– The earthquake changes nothing with regard to the need of working with mental health issues in this country, rather the opposite. I see this as an opportunity to establish the issue of mental health as an important aspect of the overall health and wellbeing.

Shristee Lamichhane’s lively appearance contrasts with the seriousness of her engagement and her chosen field of work. Coordinating the mental health work of United Mission to Nepal, she tackles a subject head on, which receives scant attention by both the government and the development biz. Mental illness is also considered something of a taboo in the Nepalese context. And now there is the after-effects of the 7.9 magnitude earthquake to deal with. But Lamichhane is not fazed.

I see this as an opportunity to establish the issue of mental health as an important aspect of the overall health and wellbeing

– With mental health, change happens slowly and results are not as easy to document as with other health interventions. Before the quake we had already treated more than 700 cases. These are individuals whose lives have been transformed. And with each individual receiving treatment, there is a chain of results, as it affects both the family and the community. We can only continue to build on this work in the current situation. The need for trauma counselling and psychiatric services is overwhelming.

Up against culture

Although more and more people receive medical treatment and counselling for mental conditions, cultural barriers are hard to overcome. Lamichhane believes it takes more than an earthquake to change the culture.

– There is a lot of stigma and discrimination attached to psychiatric conditions. To many people, the idea still remains that mental illness is connected to sins committed in past lives, or of being possessed by evil spirits. Paradoxically, the well-educated appear to be most reluctant in seeking services, fearing that they would be stigmatized if other people came to know about their condition.

A lot of people come to them with cases that are related to mental health. When traditional healers are educated on mental health, they act as key referral points.

Awareness-raising through radio programs, school outreaches, health posts and volunteers are all part of UMNs work. But one trick seems to be particularly effective.

– We are trying to get the traditional healers aboard with our program, explains Lamichhane.

– A lot of people come to them with cases that are related to mental health. When traditional healers are educated on mental health, they act as key referral points.

Crash course

Indeed, capacity building, especially of nurses and health officers, forms one of the pillars of UMN mental health interventions in the districts.

– In the past, people would repeatedly approach a health post with different unexplained physical symptoms or with the same physical problem again and again. After receiving training on mental health, the health workers are able to recognize them as possible symptoms of mental illness.

The training typically consists of a 5-day course organized by UMN in collaboration with local health authorities, based on a curriculum designed by the government health agency.

– Only five days?

Yes, it’s only five days. But through these courses, health workers learn basic signs and symptoms and are authorized to prescribe listed psychotropic drugs, which is a major improvement on the previous situation, argues Lamichhane.

Involving government. Breaking the stigma may be a tough task, but keeping the government accountable and involved is also challenging, says Lamichhane.

– We partner and lobby with the government both at the national and the district level. At the national level we work together in an alliance of other NGOs and bodies to advocate national policies, which we have succeeded to some degree to achieve.

Right now our main focus is on addressing the acute traumas of the earthquake. It will also affect how we work in the long run.

The Nepalese government is sympathetic to the cause but stretched on resources, believes Lamichhane.

– In some areas we are actually providing the drugs ourselves. Clearly this should be the responsibility of the health authorities. Fortunately they are scaling up services and has committed to providing at least seven standard psychotropic drugs. Before the earthquake struck, the government wanted us to expand our program and move into other areas. It shows the appreciation they have for what we are doing, and we are encouraged by that.

– But right now our main focus is on addressing the acute traumas of the earthquake. It will also affect how we work in the long run.