E-Kantipur

SEP 21 -

On Sept 18 at a small gathering to discuss mental health issues at Martin Chautari, Kathmandu, mental health actors spilled out their grievances. The discussion was an indicator that mental health issues require urgent debate at different levels and involving diverse stakeholders. And there are many reasons for why should diverse stakeholders, who traditionally thought that they were above mental health issues, should join this debate.

In the last couple of years, mental health issues have been getting increasing visibility particularly in the national media. Almost every week, there are reports of people living with severe mental health problems and who have been kept in custody, chained to the wall, for decades. They have been deprived of basic human needs and rights which are essential for the survival of human kind. Mental health problems have been deeply rooted in Nepali society for centuries, but these problems have just started to surface. They were not given any social or medical priority. It is hard to find any serious study done in this area. In the absence of enough information, the understanding of mental health is also limited.

There are diverse perspectives from which to look at mental health. Among them, the social and medical models of understanding mental health are at the forefront. The social model of mental health or psychosocial disability is a reaction to the dominant medical model of disability which in itself is a functional analysis of the body as a machine to be fixed in order to conform with normative values. The medical model of mental or psychosocial disability is a socio-political model by which illness or disability is perceived as a physical condition. In this model, the individual is responsible for causing damage to one’s own life because of associated illnesses or disabilities.

The medical model forces us to believe that scientific understanding undertaken by trained healthcare providers are vital in curing or managing these problems. In this model, the potential and the responsibility of medical professionals are viewed as being central and unchallenged. This model believes that the excellent healthcare system helps to prevent, promote and manage related mental and psychosocial disabilities, and allow sufferers a more “normal” life. It follows the system of “diagnosis and cure”. It implies that people who suffer from mental health related problems are “abnormal” which is inherently “wrong”, but with the support of medicines or medical science, both the medical condition and the person can be normalised.

However, the social model of understanding mental or psychosocial disability identifies systematic barriers, negative attitudes and exclusion by society (either intentionally or innocently). This modality believes that many variations like physical, mental, sensory, intellectual and psychological issues may cause an individual’s functional limitation or impairments. The social misunderstanding of these issues causes greater barriers and disabilities than the impairment itself. Regardless of individual differences, if society accepts and includes those with disabilities as equals, it helps to solve many disability related barriers.

In this model, the modes of discrimination are expressed in all areas of public life including work, social functions, healthcare and public policies. The social model understanding of mental health and psychosocial disability defines the societal values that actually disable people through imposed measures which cast out individuals with disabilities in public life rather than creating a favourable environment to seek help and support.

Dehumanisation and inhuman treatment of people with mental health problems is the result of the failure to know the social model understanding of disability. In the absence of a societal role in addressing mental health and related disability concerns, people who struggle with serious mental health problems have been denied basic healthcare rights too. Even medical professionals do not like to deal with other health problems of those who suffer from mental health problems.

For instance, it might be relevant to discuss the case of a raped middle-aged woman who was rescued some weeks ago from Balkumari, Kathmandu. In a phone conversation, Menuka Thapa, a social worker who rescued the woman and initiated her legal and health treatment, told me, “We rescued our vulnerable sister from Balkumari where she was mentally fragile, physically ill and abandoned after being gang raped. We admitted her to the Mental Hospital, Lagankhel. We knew that she could get only psychiatric help here. But she had a serious problem of uterine prolapse requiring urgent surgery. Therefore, we took her to Prasuti Griha where the government provides free services including surgery.”

However, the health professionals refused to admit her because of her mental problem. Thapa and her colleagues also tried to admit her in Patan Hospital and some other private hospitals, but no place would admit the woman. Finally, they took her to Nepal Medical College, Jorpati where both kinds of services were provided. But there too, they faced the same problem. The gynaecological and psychiatric departments at the NMC tossed the responsibility of looking after her back and forth between themselves instead of making coordinated efforts to help her. Thapa and her colleaugues, having givven up, took the woman back to the Mental Hospital where, because of their public campaigning, a team of gynaecologists from Model Hospital arrived with the necessary equipment and offered emergency medical support.

This shameful story raises many questions to be debated in medical, social and political domains. Obviously, such cases are the outcome of the medical model perspective of the problem where social, legal and cross-cutting health complications of an individual are overlooked. This case provides compelling evidence to drag multi-sectoral agencies and expertise into the mental health debate. Mental health is not only a medical concern. For a mind to be healthy, it takes more than doctors and medicines.

Posted on: 2012-09-21 08:23

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