The concept of 'well-being' for most people is usually limited to physical wellness, even though it's been nearly half a century since the WHO defined health as a state of 'complete mental and social well-being and not just absence of disease or infirmity.’ The WHO has been continuously highlighting the burden of mental illness, which they believe comprises five out of the top 10 reasons for global human disability. Any long-standing physical illness—whether hypertension, diabetes or cancer—has concomitant psychiatric co-morbidity, as high as 60 to 80 percent. And suicide, one of the 10 major factors contributing to human mortality, is linked to mental illness 90 percent of the time.
While most developed countries have already accorded needed priority to mental health , in countries like Nepal, it remains largely neglected. Health, here, is still linked to physical well-being alone. Imagine, for instance, that you needed to excuse yourself from a social function, people would readily understand if you said you have diarrhoea, fever or even a headache. But were you to say you have anxiety, or problems to do with sleep or relationships, you would no doubt be ridiculed. When fitness is an issue, say, while applying for higher education or a job, one's mental health is very rarely evaluated, and even when mental well-being is part of an application form, for example, these columns are filled up by the applicants and even health professionals without much thought. And tell someone they should seek help from a mental health professional, and they are sure to be offended. One might even be afraid to be seen around a mental health service centre, for fear of being taunted.
Mental health issues are neglected not just by people themselves, but also by health stakeholders, including at the policy-making level. People are usually in denial, quick to dismiss the possibility of themselves or their families suffering mental problems. Even when the problem is obvious, they prefer to go to faith healers and quacks than to an official mental health service centre.
It's true, of course, that most hospitals in Nepal are poorly equipped in this regard. Forget primary care centres, even tertiary hospitals do not have trained mental health professionals. This also extends to medical colleges, where it is mandatory to have at least two psychiatrists and 10 in-patient facilities for mental health cases, as per the directives of the Nepal Medical Council, but this is usually just on paper. Even when they do exist, they are not up to snuff; most psychiatry departments in medical colleges comprise one man in one room, with administrators reluctant to upgrade services because the economic turnover of such efforts would be doubtful, and because they fear the inflow of mentally-ill patients could cause security issues.
It is therefore not surprising that for people with mental health issues, proper diagnosis and timely management is rarely achieved. Obviously disturbed patients are hurriedly referred to mental hospitals, and for those with more obscure problems, most hospitals—private and governmental—usually send them home following investigations of all possible physical parametres, not even thinking to test their mental health . And after huge resources are wasted on these repetitive physical tests, they come to a dead end, occasionally even implying that the patient is pretending to be ill, or worse, offering them unnecessary fortified vitamins or alternative cures that they don't know much about themselves.
All this stems from ignorance and lack of awareness at all levels. It begins with poor training of health personnel; until a few years ago, doctors, nurses and paramedics could get degrees without having to learn the bare bones of psychiatry. The current medical curriculum is more inclusive, but there are still no separate exams on the subject, which means it is more often neglected. This has resulted in health personnel who are incapable of dealing with even the smallest of mental health issues, and if that wasn't bad enough, they are often responsible for spreading misconceptions, superstitions and stigma. Every day we come across unscientific recommendations, indiscriminate prescription of psychotropic drugs and unrelated specialists perpetuating ludicrous cures. And when these same incompetent 'experts' go on to occupy influential posts in the government, it is obvious what will happen—they will not understand the need to prioritise mental health in policy. It is no wonder then that even in this day and age, Nepal's health ministry has no department dedicated to mental health , or the fact that the mental health budget currently comprises less than one percent of the total annual funds coming into the health sector.
Part of the problem is owing to the passivity of those who are aware of the problems. Even though the prevalence of mental health is substantial—believed to affect 15 percent of the population and rising—very few people are actually willing to open up discussions or admit their own problems, fearing discrimination. This is why many people are under the illusion that mental illness is a rare phenomenon, and is limited to those who are obviously disturbed. Sure, many NGOs and individuals are working to create and raise awareness on the subject, but efforts are scattered, and will amount to little unless concerted nationwide campaigns are undertaken. The urgency for immediate and long-term strategising to address the mental health pandemic cannot be overemphasised. After all, we must remember that there is no health without mental health .
