KATHMANDU, Oct 27: In the sunlit courtyard of a mental health residential facility in Boudha, Katmandu, men and women sit drawing and painting hand-crafted paper balloons, decorating the entrance to the 100-bed Amrita Foundation Nepal building. Patients here are on a journey of recovery from various mental illnesses. “When I’m drawing, I’m not inside my own mind anymore,” says one of the men who regularly suffer hallucinations.
Nepal is still emerging from the devastation of an earthquake in 2015 that killed at least 8,000 people and left over 700,000 homes destroyed. Adding to a litany of challenges that already face the country - crushing poverty, a decade of insurgency and continuing political instability - incidents of mental health problems appear to be on the rise since the earthquake. There are reported cases of increased suicide rates in the districts worst hit by the earthquake like Sindhupalchowk. While no official data exists on the prevalence of mental health illnesses estimates suggest around 20 to 30 percent of people in Nepal suffer some form of mental health problem.
Significant strides have been made in decreasing infant and maternal mortality rates and improving access to health services. Sadly, the same cannot be said for the realm of mental health. It is perhaps the most neglected health issue in Nepal, demonstrated by the government expenditure of less than 1% of the health budget on mental health and the existence of only one government-funded mental hospital. It is alarming that Nepal was ranked 7th in the world for its suicide rate, according to the World Health Organisation in 2014.
Amrita Foundation Nepal in Boudha is a privately run mental health facility where patients suffering from illnesses including bipolar disorder and schizophrenia attend therapy sessions including some run by occupational therapists from the United Kingdom. Occupational therapy, sometimes called “OT”, aims to improve physical and mental health through engaging individuals in activities. Routines of everyday life like cooking and washing as well as leisure pursuits such as sport and music are activities that “occupy” our lives and help give it purpose.
Occupational therapists believe that a person who cannot participate in these activities because of a mental or physical ailment cannot achieve their potential and can find himself or she left behind by society. Enabling people to regain and maintain crucial life skills are vital to a successful recovery from ruptures in life is like family break-ups and natural disasters.
OT is a well-established health profession across many countries globally. In Nepal, however, it is still in its early stages and OT practitioners are a rarity amongst the health and social care facilities around the country. The Association of Nepal’s Occupational Therapists set up in 2008 is working to promote the profession and raise awareness. Their efforts connect international occupational therapists working in Nepal with Nepali who have sought OT qualifications abroad and returned to practice at home. Until now, no educational programmes for training occupational therapists have been established in Nepal.
The earthquake in 2015 served as a wakeup call for both the government and the public to acknowledge the importance of mental health. A deluge of programs launched by NGO s and INGOs are seeking to address the growing needs of earthquake survivors suffering emotional and mental turmoil. It is essential to exploit this newfound awareness to bring about a more sustainable approach to mental health in Nepal. Positive changes are happening. The government for the first time has allocated a portion of the budget to implement mental health programs in different districts, work that is mainly being carried out by NGOs. In addition, a new mental health policy has been drafted which is expected to address the gap in mental health delivery in the country.
One of the biggest challenges faced by Nepal is ensuring that all aspects of mental health care are integrated rather than only pursuing medical or biological treatment. Occupational therapy fits in this holistic perspective of mental health, which can play a major role in helping the recovery and adjustment of mentally ill people.
On Friday, patients at Amrita Foundation Nepal will gather in the garden and build a tree sculpture to mark World Occupational Therapy Day 2017, which celebrates the profession internationally. Recently one of the patients at Amrita explained how living with depression and having nothing to do meant, “days are long but months and years slip by fast”.
To ensure patients like him do not pass through life feeling this way and to enhance the quality of life for mental health patients alike, it is crucial to provide opportunities for people to be occupied.
Jenny is an occupational therapist from London; Sujan and Kripa are doing masters in Psychology