Mentally Distressed Care

Nepal’s transition from a singular to a federal system brought great promise of mental healthcare support. However, power decentralization is compromised by the financial and human resource limitations that undermine the independence granted to the lower tiers of government. Therefore, the current practice does not validate the government’s ambitious speechmaking considering the strengthening of the mental healthcare structure. Despite the allocation of enthusiastic mental health leadership at the federal level, the established lack of prioritizing mental health needs remains unaddressed. 

Nonetheless, the federalization system brings in strategic opportunities for NGOs like Chhahari to engage and collaborate with the newly formed tiers of government to promote mental health governance and government service provision through advocacy and accountability. Chhahari’s advocacy can play a  key to raising the profile of mental health on the political agenda. Chhahari’s person-centered approach can demonstrate the need for better Mental Health Care. Chhahari can collaborate collectively with the government and fill a critical governance gap by holding the government to account and stimulating people with mental health problems to claim their right to mental health. 

Despite the challenges of Nepal’s federal system, it provides scope for NGOs like Chhahari to play a more noticeable role in mental health governance and fill critical gaps that may help turn the government’s promises into pragmatism.

Working with CNMH has allowed the outreach staff access to various perspectives about mental health from different parts of the globe. They believe that they have learned many “helpful ideas about social work” from others which have contributed to their and CNMH’s growth. They believe that “a cordial and sincere relationship” that they and other social workers/staff of CNMH have built with the clients and the carers is the “foundation upon which the support mechanism of the organization(CNMH) is built”. This relationship-centered social work according to her is what other organizations can “learn from CNMH”,

                           “Our clients are not treated as individuals by society but as unimportant objects due to their mental health-related behaviors. When we reach out to them the very first duty is to build a relationship with them, but our relationship is not between superior and inferior but between those of equals. For this reason, we start by showing them respect and treating them like we treat someone we care about. Once the clients feel respected then it is easy to build a relationship with them” ( CNMH Senior Outreach Worker) 

The relationship they argue is not only between clients and social workers but also between their families and social workers. The clients and their families according to them are “not recipients of social workers’ help but are rather partners in their work”. They are very passionate about the relationship-centered model that CNMH has created,

                     “We are able to help a large number of people with mental health problems. We are focused on individuals and we help each individual by not only providing services to them but also by connecting them with a community that accepts them. We invite them to the community we have created where they have the opportunity to meet, interact and enjoy communal feasts and play games with others. During the initial stage, we (social workers) spent a lot of time thinking about ways to make the relationship of our community members deeper. The idea of going to picnic together or going to a restaurant together are some of the ideas that came up from among us to address this need. We had not anticipated that we would be creating a community. Still, we ended up building a community in which members have deep relationships with one another and they find a sense of meaning in their lives when they are here. It is however not just the clients, carers, and social workers who find a sense of meaning in CNMH activities. There are several national and international volunteers who come here as often as possible in order to participate in the welcome center programs because they claim that they find activities here meaningful and impactful. The community we have created is not like an office-based community but rather a community that is gathering once a week in an office space. Had it been a big community then our relations with one another could have been official and impersonal but because this is a small community hence, we have developed personal attachments with one another” ( CNMH Social Worker) 

Regularly visiting the clients in their homes and inviting them to the “welcome center programs” is one of the means they see as creating a positive environment for them. This however is not enough according to them because unless the attitudes and values of society change and become empathetic towards people with mental health problems, the people with mental health problems will continue to experience discrimination and be marginalized in society. “Creating a space where the clients feel safe and loved is important, but we should also try to change the attitude of the society itself”. The attitude of society can be slowly changed according to them by constantly being engaged with people from various sectors in society to create greater awareness among them about mental health issues.