Dr Shakya is an Associate Professor and Head of the Department of Psychiatry at the Patan Academy of Health Sciences
Source : e kantpur , 24th June 2013
While most developed countries have already accorded needed priority to mental health , in countries like Nepal, it remains largely neglected. Health, here, is still linked to physical well-being alone. Imagine, for instance, that you needed to excuse yourself from a social function, people would readily understand if you said you have diarrhoea, fever or even a headache. But were you to say you have anxiety, or problems to do with sleep or relationships, you would no doubt be ridiculed. When fitness is an issue, say, while applying for higher education or a job, one's mental health is very rarely evaluated, and even when mental well-being is part of an application form, for example, these columns are filled up by the applicants and even health professionals without much thought. And tell someone they should seek help from a mental health professional, and they are sure to be offended. One might even be afraid to be seen around a mental health service centre, for fear of being taunted.
Mental health issues are neglected not just by people themselves, but also by health stakeholders, including at the policy-making level. People are usually in denial, quick to dismiss the possibility of themselves or their families suffering mental problems. Even when the problem is obvious, they prefer to go to faith healers and quacks than to an official mental health service centre.
It's true, of course, that most hospitals in Nepal are poorly equipped in this regard. Forget primary care centres, even tertiary hospitals do not have trained mental health professionals. This also extends to medical colleges, where it is mandatory to have at least two psychiatrists and 10 in-patient facilities for mental health cases, as per the directives of the Nepal Medical Council, but this is usually just on paper. Even when they do exist, they are not up to snuff; most psychiatry departments in medical colleges comprise one man in one room, with administrators reluctant to upgrade services because the economic turnover of such efforts would be doubtful, and because they fear the inflow of mentally-ill patients could cause security issues.
It is therefore not surprising that for people with mental health issues, proper diagnosis and timely management is rarely achieved. Obviously disturbed patients are hurriedly referred to mental hospitals, and for those with more obscure problems, most hospitals—private and governmental—usually send them home following investigations of all possible physical parametres, not even thinking to test their mental health . And after huge resources are wasted on these repetitive physical tests, they come to a dead end, occasionally even implying that the patient is pretending to be ill, or worse, offering them unnecessary fortified vitamins or alternative cures that they don't know much about themselves.
All this stems from ignorance and lack of awareness at all levels. It begins with poor training of health personnel; until a few years ago, doctors, nurses and paramedics could get degrees without having to learn the bare bones of psychiatry. The current medical curriculum is more inclusive, but there are still no separate exams on the subject, which means it is more often neglected. This has resulted in health personnel who are incapable of dealing with even the smallest of mental health issues, and if that wasn't bad enough, they are often responsible for spreading misconceptions, superstitions and stigma. Every day we come across unscientific recommendations, indiscriminate prescription of psychotropic drugs and unrelated specialists perpetuating ludicrous cures. And when these same incompetent 'experts' go on to occupy influential posts in the government, it is obvious what will happen—they will not understand the need to prioritise mental health in policy. It is no wonder then that even in this day and age, Nepal's health ministry has no department dedicated to mental health , or the fact that the mental health budget currently comprises less than one percent of the total annual funds coming into the health sector.
Part of the problem is owing to the passivity of those who are aware of the problems. Even though the prevalence of mental health is substantial—believed to affect 15 percent of the population and rising—very few people are actually willing to open up discussions or admit their own problems, fearing discrimination. This is why many people are under the illusion that mental illness is a rare phenomenon, and is limited to those who are obviously disturbed. Sure, many NGOs and individuals are working to create and raise awareness on the subject, but efforts are scattered, and will amount to little unless concerted nationwide campaigns are undertaken. The urgency for immediate and long-term strategising to address the mental health pandemic cannot be overemphasised. After all, we must remember that there is no health without mental health .
Dr Shakya is an Associate Professor and Head of the Department of Psychiatry at the Patan Academy of Health Sciences
Source : e kantpur , 24th June 2013
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