Care & Support of the Mentally Distressed

Chhahari Nepal for Mental Health

Earthquake Response Project Report

Chhahari Nepal for Mental Health (CNMH) initiated immediate relief measures in response to the destruction and damages caused by the earthquakes in the months of April and May, 2015. The first priority has been to locate and access the safety of CNMH's clients and their families. CNMH is now widening its scope to initiate a rapid assessment of other people on the streets who may be suffering from trauma, stress and/or mental health problems as a direct consequence of the earthquakes. The objective of this Earthquake Response Project is to identify these individuals, re-connect them with their families and provide psycho-social and treatment support where necessary.

This report summarizes the findings of a project that focused on locating, and offering support to, mentally distressed men and womenafter the earthquakes in Nepal in April and May 2015. The location of this project was in the areas around Lalitpur (Lubhu, Bugmati, Khokana and Bagdole) as these areas were adversely affected by the earthquakes, but were not areas in which Chhahari Nepal for Mental Health (CNMH) had previously worked. The project lasted for one month

Three days after the first earthquake, CNMH began to locate clients, ensure their safety, then investigate and address their wider needs. The main task was to find individuals who were living on the streets in areas that had been devastated by the earthquakes who had not yet gained access to Chhahari's services, and build positive working relationships with them. While locating these new clients and their carers the focus has been on areas in the Lalitpur district that were not previously covered by CNMH.

Two Earthquake Response Officers (EROs) were assigned to complete this essential work. Both EROs had been volunteering for Chhahari prior to the earthquake, so were familiar with the organisation's work and approach. While visiting many different locations around the Lalitpur area many mentally distressed women and men were found to be living in a miserable state with various mental, as well as physical, health problems. In the field visits 21 vulnerable people were located who had not yet accessed CNMH's services (14 men and 8 women) in the areas around Lalitpur. Estimated ages ranged from 16 to 50 with most of them falling in the 20-40 age range. The EROs focused more on the areas such as Lubhu, Bungmati, Khokana and Bagdole as these were new areas for CNMH and had been badly affected by the earthquakes.

Of the 21 mentally distressed women and men who were identified during our field visits, only 4 had family support while 17 were mentally distressed women and men who live on the street.

CNMH's two EROs received extensive training relating to post-earthquake trauma counselling. This training was very helpful during the project, but also helped greatly in their own personal lives.

Initial support for individuals focuses on assessing their current living conditions, assessing needs and setting priorities for support work. The next step is tracking down their families and, where necessary, reuniting individuals with their families. Reconnecting mentally distressed people with their families/carers is essential for ensuring that basic needs for food, shelter and clothing are met, but also for meeting social, medical, educational and economic needs. CNMH often finds this partnership approach with carers and family members to be extremely effective in supporting individuals with mental health issues.

Through the undertakings of this project, it is identified that the community is provided with training courses related to trauma counselling and mental health support.Likewise, it is also noted essential that after building positive relationships and rapport with new clients, it is necessary to provide them with medical treatment. Similarly, to encourage new clients and their carers to attend the day-care centre (Welcome Centre) and to allow individuals to express themselves through creative tasks (music, arts, cooking), build self-esteem (using meditation and field excursions) and support increased interaction with others. Previous experience has demonstrated the huge contribution Chhahari's Welcome Centre makes to helping people to improve their mental health.

During the implementation of this project, the urgent need is identified to locate individuals with mental health issues who are living on the street and their carers and reunite them.

case study:  

Rita is a 35 year old woman from Khokana who lives with her family. She is married and has two children. During the earthquake Rita was working in the field alone, away from friends and family members. According to her father-in-law, Rita did not return to her work for weeks after the earthquake and was showing signs of shock, mood swings and helplessness. She was traumatized by what had happened, and had refused to enter her house for several days after the earthquake due to her fear of aftershocks.

It was suggested that CNMH could provide local people with information on mental health issues and how to deal with trauma.

The most pressing need for this client is for psycho-social trauma counselling to help her to come to terms with what happened. Also there needs to be increased awareness, as well as acceptance, in this area regarding mental health issues and mental distress.