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

 

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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Ram's expression
Ram's expression

Ram is a male client in his thirties. He has been diagnosed with paranoid schizophrenia and he experiences auditory hallucinations and persecutory delusions. Ram is dependent on his elderly mother for food, medication and hygiene. Low self-esteem and feelings of anxiety cause a reluctance to engage socially. At the weekly Welcome Centre that we run he has limited conversations only with staff and familiar clients and carers. Prior to the lockdown, our field staff visited Ram once per week, primarily to support him with his medication which has been particularly challenging. When provided with a larger supply, on several occasions Ram has taken too much at once. 

Ram is coping relatively well with the lockdown conditions. Ram understands the virus and infection prevention but does not worry about it because he meets so few people. Being confined to his home had little impact on his normal routine.  Many times we have been delivering relief food and medication supply. At times we have coordinated with the local ward and other community leaders, to support Ram and his mother to receive relief support from the government. 

Ram does not have access to mobiles, TVs or radios for communication and information.  Before the first lockdown( Nepal implemented the first lockdown from 24th March 2020) we provided him with the analog mobile phone so that support can be made possible even though he will be homebound (due to the lockdown). For us simply providing Ram with a mobile phone was however insufficient. We have also been constantly trying to provide training on its use as he has been struggling.  Finally, after many months of training, he can now answer our call, charge the phone but still struggles to call us back. 

Our telecommunication support involves compassion, empathic listening and humour while our clients and carers (the main person responsible for the day-to-day unpaid care of the family member that has a mental disorder)  share their experience of strong emotions.  In this way, we are maintaining our support services, and the obstacles imposed by Covid-19. This is an activity that both Ram and his mother a carer enjoys. 

Ram loves music, art and drawing. We have now started entertaining him by playing some music from our end, this has been a lot of fun. We have also provided Ram with some drawing materials (Pen. Pencil, colors, papers). He has been drawing and writing as a medium to communicate and express himself.

Ram's expression
Ram's expression
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Sita is a charming 37-year-old who is not afraid to speak her mind. She likes to wear makeup, beautiful clothes, jewellery and always makes an effort to look nice.  

When her family realized Sita was suffering from mental health problem, and were under the impression that marriage would cure her. While married and living away from the family home for one year her condition was somewhat stable. However, she contracted typhoid and after receiving medication for such her condition worsened and she became violent and started to roam undressed in the streets. Sita’s partner and his family were neither supportive or compassionate when her mental state declined, rather, they were ashamed. The marriage was broken off and Sita moved back into her family home.  

After few years her mental condition deteriorated as a result of stress over her brother’s disability. She has always been very close with her brother. Her brother was paralyzed after falling from a tree at his place of employment, rendering him immobile and incapable of independently caring for himself. At this time she became violent and her family, unaware of how to deal with her, tied her to a chain-link fence outside of the home.

Sita’s  family sought the help of traditional healers. The family, unaware of how to support Sita, and under the impression she was incapable of any level of recovery, contacted Chhahari with the request of ‘taking her away’. With the support and knowledge passed on by Chhahari the family was able to make an informed, and humane, decision regarding the care of Sita. 

For the past 4 years Chhahari has been supporting Sita and her family. With the support from Chhahari her treatment started and she has been diagnosed with bi-polar disorder . She now works as a part-time cleaner at a local school earning approximately 3000 rupees/month( 40 USD). Her medication costs are approximately 1500 rupees/month( 20 USD) , sometimes more. 

Last year on 1st of April her brother passed away and since then she is finding very difficult to cope. Now, due to lockdown she has not been able to continue her work as a result  her mental state deteriorated  and subsequently relapsed twice this month. She is now admitted in Patan Mental Hospital, Nepal’s only government Mental Hospital. Chhahari has been continuously supporting Sita and  providing service; arranging for warm food deliveries for both Sita and her mother. Also, continuously in contact with her doctor and providing support during this crisis time. Sita says  "During this difficult time Chhahari family remembered and cared and found ways to provide hot meals for me and my mother. I just wish Chhahari family can come and visit me frequently as I miss having conversation”. 

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Organization Information

Chhahari Nepal for Mental Health

Location: Kathmandu, Province 3 - Nepal
Website:
Facebook: Facebook Page
Twitter: @chhaharinepalmh
Project Leader:
Bidya Maharjan
Program Manager
Kathmandu Valley, Bagmati Nepal
$36,374 raised of $50,000 goal
 
461 donations
$13,626 to go
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