There is a lot of stigma associated with mental health

World Mental Health Day, 2017 Special

On the occasion of World Mental Health Day, 2017, we caught up with Ms. Sailu Rajbhandari, a clinical psychologist with several years of experience working in the field of mental health in Nepal. Ms. Rajbhandari shed light on the situation of mental health in Nepal and also shared her thoughts on the theme of World Mental Health Day, 2017 “Mental Health in the Workplace”.

Q. The theme for World Mental Health Day, 2017 is “Mental Health in the Workplace”. Can you tell us something about mental health in the workplace in Nepal?

A. People experience a lot of problems in the workplace. A huge chunk of a person’s time is spent in the workplace. If the office environment is favourable, a person and work and produce outputs accordingly. Mental health in the workplace is dependent on a multitude of factors; openness in the office environment, the office management needs to be considerate and sensitive to employees’ needs and ensure a mechanism for employees to put forth their problems.

I have come across many patients who come with mental health problems associated with their workplace. Some common causes of mental health problems include work pressures as a result of lack of openness in the workplace for employees to discuss their work issues, low pay, and high work expectations resulting in pressure.

Q. What are your suggestions for improving mental health in the workplace in Nepal?

A. I suggest every person with mental health problems to seek counselling, seek help. In the workplace, an open environment where staff members can come forth with their problems needs to be created. An idea could be installation of ‘suggestion boxes’ in the workplace. Depending on the type of workplace, appropriate mechanisms for staff to put forth their concerns need to be established.

Q. In the context of Nepal, workplace could include a variety of settings for different types of workers ranging from office employees to labourers or farmers. For some jobs, the work is primarily manual or physical, while for other jobs, the work may be largely mental. How do think the type of occupation links to mental health?

A. I think the general mantra for mental health would be to talk about your problems. Mental problems aggravate when you do not have an outlet for things that causes stress. I advise people to share their problems with family/ friends and not to bottle their feelings to themselves.

Q. What is the situation of mental health in Nepal?

A. Mental health problems are very common in Nepal, especially after the earthquake. In low and middle income countries (LMICs) such as Nepal, mental health has not been prioritized compared to developed nations. Although the prevalence of mental health in our country is high, the budget allocation for mental health from the Health Ministry is very low.

Although mental health conditions are observed in all age groups, some groups are particularly vulnerable. For instance, mental health conditions among the elderly are quite high especially amongst the elderly who have been affected by earthquake or who live alone because their children live abroad. Other vulnerable groups include women are children and those whose social support mechanism is not strong.

Q. Can you tell us about the availability of data/research in this area?

A. There are several organizations working in this area. Especially after the earthquake, there have been several studies in earthquake affected districts. Post-earthquake studies have shown that mental health conditions in general and Post Traumatic Stress Disorders (PTSDs) in particular, have increased in affected areas.

Q. Could you tell us about any government policy/ strategy pertinent to mental health in Nepal?

A. The government is in the process of formulating policy/ strategy relevant to mental health.

Q. What challenges do you think exist/ could arise while implementing policies on mental health?

A. Up until now, mental health has not received priority in our country. People did not take this area seriously. However, in the recent years and particularly after the mega-earthquake of 2015, the government bodies have acknowledged that mental health issues need to be tackled. That is my personal feeling, but I cannot speak for everyone.

Q. Can you please tell us about your experience in mental health?

I have worked in the field of mental health for many years. I feel that counselling can play a very important role in managing mental illness and therefore should supplement medicinal treatment. My experience is mainly clinical. Over the years, I have been a part of the training team that provides training to the health workers on basic psychosocial support. There is a lot of stigma associated with mental health. People do not come to seek service for mental health, they say they have headache or stomach-ache. The purpose of training health workers at the health post level is to enable them to recognize mental health problems and refer them.

The training has not yet been delivered throughout the country. However, the government has prepared a training manual for 2-4 days of psychosocial support training. A basic level of support for people suffering from mental health conditions can reduce their problems greatly.

Q. What kind of services are available from the health facilitates for people with mental health problems?

A. We do not have many mental health hospitals in the country. The government has been planning to allocate a Psychiatrist doctor in each district hospital. Having said that, mental services are not easily available in our country. Psychotropic drugs are also not easily available, they need to be administered for a longer duration than other drugs. People stop taking psychotropic drugs after a while thinking they are fine as the symptoms have subsided, probably because of their economic condition. This aggravates their condition. These are the problems with managing mental health conditions.

The development sector including non-profit organizations has been playing an active role in managing mental health conditions. Some also provide these drugs for treatment. But for how long can they keep this up? The government needs to been accountable for these services. The training of health workers enables them to identify mental health conditions and refer them.

Q. Where are these identified cases referred?

A.  As of now, most cases are referred to the development sector (referring to non-profit organizations working in the concerned areas). From the government’s side, counselling services have been made available via the Women Development Offices in some districts. So, there has been an initiation from the government’s side to tackle mental health problems. This is very recent, it’s been less than a year.

Q. Why do you think people suffering from mental health issues do not access the services provided?

A. People are not aware that mental health problems are not much different from conditions such as common cold, it can afflict anyone. Common cold can be treated with simple treatment. It is the same with simple mental health conditions. General counselling and sharing one’s problems with friends/ family can remedy the condition. But if you ignore it, the condition will worsen just as with common cold.

Q. You have worked with HERD for provision of psychosocial counselling to Multi-Drug Resistant Tuberculosis (MDR-TB). MDR-TB requires treatment for a long time and affects multiple aspects of your lives including work and family. What do you think needs to be done to better support these MDR TB patients?

A. MDR TB requires treatment for a long duration and you might still not recover fully. Therefore, patients might be depressed. We need to know the severity of the depression. Many of these patients live away from their families. They might not have anyone to share their feelings with. So, if they can find an outlet for their thoughts, if the service provider is patient and listens to the patient’s problems and offers advice, this can help a great deal.

Q. What do you think the government as well as the concerned bodies should do to mainstream mental health in Nepal?

A. In the recent years, there is an increased realisation among the government stakeholders on the need to tackle mental health issues.  I feel that we need to sensitize our stakeholders on mental health issues. Awareness at all levels, including household level is essential. A person receives love and support from family members in case of a physical illness such as stomach-ache. But if a person shares with his/ her family regarding a mental health condition, s/he is made fun of. Naturally, people hesitate to accept and share mental health problems in public.

Therefore, to mainstream mental health in Nepal, awareness that mental health problems is common and can affect everyone, needs to be provided right from the community level and household level. Additionally, government bodies need to prioritize mental health, introduce policies and allocate budget accordingly.