Care for the Mentally Distressed in Nepal

by Chhahari Nepal for Mental Health
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Care for the Mentally Distressed in Nepal
Care for the Mentally Distressed in Nepal
Care for the Mentally Distressed in Nepal
Care for the Mentally Distressed in Nepal
Care for the Mentally Distressed in Nepal
Care for the Mentally Distressed in Nepal
Care for the Mentally Distressed in Nepal
Care for the Mentally Distressed in Nepal
Care for the Mentally Distressed in Nepal
Care for the Mentally Distressed in Nepal
Care for the Mentally Distressed in Nepal
Care for the Mentally Distressed in Nepal
Care for the Mentally Distressed in Nepal
Care for the Mentally Distressed in Nepal
Care for the Mentally Distressed in Nepal

 

Sita,  Ram’s mother, is also his sole carer feels that her son loves CNMH’s weekly welcome center programs. “He loves playing board games with other people”. “Only here” according to her “does he have game partners and opponents to play with or to play against”. “He loves playing board game and here he is a champion”. “No one can defeat my son here” she said calmly and added “but of course sometimes he loses”. The games however are not only attraction for him. According her “he loves being around the social workers from CNMH”. “Even during his worst phase, a mere presence of CNMH’s social worker in the house used to calm him”. She added “everything he likes is here”. she said:

“He loves me very much and I am always with him every Wednesday in this CNMH office. Apart from me he loves being around social workers here who are also present here during the welcome center programs. He has two other friends here with whom he smokes and play games. He meets his friends only once a week and only here. He loves playing games here. I think he is most happy when he is here. I love seeing him happy. I wish every day in his life will be like this” 

Ram’s mother also finds welcome center very important. According to her, Ram always ask her “when is the time to go to CNMH ?”. On Tuesdays (a day before the welcome center) he regularly asks her “if his formal clothes are clean”. She adds “Wednesday morning is the only time when he washes himself and combs his hair”. “It is also the only day when he wakes up slightly early than before and spend time in front of the mirror”. According to her, what Ram likes about welcome center are “social workers”, “friends”, “food” and above all “acceptance”. 

“ My son is simple minded and quiet, but he knows if someone loves him or not. He knows I love him (smiles) and he knows sathi haru (friends at the center and social workers from CNMH) love him. They comb his hair, cut his nails, and arrange doctors and therapists check his condition.  He likes coming here and he also enjoys meeting his friends. Whenever I bring him here, I feel I have brought him back to home from school when he was a child. He used to get so excited to come back home and I see the same excitement when he comes here. He also loves receiving transportation money from CNMH. He loves giving a small portion of this money to me (with tears in her eyes)”  

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Chhahari Nepal for Mental Health participants ( clients: an individual with mental health problems and carers: family member looking after their loved ones with mental health problems )  expressed interest in different types of participation which was something new to our clients and their family members categorically. It was interesting to learn that they had their interpretation of transformative participation, for eg: they saw it as a process of bringing about positive changes in their lives through their participation rather than the bigger systems. 

Clients and their family members brought out their perspectives on participation based on their own experiences. They were vocal about their emotions and thoughts on the process of participation including the facilitators and the barriers to it. They felt light-hearted, happy and being invited to events and sessions at CNMH welcome center sessions to share their perception and simply talk which made it meaningful. They can express themselves, speak up and be heard. They were also happy to be part of a learning experience. 

Most family members who look after people with mental health problems are females but this is accepted as normal and not out of the ordinary. Most of the female family members feel that their participation has been transformative or representative because they have been part of the positive changes in their own lives or participated in programs as a representative/ caregiver. The majority of opinions were voiced by the family members who are representatives of clients. This power dynamic seems to exist and is accepted. 

CNMH connection and support is the major key that facilitates participation. Their introduction to CNMH has opened the doorway to many things- proper treatment, support, access to their rights, social support etc. Facilitation is necessary without which they are running around like headless chickens. Due to the ‘sickness’, clients cannot venture out which is the biggest barrier to participation. Without the correct treatment and medication (right dose, right type) the condition of the client would not improve. They may not be able to express themselves or are not participating by themselves in events and are usually accompanied by their carers when participating so clients an individual level of participation is low.

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Sachin hated coming out of his room and was afraid of meeting other people. Social workers from Chhahari started building a relationship with him and now we have been working with him for over 5years.

