Care & Support of the Mentally Distressed

An investigation into the socioeconomic factors impacting on mental wellbeing in Kumbeshwor and Imukhel area (Lalitpur, Nepal).

This report shares the findings of a three-month research project into the idiosyncratic realities and socioeconomic factors that might make certain populations more vulnerable to mental distress and mental illness. The location of our research was the Kumbeshwor and Imukhel area in Lalitpur(Kathmandu, Nepal), which was identified by Chhahari Nepal for Mental Health (CNMH) as being of concern due to the magnitude of mental health issues seen in the area.

In Nepal mental health issues have not been adequately addressed, either by the government, private sector or non-governmental organisations (NGO). It is estimated that around 20% of the country’s population of around 30 million people are affected by mental health problems in some form, yet only 0.14%of the national health budget is currently spent on mental health. On the positive side, in recent years there have been increasing efforts on the part of NGOs to work on mental health issues, including the establishment of a national level Mental Health Network, of which CNMH is an active member.

This work was commissioned by CNMH during the two volunteers who prepared this report worked. CMNH is a secular local NGO that has been working for over five years in the district of Lalitpur in the Kathmandu Valley  , with the aim of establishing a more just and equitable society where the mental health needs and wellbeing of all people, women, children and men alike, are addressed.

Within Lalitpur, the focus of research was narrowed to the smaller area of Kumbeshwor and Imukhel, where CNMH identified a larger than average number of people suffering from mental illness and/or distress. Interestingly, narrowing geographical focus simultaneously led to a particular ethnic group, as the majority of people living in Kumbeshwor and Imukhel are Podes (or Deulas), who belong to the Newar lowest occupational caste, the so-called ‘untouchables’.

This report narrates and analyses the data collected, seeking to function as a bridge between the realities in the field and the professional lens on these issues, revealing several common themes but also some discrepancies between the two. Finally, informed recommendations is also provided for mental health service providers in Nepal with more specific recommendations tailored to CNMH.

Both the professionals and most of the clients' families and neighbours acknowledged the huge reliance on traditional healers, especially when there is no sign of physical injury or illness. In fact, it was said that several informants believed mental illness is caused by someone casting a spell to ‘ruin you’ due to jealousy or hatred.

Here is an example, Shyam’s neighbours thought that his mental distress was caused by a stranger having ‘ruined him’ by giving him some milk to drink. However, they admitted they didnot see him drink anything offered by anyone else and Shyam himself does not hold that belief. His neighbours also confessed that they were afraid of Shyam during full moon nights because they thought his behaviour would become erratic and violent. When inquired whether they were referring to the mythical story of a man turning into a werewolf on a full moon night, they agreed this was so.

A social development practitioner reiterated the popularity of traditional healing beliefs when there is no sign of a physical wound. The reductionist association of all illnesses to a physical injury causes people to believe that those who become mentally ill or are mentally distressed must have been ‘ruined’. Hence, they are taken repeatedly to traditional healers. The social worker mentioned that people only acknowledge the one person who is 'cured' by a traditional healer; which in his words ‘could be a coincidence’ rather than the many who are not cured. Hence, according to him, sufferers and their families have no faith in recovery through medication and hospital visits but continue to visit faith healers, despite inconsistent results, posing a challenge to modern health care.

Poverty was one of the first factors thought was impacting on the capacity of individuals and families to respond to mental health problems and indeed found it to be a fundamental contributing factor. However, it is important not to impose a label and let it stand as a full explanation for a circumstance or behaviour. It would be overly simplistic to conclude that the families of the Pode community do not seek out treatment or follow through with it purely because of a lack of financial resources. Although it undoubtedly does play a role, there are other more subtle dynamics that unfold in particular ways within unique circumstances that could explain behaviours

The same problem of resources present in the families of informants applies more generally to the health care services in Nepal. The specific vulnerabilities that the Pode community might face in responding to mental illness and distress are exacerbated by the general lack of government resources allocated to these societal issues. Indeed, caring for the mentally ill and distressed is generally considered the responsibility of the families or communities of the distressed.

 We are in the final process of editing this research project report. The full version of the report will be shared upon request. Contact or email us for more details on this report.