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print version(Published earlier in The Guardian)
The appalling psychiatric care in Nepal and other developing countries condemns thousands to a living hell
by Jagannath Lamichhane
In the popular imagination, the psychiatric hospital in Patan, Nepal, is a place to store socially discarded people. The inpatient ward smells of urine, the toilets stink, and the bedclothes look as if they have not been cleaned for months.
The patients, demoralised, hopeless, sometimes chained – and mostly comprising the illiterate and ultra-poor – desperately tell anyone who is willing to listen that if there is a hell in earth, it is this hospital.
Time and again, when I visit psychiatric hospitals and talk with patients and their family members, I see no social hope for them. Some families have been routinely visiting for the last 15-20 years. Their already degraded socioeconomic status is being ruined; the constant stress of taking care of of a mentally ill family member has led to mental illness among others in the family. But they can expect little help from society, state or international community.
Psychiatric patients in Nepal feel that they are treated like animals. They have no choice of treatment, and electroconvulsive therapy is common. The hospital does not provide any psychotherapy or psychological services: patients are solely dependent on medicine. There is no two-way communication between psychiatrists and patients. Patients are not informed why they were brought here, what is happening to them, what medicines they are taking. And the food is so bad, some of them complain it is unfit even for animals.
This raises a fundamental question: in poor countries such as Nepal, in the discourse about healthcare, development and human rights, why is mental health forgotten? Clearly, many social, cultural, religious, legal, economic, educational and international factors combine to undermine mental health provision in poor countries.
In Nepal, socially, culturally and religiously, mental illness is condemned. Since my early childhood, I have often seen mentally ill people subjected to public abuse and inhuman treatment. There is a popular belief that their condition is the result of bad karma. The human rights of mentally ill people are not recognised. A huge proportion of the population are not aware that mental illness is a real health condition – one that is treatable – and that the state has an obligation to protect the human rights and dignity of an ill person.
The Nepalese government spends a token amount (0.08%) of its total healthcare budget on mental health. The "new" national mental health policy approved by the cabinet 13 years ago has still not been implemented.
Meanwhile, international agencies, whose primary mandate is to act on the principle of non-discrimination and human rights, are themselves part of the discrimination where mental health is concerned. For example, there are more than 275 disability rights organisations working in Nepal. Of those, only three or four work in mental disability rights. Organisations focused on physical disability are moderately funded, but those concerned with mental disability have yet to receive any committed grant either from government or international agencies. Mental disability rights organisations working in other developing countries tell a similar story.
In principle, the Convention on the Rights of Persons with Disabilities (CRPD), which Nepal has already ratified, emphasises that physical, mental and psychosocial disability rights are to be protected equally. But in Nepal, this does not happen in practice: the rights of the severely mentally disabled are simply not recognised. These multiple discriminations lead to more stigmatisation of mental illness.
Of course, many people in Nepal dismiss the western forms of medical and psychosocial treatment, believing mental illness to be the result of fate, or some other external power. Traditional healers are often the first point of call, though there are many question marks over the effectiveness of the healers’ treatments, which produce as many negative results as positive ones.
For chronically mentally ill patients, psychiatric hospital is a last resort. It’s a place where they can get medical help, but one where they also become victims of an outdated mental health system. Recovery and social rehabilitation always remain a distant dream in their lives.
