A trip to Ethiopia 

I was in Ethiopia recently for the short course on Mental Health in Complex Emergencies. I had a nice stay there, some of the pictures from Addis below:

Lightening during Meskel Festival.

Bole Medhanialem Church

Dance at the cultural center.

Abyssian Restuarant for native food and cultural dance & songs. 

I loved the local coffee  !!

With Nepalis working in Ethiopia on the first day.

Lynn Jones, one of the course directors.

The growing city – Addis Ababa!!


Mental Health and Dignity

Every person has the right to live a life with dignity. No matter which country, color or culture one belongs to, we all have our own value and worth in this world. However, in reality, it is not what we wish to it to be. People are often facing discrimination, structural inequalities and oppression that violates the inherent dignity and worth of the human being. It is even more frequent in the case of people living with disabilities and mental health problems. In Nepal, people suffering mental illness and mental health problems face discrimination and stigma within the family and in the society. There are news coming from various parts of the country where mental health services are inaccessible and the people with mental health problems are restrained, kept in captivity and tamed like animals. They are forced to live and bear the inhumane treatment by family and community. We all need to be aware and help people with mental health problems in living a life with dignity.

This year World Mental Health Day is being observed today with the theme ‘Dignity in Mental Health’. See: infosheet_wmhd2015

People with mental illness can recover and can function well with necessary medical & psychosocial support. Below, we can view a short video of such man, Shiva Sharma,  telling his story of recovery. It was produced by BasicNeeds Intl:

If you are on twitter, you can find related tweets by following this link: https://twitter.com/search?q=Dignity%20in%20Mental%20Health

Call for Participation – ENACT (Enhancing Assessment of Common Therapeutic factors) scale

Dear All,

We are looking for some participants to score the counseling sessions using the ENACT (Enhancing Assessment of Common Therapeutic factors) guidelines that helps to evaluate the set of 18 different skills often used by mental health professionals. The eligibility for participation is MA/PGDPC (psychology) with some experience in counseling practice. We need around 4-5 raters for rating the audio/video recordings. We also see the possibility of collaboration for sharing authorship on articles/papers about it.

The participants will be provided audio/video recordings of the sessions. Some financial incentive is provisioned for compensating the time used for participation in this task. The payment rate would be around Nrs 200 – 250 (tax deductible) for each recording. The average length of the recording is 10 minutes.

Kindly find attached herewith a paper and guidelines that need to be studied before participating. Interested candidates can contact directly Sauharda Rai (sauharda.rai@gmail.com) who is the focal person for this study.

With Best Regards,

On behalf of the study team –
Sujen Man Maharjan

ENACT Scoring Guidelines for raters_Aug 2015_edited version.docx

Living with Ambiguity

“I wanted a perfect ending. Now I’ve learned, the hard way, that some poems don’t rhyme, and some stories don’t have a clear beginning, middle, and end. Life is about not knowing, having to change, taking the moment and making the best of it, without knowing what’s going to happen next. Delicious Ambiguity.”
Gilda Radner

mother showing a pic of her sonA mother of missing showing the photo of her son that she carries all the time hoping to find him some day.

Life surprises us with ambiguities of many sorts. Not all ambiguities are delicious in nature. Some are very painful and long lasting. Some, of course, might be exciting, temporary and teach us lessons in life. Being able to accept and live with ambiguity can be a great strength.

The ambiguity of loss is one of the most painful and difficult ones to deal with as it is unclear and ones who are facing them swing between hope and despair most of the times. Hundreds of thousands of relatives around the world are living with ambiguity about the state of their loved ones whom they have lost due to armed conflict, natural disasters, accidents, migration, etc. On International Day of the Disappeared, marked every year on August 30, missing persons are publicly remembered and solidarity is strongly expressed to the families for their right to know the fate of their loved ones.

Psychologist Pauline Boss calls the phenomenon of living with ambiguity of loss when a person is physically absent but psychologically present as ‘Leaving without Good Bye’. Family members are often hopeful of their return some day or at least finding out what actually happened to them even after decades of disappearance.

In Nepal, around 1350 people are still missing from the time of people’s war (1996-2006). Families are still searching for the answers about the fate of their loved ones. Parents hope to see their children back to support them in an old age, wives still believe themselves to be married and not-widows, and children are equally ambivalent about the status of their missing father/mother. Wives pray and do fasting for their husbands’ longevity on the occasion of teej and other religious occasions although they do not know where they are. In case of missing from other phenomenon such as natural disasters, accidents, and migration, families presume such people to be dead after certain period of time, then, they carry out certain final life-cycle rituals according to their cultures & religions and they move on with their lives. For ones missing in relation to armed conflict, there is no basis for performing the final rituals as it could be seen as betrayal and abandonment of hope so, the ambiguity is stronger and long-term. The closure is not attainable as it occurs in normal circumstances which is often expected by the society.

Families remain confused and in dilemma. People cannot make sense of what is happening and cannot find the meaning or get the sense of coherence. Without meaning and coherence, they can’t find hope to move forward in their lives. As a result, both coping mechanisms and grieving processes are immobilized. These are the effects of the ambiguous loss which cannot be judged as pathological as clinicians might view it as some of the effects look like the symptoms of PTSD, depression, and anxiety. However, the risk of developing clinical pathology must not be undermined in the long run. The impact and results of support programs for the families have shown that community-based and local approaches are better than the clinical interventions such as individual counseling/therapy. The interventions that reinforces the new relationships and social network, and that focuses on utilizing their own resilience & resources and developing tolerance for ambiguity have found out to be effective in terms of mental health and psychosocial support.

Living with ambiguity is difficult but developing tolerance can become great strength in this ever-changing world around us. Lack of closure and not knowing can be embraced gracefully.


Psychological First Aid and Art Therapy


Dear Friends,

The Art2Healing Project is coming back to Nepal soon to facilitate a Psychological First Aid and Art Therapy Program.

Please, find below the message about the training that is happening in Kathmandu on 26th August – 8th September. If you are interested to participate, then, kindly contact local project coordinator, Hira Dahal, at hiraisika@gmail.com, for confirmation.

More details in the attached invitation letter.



Psychological First Aid Invite.pdf