A recent major study of the mental health of earthquake survivors showed surprising results. 

According to the report, which was organised by the Red Cross and Transcultural Psychosocial Organisation Nepal (TPO Nepal), 39.4 percent of people in earthquake hit areas showed problems with depression, (38.4 percent) had anxiety, 25.5 percent had problems with alcohol, (21.7 percent) were living with thoughts of suicide, and (16.3 percent) had signs of post-traumatic stress. This information was collected approximately eighteen months following the 2015 earthquake. 

These results were surprising because they were higher than those found in a similar study taken four months after the earthquake and also higher than both the World Health Organisation’s estimates for depression and anxiety following a humanitarian emergency, and rates found in similar studies after earthquakes in Haiti and Japan. It was alarming that mental health problems were continuing to rise almost 2 years following Nepal’s earthquake. 

One explanation for these surprising results is that there was an influx of help directly following the earthquake and an abrupt decline of assistance once the “crisis” was considered over and response teams left the affected areas. Most NGOs and responding agencies view crisis through the lens of basic survival issues such as shelter, water, and sanitation. Mental health care after the earthquake in the affected areas was only short-term and provided as available. When people had basic shelter, water and toilets, the crisis was considered over by responding agencies—and those helping with mental health issues were pulled away with their teams. But the mental health crisis was not “solved.” Survivors were left with anxiety, fear, difficulty sleeping, panic and lack of hope for additional help. The lack of resolution for many individuals suffering after the earthquake created a spiralling effect. Their mental health continued to decline with major repercussions for their overall well-being. 

The Red Cross report also made other recommendations: to address distress as a core priority, focus support for at-risk populations, mobilise existing community-level systems, and strengthen national policy and mental health care delivery. It is notable that, when people were asked to identify “serious problems” resulting from the earthquake, emotional distress was the most common answer after income/livelihood (73.2 percent) and shelter (63.5 percent). For those experiencing distress, it was more important than hygiene, drinking water, food and toilets. 

The report emphasised the need for more attention to mental health as a part of regular health care.  “A scarcity of mental health services within the existing health care system to address these high rates of mental health symptoms is challenging. Integration of mental health services into the existing health care system could be an effective and sustainable approach to provide mental health services.”

 The Red Cross report highlights the need for awareness and support for mental health in Nepal. It is obvious that amongst the many needs and few resources, mental health is begging for a place at the table.

- Dr Moulton is currently serving as a Fulbright Specialist in Nepal from her home University, Northwestern State University, Louisiana, US where she teaches as a graduate full-professor in Clinical Psychology. Dr Moulton is an author of numerous text books in the field. She is licensed as a psychologist, a professional counsellor, a marriage and family therapist and an addiction therapist. She also sits on the board for the Nepali NGO, Empower Nepali Girls,  and has worked in Nepal for the past seven years