Focusing on Mental Health

Introduction

When we think of Nepal, images of majestic mountains, serene landscapes, and warm, smiling faces often come to mind. While the country is known for its natural beauty and cultural richness, there is a lesser-discussed but deeply pressing issue lying beneath the surface: a mental health crisis.

Anuka Limbu Neupane, writing for The Himalayan, paints a grim picture of mental health in Nepal. Citing a World Health Organization (WHO) report, she highlights that Nepal has one of the highest rates of mental illness in South Asia, with approximately one in four Nepalese experiencing some form of mental health issue. These conditions range from common challenges like anxiety and depression to more severe illnesses such as schizophrenia and bipolar disorder.

The mental health landscape in Nepal is further complicated by stigma, lack of awareness, and limited infrastructure. While mental health support is inadequate even in developed nations, in Nepal’s rural communities, it is often an unknown concept altogether. People suffering from severe mental illnesses are frequently labeled as “mad” or “dangerous” and are hidden away by their families, who view the condition as a source of shame. What begins as mild stress or anxiety often escalates into more serious issues when left unaddressed. According to a post published in The Kathmandu Post,  “mental health problems are enormous in Nepal, mainly due to lack of awareness and infrastructure to tackle them.”

To better understand mental health and address the needs of children with mental health issues, we recently organized a program for our mentors and staff. Led by professionals Sambhavi Adhikari and Batabaran Aryal from the National Institute of Mental Health (NIOMH), the session provided valuable insights for our mentors and staff in  identifying and managing mental health challenges.

Why the training for Mentors and the Staff

Our work involves young girls from underserved rural communities, who we are trying to empower through education and extracurricular activities through our Mentors and our staff.  We realized that we need to empower mentors to empower girls under their mentorships. We already learned that nobody turns insane all of a sudden. It starts with stress and anxiety about something and gradually escalates if unchecked on time. In order to treat such illnesses, we must understand the nature of the illness and seek help accordingly. Our team and mentors have to fulfil different roles as a house-wives, teachers and mentors, and are overworked and stressed on a daily basis.  This awareness session aims at educating  about mental health, its causes, early signs and methods of reducing stress. 

The main objectives of the program were:

• To provide mentors with strategies to manage stress in their busy lives.
• To clarify the distinction between stress and mental health disorders.
• To help mentors identify the mental health needs of their mentees and guide them in managing stress.

Resource person Mr. Batabaran Aryal asked the participants what comes to their mind about mental health? Most of the answers were : 

Finding small things that make them happy, 

Being mentally fit and fine, 

Being able to avoid tensions.

The presenter agreed to the answers. He said that people with good mental health can cope with their problems. “The World Health Organization (WHO) defines mental health as a “state of well-being in which an individual realizes their own abilities, can cope with the normal stresses of life, can work productively, and is able to contribute to their community.” But, it is different in dealing with cases of mental health problems. Talking about mental health is a sensitive subject and we  have to be very careful when talking about mental health. He asked the mentors what they think the challenges are? The mentors responded that people often view mental illness negatively, labeling it as madness, and there is a tendency to discriminate against individuals with mental illness. Some people even perceive mental health as a result of sins from previous lives (Paap ko fal). 

Before describing mental health, a short video was presented to the participants. The purpose was to see what they think about the characters shown in the video.

Video Presentation

Rama, a teacher,  who maintains good relationships with parents and friends. She organizes regular Parent-Teacher meetings, is well-regarded in her community, practices meditation, and offers guidance on mental health and stress management to teenagers. Rama has a well-structured daily routine, which helps her manage time and stress effectively.

Sumitra, another teacher, who struggles to balance her work and family life, leading to constant worry and stress.

Among the two characters, Rama displays good mental health. She has all the key elements of good mental health described by the WHO. They are:

• Social well-being
• Self-realization
• Stress management
• Life satisfaction
• Effective functioning

Describing common Mental health problems

Mental health can be related to:

 Biological: The disturbance of neurochemical processes at a social level.

Psychological: How we perceive things, our routines, patterns, and behaviors, and

Social: Conflicts and relationships that affect mental well-being

The presenter described that most people go through some problems in their lives. They are Stress and Anxiety and were explained with examples:

1. Stress: Stress occurs when you face changes that are difficult to adapt to. It can be divided into two categories:
   • Positive Stress: This type of stress can contribute to personal and professional growth. For example, the stress of an upcoming exam can motivate you to study.
   • Distress: When stress becomes unmanageable, it turns into distress. For example, failing to balance personal and professional responsibilities can lead to overwhelming stress.
2. Anxiety: Anxiety is characterized by the following symptoms:
   • Persistent tiredness
   • Difficulty sleeping
   • Inability to complete tasks
   • Difficulty breathing If these problems persist for months or years, they may indicate anxiety.

