The World mental health day 2020 is just over. This year the slogan is Mental health for all : Greater Investment-Greater Access. Everyone Everywhere…….The world mental health day was first observed on the 10th October, 1992 as an annual activity of the World Federation for Mental Health and thereafter it has been commemorated every year.This 2020 world mental health day is very timely considering the Covid-19 outbreak the world over.
Due to the COVID-19 and its threat there has been upheavals in every sphere of human life across the world leading to a myriad of mental health issues due to economic hassles, social distancing and the political anarchy.
According to Child & Family Tracker household survey 2020(July 2020 findings of UNICEF Family Tracker household survey), 49 per cent of families reported an increase in stress levels since the lockdown, mainly related to concerns about their capacity to support their children.
The covid-19 has increased the Gender Based Violence against women as many women and girls have to suffer confinement at home with their abusers. Also the services to support survivors of other social evils have been disrupted. Since the government agencies are occupied in the Covid-19 related administration, there are no takers for the abandoned, chained or locked up people with the mental health issues, specially the women and the girls deserted on the streets due to the fear of stigma.
The children and adolescents facing disruption in their education, family stress and social isolation have been exposed to higher rates of abuse or neglect and are in the high risk group of acquiring mental health issues. Furthermore, the mental disorders also increase the risk of disability and premature mortality from the other diseases including cardio vascular ailments, diabetes, HIV/AIDS, and other chronic conditions.
The suicide rate has alarmingly increased to almost 17 suicides per day. Prior to COVID-19 the leading cause of death amongst the women of reproductive age 15-49 years was suicide. That apart, Nepal has the second highest adolescent suicide rate in South Asia. Data from Nepal Police, Central Investigation Department, Women, Children and Senior Citizen Service Directorate shows that Suicides among adolescent girls have increased by almost 40 per cent during the four months of nationwide lockdown compared to the previous year. Out of 4448 cases recorded to Nepal Police from 11 Chaitra2076 to 10 Shrawan 2077, there was high number of cases related to violence (domestic violence 1931 cases, rape 717 cases and attempt to rape 199 cases).
Therefore, to protect lives the mental health issues in Nepal need immediate attention specially for the women, children and the adolescents under duress.
The UN (2020) states that “good mental health is critical to the functioning of the society at the best of times. It must be front and center of every country`s response to and recovery from the covid-19 pandemic. The mental health and wellbeing of whole societies have been severely impacted by this crisis and are a priority to be addressed urgently”.(UN , Policy Brief 2020).
As per WHO mental health is “a state of well being in which every individual realizes his or her own potential, can cope up with normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.”
The mental illness is defined by WHO as a suffering, disability or morbidity due to mental, neurological and the substance use disorders which can arise due to the genetic, biological, and psychological make up of individuals as well as adverse social conditions and environmental factors.
Around 35% of the population of Nepal suffer from mental disorders. But the 85% of these persons have no access to mental health treatment and a lot of them are not even willing to take the treatment. They and their families prefer to visit traditional healers, the quacks called witch doctors. There is massive stigma, victimization and discrimination attached to mental health issues in Nepal and it is widely believed that the mental health issues arise because of the past sins, bad character conduct, witch craft and blasphemous conduct against social and cultural norms. So people hide their symptoms and do not have courage to approach medical help.
The mental health well being is a basic human right of any individual. But despite the numerous legal provisions and policy documents since 2010 when Nepal signed the United Nations Convention on the Rights of the Persons with Disability, less than 1 % of the health budget is allocated for mental health and 80% of that goes to mental health hospitals instead of the community sensitization and awareness programs. The international development assistance for the mental health is estimated to be less than 1%for all development assistance for health.
That apart, there is lack of appropriate infrastructure and trained medical personnel at the grass roots in Nepal. There is only 0.59 staff work in Mental Health per 100,000 population of whom only 0.13 are psychiatrists. The existing mental health services are very primitive and institution based and the psychosocial therapies including counseling are not available in most of the centers.
A sincere effort is required to uphold and uphoist mental health well being in the high priority list of the Government agenda in Nepal. Extra funds are urgently needed in Nepal to develop the existing structures and human resources to deliver best possible mental health care.
Ms. Devora Kestel, the Director Mental Health & Substance Use, WHO states that , ” The evidence -based care for depression and anxiety alone brings a US$5 return on the investment for every US $ 1 spent.” As per WHO for every US $1 put into scaled up treatment for common mental disorders, there is a return of US$4 in improved health and productivity.
Apart from the direct service delivery at the community levels ,KOSHISH has been actively involved in advocacy with the Government bodies at the Federal, provincial and the local levels and requests your participation and support in the matter. Please pledge your solidarity to the cause by taking affirmative actions on this coming World Mental Health Day.
Mental health issues have to be dealt with, on priority basis to ensure sustainable development and healthy societal growth. Investing in mental health relates both to the promotion and protection of the mental health as also to the prevention and treatment of mental illness or disorders. The benefits of investing in the mental health are numerous. Healthy childhood and adolescence leads to sustainable task force for the near future.
The mental health well being is an inviolable basic human right and a necessity like food, drinking water and shelter. One wonders, why can`t these services be improved and integrated in the primary health care system at the grass roots levels in the communities through the Government support and solidarity ? Why can`t these services made accessible to persons with the mental health issues as also to the general public for their mental health well being? We are wondering how can we raise our collective voice and give solidarity to the grassroot voices like us.
(Mr. Devkota is founder chairperson of KOSHISH, expert through lived experience. He wants to help ensure the rights of persons experiencing these issues, to a dignified life, through self-advocacy and service delivery. Mr. Devkota had acknowledged with the Dr. Guislain “Breaking the Chains of Stigma” Award, in 2013; was elected as an Ashoka Fellow in 2017.)
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