Talking about mental illnessWhen it comes to illness that concerns the mind, even the young, educated and privileged in the country’s most urbane and modern city find it hard to accept, let alone embrace,
When it comes to illness that concerns the mind, even the young, educated and privileged in the country’s most urbane and modern city find it hard to accept, let alone embrace, and so the stigma against mental illness makes a forceful presence even among them. No statistic tool could generate numbers to capture the subjectivity and intensity of the stigma faced by mentally ill patients. Yet the World Health Organisation (WHO) data for the European Union showing that nine out of every 10 mental health patients reported that they faced discrimination shows the deeply pervasive nature of the stigma. Our deeply embedded stigmatising psyche is on display for all to see in Kathmandu, the capital city. In the streets of the Capital, those who are mentally ill roam astray, abandoned by their families. Kathmandu denizens loathe and abuse them, and the government remains apathetic towards their treatment and rehabilitation.
For the patients and their families, stigma inflicts devastating consequences. They suffer humiliation and discrimination, their economic opportunities are hindered and social ties severed. For anyone who learns that s/he is mentally ill, retreating to silent suffering becomes a more preferable option than seeking treatment, which further worsens the problems s/he wants to escape from. WHO identifies stigma as one of the biggest challenges in tackling mental health issues.
Some striking factors make the stigma against mental health particularly grave for a country like Nepal. Firstly, it exists against the backdrop of soaring mental health statistics. A 2013 study showed that 37.5 percent of Nepal’s population suffers from mental disorders. More frighteningly, WHO’s 2012 global suicide survey ranked Nepal seventh for suicides, depression being the major suicide trigger. Secondly, this bleak picture will most likely deteriorate given the WHO conclusion that low-income countries like Nepal are more vulnerable to ill mental health due to their economic hardships, conflicts, and disasters. Thirdly, mental illnesses are the most disabling diseases with a research in The Lancet showing that they account for the largest (32.4 percent) socio-economic burden of disease in terms of productive years lost due to disability caused by disease. Finally, Nepal faces a grim shortage of resources to meet mental health patients’ needs. Only 0.22 psychiatrists and 0.06 psychologists are available per 100,000 people, and budget allocation is a nominal 1 percent of the total health budget.
Such deeply rooted stigma can be nothing less than a serious victimiser in a country like Nepal, where a dearth of resources already takes a toll on the patients’ needs. Acceptance, understanding and support from family and friends have the powerful ability to pacify and heal the patients and so are vital in Nepal’s resource-scarce circumstance. Stigma does just the opposite; it devastates victims, entrapping tens of thousands of Nepali mental health patients in the vicious circle. Patients and their families bear the burnt. With productive forces immersed in their own agonies, there is no doubt that sooner or later, Nepal’s economy will suffer too.
Discussing issues openly
Nepali society can no longer pretend to be in a deep slumber when it comes to conceding the gravity of mental health and taking steps to tackle stigma. At least in principle, it is not a complex, costly endeavour to tackle stigma. All that needs being done is to talk about mental health issues. But Nepali society in general—our homes, our schools and communities—have maintained a deafening silence when it comes to speaking about matters of the mind. Nepalis share without hesitation, even with a tinge of humour, about ‘pressure’ and ‘sugar’—colloquially used terms for blood pressure-related problems and diabetes respectively—or their bypass surgeries. The government runs campaigns and puts up large hoarding boards to make people aware of heart ailments. But mental health issues remain ignored.
No longer should things stay this way. Families, schools and communities should make mental health a topic of discussion. Nepali families and schools seem to put too much stress on passing on the values of professional and/or economic success to their children and students while ignoring equally important values of living peaceful, happy lives, something that is unimaginable without good mental health. Now, parents and teachers should educate children on the importance of living fulfilling and peaceful lives and encourage them to pursue professional ambitions. They should cultivate in them a habit to share all their worries and stress—factors that are the starting points of ill mental health—so that these children turn into adults who easily embrace mental health and seek help when they need.
As the country’s guardian, it’s the government on whose shoulders the onus lies to spur this talk. Studies say that individuals more informed about mental illnesses view it with less stigma. So by taking the initiative to spread mental health literacy through an effective strategy, the government can help to break the stigma. Five points should be core to such government-led education campaigns. One, our mind and body are interrelated parts and both are equally likely to make us ill. Two, facts and figures showing mental illnesses are among the fastest rising diseases. Three, no one is immune to mental illnesses. Fourth, stigma worsens and perpetuates mental health problems. Finally, mental health patients need love, care, and support.
Only an informed population that embraces mental health will spearhead the fight against the epidemic of mental disease and lead to healthier, happier people who can contribute to their families and society. If the nation continues to ignore the suffering of millions of its citizens and falls under the shadow of mental illnesses, it will not be long before Nepal will fall victim to huge socio-economic burdens.
Gautam is a freelance write who writes on contemporary social and cultural issues.