Video Presentation on Stress in Children: Resource person Sambhavi presented videos highlighting stress in children. Common sources of stress for children include:

• Separation from parents
• Phobias
• Difficulty adjusting to the community
• Being chosen or favored by others, such as teachers favoring high-performing students.

1. Depression: Depression involves prolonged periods of the same negative emotions, such as:
   • Feelings of loneliness
   • Staying in dark places or withdrawing from others
2. Post-Traumatic Stress Disorder (PTSD): PTSD occurs when someone continues to remember a traumatic incident for a long time. For example, a character named Binita lost her family in a flood and was unable to return to her village due to the trauma and fear.
3. Bipolar Disorder: Bipolar disorder is characterized by extreme mood swings, where a person may feel very aggressive at times and overly happy at others.

6. Obsessive-compulsive disorder

• a personality disorder characterized by excessive orderliness, perfectionism, attention to details, and a need for control in relating to others.

This presentation was very helpful to our staff and the mentors to understand the mental state of bahinis (younger sisters) who they mentor. They will be able to ask appropriate questions and try to help with their problems. 

Facts vs. Myths Game 

During the presentation, a game was played where participants were asked to identify facts vs. myths about mental health from the given statements. 

Mental Health Diseases are a problem

People who suffer from mental health diseases can’t work

Traditions can also cause mental health diseases

Mostly women suffer from mental health diseases

Mental Health Tree

Participants were instructed to draw a mental health tree with the following components:

• Roots: Foundation of Good Mental Health
• Trunk: What helps you stay strong or cope with stress?
• Branches: What are some challenges, stressors, or outcomes related to mental health?
• Fruits: What benefits come from caring for mental health?

Participants were divided in three groups and worked together to complete their mental health tree. The summary of their findings were:

Good mental health starts from a strong root. Strong roots need love and care, positive thinking, support from family, friends and teachers, confidence and time management skills.

Strong trunks can help to grow the branches strong. Strong trunks need self motivation, meditation, engagement in favourite activities like  diary writing, music, comedy shows, traveling, etc.

Branches can be affected by many factors. Some branches can produce better fruits and some can be bad. Branches that do not get healthy nutrients like family support and understanding, encouragement, and have family issues, superstition, can not produce healthy fruits. If we have  support, understanding, self determination, motivation, we can have good fruits like happiness, achievement, capacity development, peace, low stress, self respect, and good mental health.

Coping mechanisms

Trainer Aryal asked the participants about how they handle their stress? Some of the answers were: Writing journals; Folding laundry and doing some work requiring repetition.

The trainer explained some techniques that help clear the mind and help relieve stress.

Square Breathing Technique: Participants learned the square breathing technique, which involves inhaling for 4 seconds and exhaling for 4 seconds. This technique helps in calming the mind.

Grounding Exercise 5-4-3-2-1: This exercise is a calming technique that connects you with the present by engaging your five senses:

• 5 things you can see
• 4 things you can touch
• 3 things you can hear
• 2 things you can smell
• 1 thing you can taste

The trainers provided some hotlines in case someone needs to seek help for mental health support. They are:

• Nepal Government Health and Population Psycho-social Helpline: 116600121600, 1166
• TPO Nepal: 1600102005
• Kanti Children’s Hospital: 9808522410, 166011066
• Teaching Hospital: 9849360430, 9840021600

Mental Health Chatbot: UNICEF Nepal has developed a chatbot to provide children and adolescents with information and tips on managing their mental well-being. The chatbot also connects users to mental health professionals for tele-consultations when needed.
Chatbot Contact: +977 9802038992

Overall, the session was highly effective. Participants learned that mental health issues should not be a source of shame. It is important to identify whether one is dealing with stress or anxiety and learn to manage stress through various activities.

Shrijana Ghising (Mentor of Pharping G.L.O.W Club)
“The training was refreshing and helped me recognize my own mental health. I also learned techniques to manage stress and plan to incorporate these methods into my daily life. I believe that individuals with mental health conditions should not be mistreated. People should feel comfortable sharing their struggles.”

Outcomes of the Program
Participants  realized that individuals with mental health conditions are capable of performing tasks. Participants learned that such programs can help change people’s views towards mental health patients. It also helped participants understand the difference between stress and mental health conditions. Additionally, they recognized the importance of sharing mental health issues rather than feeling ashamed of them.

Photos

https://drive.google.com/drive/folders/1tNRbFaJ-bd2MlKwNP-jHw74rkIHvZXK4