Whenever Social Workers from Chhahari went to meet him they started building trust and connection. Then slowly they started taking him to a nearby restaurant, parks and places he enjoyed visiting. During a walk to the restaurant, he began opening up and sharing his frustrations. They slowly learned that he sometimes likes to smoke a cigarette and hence they invited him for a walk allowing him to smoke. After a long-continued relationship, Sachin gradually started attending the Welcome Centre Session at Chhahari. Now, he is one of the “regular clients” to attend the session.

We were able to bring him out of isolation and now he has managed to make three friends from the welcome centre session. All three love to go out together and smoke cigarettes and play ludo game, they are the only friends he has and enjoys their company. The friendship that Sachin has built with one another has helped him to have a sense of companionship and belongingness.

The social workers from Chhahari are able to gain the trust of clients and their families because we invest long hours of time and energy building connections. Some of the clients and their families have been interacting with the same social worker for almost 7 years.

For many clients and their family members, the support from Chhahari social workers may not represent the ultimate solution to all their problems, but they nevertheless are people who they can turn to talk about their problems and be comfortable with.

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One of the youngest clients of CNMH is suffering from chronic mental health problem. It has been a struggle for the CNMH social workers to assist her to psychologists/ psychiatrists. Her mother who owns a small restaurant has a serious health condition. According to her doctor and medical reports, she needs heart surgery as soon as possible. The delay in her heart surgery is related to her economic status.

CNMH social worker has identified government provisions through which the cost of her surgery could be reduced by almost one third. It is however not easy to be eligible for it because it needs various government recommendations and certificates. Although this is not related to her mental health, CNMH believes that it will have a positive impact on the mental health of her daughter if her mother gets better.

CNMH is on a mission to help as many clients as possible to have access to Social Security Allowance (SSA) from Nepal Government. At the same time, many of the clients in the streets do not have proper citizenship certificates.

For the past few years, CNMH has been working towards getting a Social Security Identity Card from the government for many of the clients with chronic mental health problems.CNMH have been able to slowly and successfully manage to link clients and carers ( carers refers to the main person responsible for the day-to-day unpaid care of the family member that has a mental disorder) with the government's social support programs.

Few of the clients now have security and some independence. However, the challenges still remain. 

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Sam's lockdown expression
Sam's lockdown expression

Sam is a male client in his thirties. Although he has a room provided by a local temple, he still roams the streets and can disappear for days at a time. He has been diagnosed with schizophrenia and experiences auditory hallucinations. Without assistance, he rarely takes his medication, although he has not been hospitalised since Chhahari Nepal for Mental Health (CNMH) began supporting him. His nephew is his primary carer, helping with medication and hospital appointments. He cannot work.

Sam does not understand the Covid-19 pandemic or the public health measures, although he began wearing a mask in public, months after this became mandatory. Sam’s income came from begging at the temple, but this has not been possible during the lockdown. He continued to roam during the first week of lockdown, then stayed home for two weeks. Since then, he has been going out again, including to CNMH office every Wednesday for the (closed) Welcome Centre Sessions.

Since the lockdown, Sam has been going to his nephew’s house every morning and evening for food, after which the nephew gives him his medication. It’s good that during the lockdown there is the routine set up of going to his nephew. On two occasions he went several days without medication, once because the nephew forgot and once because Sam received food elsewhere. CNMH Staff has been in constant communication by phone with his nephew and sister.

He has been spending more time at home and looking after himself better. His (late) mother’s friend lives nearby and has been providing Chhahari with regular updates, including seeing him washing and changing his clothes more often. CNMH staff is teaching Sam on a regular basis to use a mobile phone but he still struggles so regular home visits have continued under lockdown. CNMH provided arts and crafts materials, which he enjoys and uses to express himself.( Attached Sam's expression of lockdown) 

CNMH prioritised continuity of care above all else, to the greatest extent possible and are continuously working to ensure our clients have access to a sufficient supply of medication, food, shelter and social support.

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Organization Information

Chhahari Nepal for Mental Health

Location: Lalitpur, Province 3 - Nepal
Website:
Facebook: Facebook Page
Twitter: @chhaharinepalmh
Project Leader:
Bidya Maharjan
Program Manager
Kathmandu Valley, Bagmati Nepal
$37,716 raised of $50,000 goal
 
502 donations
$12,284 to go
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