Oped»
Death wish
MAR 31 -
Although it happened almost 25 years ago, I remember when one of my close childhood friends’ niece was brought to Vellore, India for treatment. We came to know that she had attempted suicide. Though her family wanted to keep the matter totally confidential, rumours were circulating that she was mentally disturbed. Despite the family’s best efforts to tighten their lips in fear that no one would marry her later, somehow, the beans were spilled that the poor girl was forced into confinement in an isolated room whenever her family felt she was under the influence of evil spirits.
Although we never learned the name of the disease her doctor diagnosed, I know that she was prescribed medicine for the next few months. Now, the good news is she is a completely fit woman, enjoying an executive post in a flourishing financial institution. The bad news is that two and a half decades down the line, we are still carrying a similar mentality about mental health care. The worst part of all is that when I asked her permission to do this story, I was only allowed to do so on the condition that her identity must be strictly withheld.
It seems that the societal “threat” is still so profound that, despite being a financially successful woman commanding a prestigious status in her family and community, she doesn’t want to speak about the incident that occurred so many years ago. The fact of the matter is that she was suffering from a minor curable disease which was blown so out of proportion that it almost cost her life.
A week ago, I got a mail from a reader of my last article asking about my take on the improved maternal mortality rate (from 539 to 229 per 100,000) in relation to suicidal death being reported as the single leading cause of death for women of reproductive age (15-49 years) in Nepal. She cited the Maternal Mortality and Morbidity Study (2008-09) undertaken by the Family Health Division of the Department of Health Services with the primary objective of tracking changes in maternal mortality in Nepal since 1998. I wrote back with an honest answer: There is no accurate reporting of suicide cases, and I do not want to base my opinion on unconfirmed data.
The Maternal Mortality and Morbidity Study findings suggest that the key contributing factors to suicidal death are mental health problems, relationships and marriage and family issues. In addition, women activists argue that existing prejudices and rigid customs against women, domestic violence and abuse, migration of men, poverty, depression, dowry and abortion are among the main reasons. Moreover, the general belief is that women face unique social and psychological conditions that force them to take this kind of desperate measure in extreme cases. It is also true that many female suicidal cases go unreported as the families of the victims are afraid to deal with police cases as well as the perceived negative consequences thereafter. There has been no such specific empirical study carried out so far in Nepal to prove a correlation between domestic violence and/or prejudices and women’s suicide.
Suicide and depression have been proven to be seriously inter-related public health problems. The World Health Organisation has estimated that by 2020, depression will be the most prevalent cause of disability in both the developed and the developing world. It has been noted, particularly in the developing countries, that the majority of people with depression lack access to treatment. In the case of Nepal, due to the social stigma associated with psychological problems, those suffering from depression and thus being at high risk of suicide hesitate to seek the care they need.
Marginalised women, owing to the patriarchal system common in Nepal, are at a higher risk of depression and suicide compared to men. In addition, women in remote areas are more prone to attempt suicide than those in urban areas due to their comparatively limited access to education, awareness and other economic resources. A majority of psychiatric patients get treatment in hospitals and clinics centred in urban areas.
For a variety of reasons ranging from lack of resources to political conflict, the attention of the government and the non-governmental sector being focused on mental health related problems has been very low. The Maternal Mortality and Morbidity Study has clearly shown that we better start working on a proper response now. The 1996 Nepal Mental Health Policy already set out key areas needing attention, such as ensuring the availability of essential mental health services, promoting wide awareness about mental health, preparing human resources and protecting the human rights of the mentally ill. This leaves us with the task of working out and following the “hows” of this “wish list” in a cost-effective manner.
The identification of individuals at high risk of suicide should be a stepping stone to kick off the response strategy. The identification, however, has to be backed with adequate arrangements of necessary services and facilities thereafter. Otherwise, the identification will only end up with increasing frustrations among individuals from the not-so-friendly Nepali communities towards people with such problems. This response strategy should also call for parallel efforts to abolish the social stigma associated with mental illness, which would, in turn, encourage those suffering to accept referrals for treatment without fear of mistreatment by society. Besides, mechanisms have to be in place for continuous evaluation of these interventions to allow subsequent adaptation in strategies and approaches.
Women living in remote areas become more vulnerable due to the common reluctance of trained professionals to be posted in remote areas. In the face of their preference for emigrating in search of better opportunities elsewhere, there remains the challenge of retaining these valuable individuals and restricting the brain-drain syndrome by providing a package lucrative enough to hold them back.
Nepal also needs to adopt activities aimed at improving awareness on mental health issues by educating people about depression and suicide. Countries such as Japan, Australia, Korea and China have successfully undertaken similar efforts through programmes on television and radio, distribution of leaflets, posters and other information materials, as well as organisation of depression screening sessions, counselling services, seminars, community activities and street dramas.
A 2005 WHO study concluded that it was extremely difficult to anticipate and generalise suicidal behaviour. The study was based on assessing thoughts, behaviours and opinions in reference to suicide in various cultural and demographic settings. The suicide committed last month by a family in Rukum also points to the fact that a proper response has to be rather holistic in nature. The trio, husband Dal Bahadur Oli (70 years old), wife Kali Devi Oli (68 years) and daughter Tulasa Oli (27 years) hanged themselves out of desperation due to lack of money for the treatment of Tulasa’s epilepsy.
Knowing such a horrific reality, I could not cherish reading the summary of the progress on the Millennium Development Goals (MDGs) which claims that the poverty rate has gone down by over one percentage point per year since the mid-1990s. If the fate of the Oli family is the face of our declining poverty, how can we take pride in these calculations? The government has shown its commitment to achieve the MDGs, and the 20 or so UN agencies present in Nepal claim to be actively supporting the government in fulfilling its commitment. Could these dedicated groups look a little beyond these numbers and attempt to ensure that no more Nepali families face the fate of the Oli family? We will have every reason to celebrate if such a clearly visible impact of poverty reduction at the grassroots level is felt!
upadhyay_b@yahoo.com
Posted on: 2010-04-01 07:58
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