to provide for her sons in her old age. As an aging caregiver, Raju’s mother is deeply concerned about her son’s will fare when she is no longer around. Referencing her age, Raju’s mother stated: “I have to do everything for my sons and I just want to die sometimes” .Providing an example of a time when she was hospitalized for three days then spent two further days at the home of a relative for further recovery, she tells that neither of her sons were able to cook for the entirety of the time she spent away from the household and as a result they relied on eating dried goods. She then stated: “If I die, I want them to die as well” or “I want them to die before me” indicating she is worried about their well-being when she is gone.

Raju’s mother holds deep beliefs that relatives of the family have cursed both Raju and the family home with black magic and that is why he is ‘pagal’ (mentally unstable).  As a result, she sought the help of traditional healers in the past, to no avail. Approximately two year ago Chhahari was introduced to her through the community member and the family has been receiving both social and financial support ever since.  The family is under immense financial distress and they live off of intermittent financial help from family members who no longer live in the household and from the senior citizen allowance that Raju’s mother collects monthly. When Raju was well he worked as a tour guide and as a waiter. However, the illness coupled with back pain from an injury he sustained when he jumped from a window of the family home after hearing a voice that told him to do so has hindered his ability to work. Moreover, this has left him socially isolated.  Raju was quick to express his appreciation for our company during home visits on multiple occasions. Though living in a state of financial distress, the social support offered by CNMH is more vital to the family’s well-being. The entire family is incredibly stigmatized in the community and as a result the family suffers from social isolation. When Raju is asked about relationships outside of his home, he speaks exclusively of his relationship with Suraj (chhahari’s client), who he socializes with at CNMH. This provides an important example of the social network that has emerged as the result of CNMH’s Social Model approach to mental health care. The approach has facilitated positive relationships in the community that act as supportive relationships for clients  who are socially excluded and isolated.

Mar 21, 2017

Social and Medical Models in Supporting Clients

The article highlighiting Chhahari’s work has been published recently in the local newspaper where we have tried to highlight the debate of mental health in Nepal which is all centred on a medical approach. This is what the socio-medical model aporoach is attempting to change, not just in Nepal but internationally as well. Even veteran psychiatrists across the globe have been urging to focus more on the social conditions that contribute to or escalate mental ailments.

Case Study of our client highlightining socio-medical model : Suresh Khadgi, 33, of Patan, Nepal has a long struggle with his mental illness began 15 years ago when he suddenly started hearing noises ringing in his ear, sometimes it would be a loud shriek, at other times just loud, indecipherable rumblings. Khadgi would run towards the noise but he couldn’t ever figure out its source, and would often get lost for days scouring the neighbourhood and the larger city. Disorienting and persistent as the noises were, he did not believe his family and peers when they said that he was the only one hearing them. 

By the time doctors diagnosed him with schizophrenia, Khadgi had all but fallen through his many safety nets. If the community had once sympathised with the “boy who heard noises”, as Khadgi’s illness progressively worsened, he was often beaten up for causing a ruckus, while even small kids in the neighbourhood made up games where they would try and scare him by catching him off guard. At the time, even medications had failed to bring him back from the brink. But, today, things are slowly changing, thanks to his mother who refused to give up on her son. Khadgi now lives with his parents and has constant follow ups with doctors.

Our team regularly meet up with his parents every week to discuss the various issues regarding Khadgi’s health and his progress. His mother, Keshari, drawing from her experience in dealing with her son, is now also an active advocate of caring the mentally ill patients through a two-pronged approach where social rehabilitation supplements the administering of medicine. Many mental problems stem from social issues and this should be dealt with accordingly. Instead of ostracising them, a shared bonding with family members and their reconnection with the society goes a long way. We have felt the difference.

It is a paradigm shift that has been a blessing for Suresh Khadgi and his family. After years of investing in purely medical treatments to Khadgi’s schizophrenia, without significant results, their involvement with us and a switch to a socio-medical approach, Keshari admits, has been a game changer. “Things are not normal, far from it,” says Keshari, “But Suresh has made such progress. If once many thought that he was a lost cause, today, we at least have reason to hope. Just that in itself is a big leap forward.” Suresh attends our support center everyweek.


The website for the featured article:


Dec 21, 2016

Vulnerability and Resistance in Lubhu, Nepal

This report provides a qualitative assessment of a rural/urban community for the protection and promotion of mental health and well being following the 2015 earthquake.

The report seeks to assess the impacts that the 2015 Nepal earthquake had on the mental health and psychosocial wellbeing of Lubhu residents, a semi rural town in the Kathmandu Valley. We had a Masters student from Edinburgh University doing her intern with us who carried out the full research with Chhahari staff. 

The investigation into how mental distress is expressed within a Nepali context and what formal and informal support sources exist for those experiencing mental distress – at a micro and macro level was carried out during this research.  Through a culturally grounded, qualitative assessment, conducted via semi structured interviews and observations, we explored the immediate and mid term effects the earthquake had on psychological wellbeing from social determinants of health perspective. The overall objectives of the study into post-earthquake mental health and psychosocial support are as follows:

1.Using interviews and observations, identify the impacts of the 2015 earthquake on the residents of Lubhu in terms of: Overall mental health and wellbeing.The social determinants of mental health and wellbeing (including housing, livelihoods, social relationships and roles) in this community.

2. Using interviews and observation identify the positive, desirable sources of support available to residents of Lubhu in the 12 months following the 2015 earthquakes.

3. Critically assess any ongoing gaps or areas of unfulfilled need regarding mental health and wellbeing support in this community.

We spent time with community members, conducting semi-structured interviews. This allowed for the progressive development of early research questions through the lived experiences of participants and enabled the narrative data collected, to be directed by the participants’ perspectives. We were able to extrapolate trends from the emerging data and explore these within a wider narrative of post disaster mental health issues and existing psychosocial challenges in contemporary Nepal.  We also interviewed mental health and social work NGOs as well as mental health professionals working in the greater Kathmandu with whom to speak with-in more detail- about specific themes emerging.

Our  findings show that social support is fundamental in facilitating mental wellbeing and community resilience in the face of a disaster. The networks of social capital that exist at a community level can compound the negative effects of trauma and provide psychosocial strength to those that utilise them.There is however no single approach to promoting mental wellbeing and it must be understood as part of a larger and complex sociocultural phenomenon. Factors such as stigma, lack of understanding of mental distress and lack of funding to health services can all act to mitigate support sources.The impacts and suffering arising from the trauma of the earthquake have generated an increased need to establish and deliver effective mental health and psychosocial support to those who have been affected. This can be viewed as both a challenge and an opportunity: immediate assistance was needed as a matter of priority, but the need for longer term support for those suffering from the effects of trauma related to the earthquake, and mental distress in general, was clearly highlighted.Thus too was the need to restructure and develop the existing mental health care systems to create a more effective and encompassing structure, as well as need to de-stigmatise mental distress and encourage those experiencing mental distress to access support services.

Understanding the socio-cultural factors that impact on the attitudes towards mental health is inherently important in understanding the patterns of existence and utilisation of support systems and services.

The full version of this report can be provided upon request.

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