Diseases such as diabetes or blood pressure are no longer considered social stigmas. Anyone suffering from a heart problem also frankly admits that he or she has a heart condition. However, the case of those suffering from mental health is different. Many mental health patients still keep their ailment private and are hesitant to even consult a doctor. Some even hide their illness from their close ones, and if they do visit a doctor or take medication, they do so secretly.
Matrika Devkota, chairperson of Koshish, a national mental health self-help organization, was a mental illness patient himself since the age of 15. At 25, he says, he turned ‘crazy’. However, following his treatment at a mental health center, a semblance of normalcy returned to his life. “It has been 17 years, and I am still on medication,” Devkota says. “Earlier, I used to hesitate to take medicines in front of people, but now I take it openly like people who suffer from other
[common] illnesses.” This issue of mental illnesses and the taboo surrounding it is not unique to a particular country or culture.
According to a 2006 report by the World Health Organization (WHO), 40 percent of all countries do not have any policies and programs to tackle mental health. An earlier WHO report from 2001 shows that 20 to 30 percent of the population from low-income countries suffer from mental illness, of which one to three percent include people who have to endure severe mental diseases.
In Nepal, mental illnesses are still a social stigma. If someone admits he/she isn’t completely mentally sound, even the so-called educated start to brand them “mad” or “crazy”, and look down upon them. Families and communities, both socially and culturally, consider mental health patients outcasts and the issue is still a taboo. Hence, they are compelled to hide their sickness and suffer in private. Known cases of mental illnesses invite barbaric reactions from family members or near and dear ones. It is not uncommon in Nepal to hear reports of parents locking their mentally ill children in rooms or chaining them like animals when they become violent.
According to WHO, Nepal has over 260,000 people with severe mental health disorders and twice the number of people suffer from neuroses, milder forms of mental illnesses.
A report by the Center for Mental Health and Counseling-Nepal (CMC-Nepal), based on the experiences from 28 community health-related programs conducted between 2003 and 2012, found that among the 31,288 people suffering from mental diseases, 27 were mentally irritated; they comprised far more women (68 percent) than men (32 percent).
According to mental health specialist Kapil Dev Upadhaya, compared to men, women are more mentally distressed. Women have to take on extra burdens, he says, especially if men leave their homes for better opportunities. He further adds, “due to mental irritation, about 15 percent of mental health patients commit suicide”.
Lack of women empowerment, domestic violence, sexual harassment and patriarchal social structures are some of the main causes of mental illness among Nepali women. For example, if a woman gets divorced, neither her maternal family nor her husband’s family takes care of her and she often becomes a destitute and is rendered homeless. Some resort to suicide to escape the social stigma of having to live a life of disgrace and apathy.
Women have been guaranteed equal rights, but only on paper. The Interim Constitution has several provisions for women, including political representation and legal recourse to injustice. However, many mentally ill women suffer even more when their husbands, instead of trying to identify the cause of their illness and helping them overcome it, abandon them, and some—irrespective of their educational level, income or professional status—opt to bring another wife home.
The Nepali Civil Code 1963-64 stipulated that it was the responsibility of the state to treat its mentally ill citizens. However, the legal definition of mental illness was not clear. The language of the legislation implied someone with a broken mind or madness. This attitude is reflected today in the routine reference to mentally ill people as “crazy”.
In 1997, the government adopted a national mental health policy and included mental health as an element in primary health care. However, even today, mental health is given less priority in the national health agenda. According to Nepal Government Red Book (2000-2001), only 0.14 percent of the national health budget is spent on mental health. And this allowance is only for hospital services.
In the 2006 UN Convention, mental illness was included in the Right of Persons with Disability as a psychological disability and Nepal’s Parliament also ratified this convention on December 27, 2009. Now the convention must be included in Nepali laws to ensure the rights of persons with mental illness/psychosocial disability.
Mental health patients are not considered for government jobs. Poor implementation of mental health policy means the cases of violence involving mental health patients go unaddressed. Mentally disturbed people may violate rules and regulations without adequate knowledge of the laws, and it may be difficult to control them, and call for involvement of human rights activists.
There are many issues that concern the safety and well-being of the mentally ill in the country. But the most important one concerns their timely medical care. Unfortunately, health facilities for them remain dismal. Although several hundred people need such health services, the country has only one hospital exclusively catering to the mentally ill. Cumulatively, there are only 171 beds for psychiatric patients within the Kathmandu Valley, including both government and private hospitals. Out of 75 districts, only 10 have psychiatric treatment facilities.
More than seventy years ago, Abraham Harold Maslow, the late American psychologist, wrote that human motivations move through what he called the “hierarchy of needs”. To live a healthy life, human beings have five basic needs—psychological, safety, love and belonging, esteem and self actualization. Our mentally ill fellow-citizens deserve their rightful place in this hierarchy.
As we commemorated the World Mental Health Day earlier this week (Oct. 10), the best we can do now is renew our commitment to the cause of these wronged citizens.
The author is a freelance journalist who writes on social and human rights issues