Oped»
Driving everyone nuts
MAY 20 -
In Kathmandu, most of the private psychiatric wards including the Mental Hospital in Patan and the Teaching Hospital in Maharajgunj are overcrowded with mental health patients. Mental illness has been the most measurable reward of the 10-year-long conflict and the following political impasse for the citizens of Nepal. The existing political confusion is certain to intensify mental disorders in the country ending our hopes of becoming happy, healthy and prosperous citizens if the political parties fail to reach a national consensus. It is a misfortune for us to have to live in a country where the leadership does not understand how their cynical and egoist behaviour has been affecting the mental health of the population in their everyday lives.
There are two aspects of mental suffering in the country. One is the collective suffering resulting from the political mismanagement, and the other is the individual suffering because of the nature of the mental disorder. In fact, mentally affected communities are victims of double discrimination. They suffer from political uncertainty and mental illness and its associated discriminatory social outcomes which are suppressed and invisible. Political management and the country’s mental health system need to be improved hand in hand to ensure our sustainable future. Improving political management and the mental health system requires radical innovation and a shift in its approach and practice. Here, I will be specific about how to address mental suffering in Nepal. I expect a more lively debate around this issue.
Like other contentious issues, the mental health system in Nepal is also urban centred. More than 80-90 percent of the population has no access to treatment. It is one of the worst and fragmented services that the government provides to its citizens. Even the World Health Organisation and other international development agencies are doing almost nothing to advance mental health services in the country. Amid this vulnerability of the mentally affected community, the UN Convention of the Rights of Persons with Disabilities (CRPD) has provided a little support helping to boost the morale of the mentally affected community. However, it has not made any remarkable difference in the lives of the people with mental disorders in terms of their social inclusion and emancipation. Based on the CRPD, there is huge scope to mainstream mental health in the practice of social, political and development rights.
Theoretically, WHO has done praiseworthy work; but in practice, a deep failure surrounds the mental health area. This is because of lack of understanding of mental health in the political context and lack of basic social support in favour of mental health. Even while talking about the role of WHO, producing a series of enlightened reports has less meaning if it fails to reform its own structure to make it inclusive to represent civil society’s aspirations.
According to the WHO report 2001, management and treatment of mental disorders in primary care is a fundamental step which enables the largest number of people to get easier and faster access to services. It is estimated that one-third of the people who visit primary health care centres in the developing countries demonstrate symptoms of common mental disorders which can be dealt with at the primary stage by general health workers. This not only gives better care, it cuts wastage resulting from unnecessary investigations and inappropriate and non-specific treatments.
For this to happen, however, general health personnel need to be trained in the essential skills of mental health care. Also, mentally affected communities need to be supported to take the leadership role to initiate public mental health education campaigns. Such training and support ensures the best use of the available knowledge for the largest number of people. It also makes possible immediate application of interventions and helps to reduce the social stigma too. Mental health should, therefore, be included in the training and educational curricula by developing short-term refresher courses to improve the effectiveness of the management of mental disorders.
The Ministry of Health and Population is in charge of implementing this initiative. According to Dr. Sudha Sharma, secretary at the Health Ministry, the ministry has included mental health in its four-year health plan that is due to be finalised soon. Dr. Sharma says, “Even though there is no explicit preparation about how to address mental health in the four-year plan, mental health will be given serious attention because of the growing need and concern of mental health in Nepal.” It is a welcome beginning for a country that urgently needs government-level initiatives to remove the suffering of the people living with mental disorders and their families.
Political commitment is the first requirement to bring innovation in mental health services in the country. The Health Ministry, as a concerned government authority, has to be committed to channelise its resources in the following ways:
1. Integrate mental health services into primary health care and start providing mental health services in the community.
2. Support to organise and enhance the leadership capacity of mentally affected communities including family members and involve them in the national mental health public education campaign.
3. Collaborate with different stakeholders like human rights, law and development agencies and other ministries like education and finance and set up a human rights review body to ensure that the basic needs and rights of mentally affected communities are protected.
The Nepal government must pledge to fulfil these three agendas to take this country into an innovative journey of mental health.
jagannathlc@gmail.com
Posted on: 2010-05-21 08:50
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