If some of you (voluntarily or in some organizational capacity) are interested for MHPSS response in flood and landslides affected regions of Nepal, then, kindly coordinate with Protection Cluster Nepal led by Department of Women and Children of Nepal government which is coordinating the efforts between different agencies and trying to facilitate the best ways to reach the most affected as soon as possible.
I would also like to share some resource which might be useful:
IFRC toolbox: Key Actions for Psychosocial Support in Flooding
Inter-Agency Standing Committee (IASC) Reference Group for Mental Health and Psychosocial Support in Emergency Settings (2015). Nepal Earthquakes 2015: Desk Review of Existing Information with Relevance to Mental Health and Psychosocial Support; Kathmandu, Nepal.
James, L, Welton-Mitchell, C. & TPO Nepal (2016). Community-based disaster mental health intervention (CBDMI): Curriculum manual for use with communities affected by natural disasters in Nepal.
This post might be useful for students who want to study Psychology after passing Secondary Education Examination (S.E.E) in grade 10. As psychology is taught under the faculty of Humanities, at least C+ is required to pursue studies in psychology.
This year’s SLC results came out few days before. SLC can be considered a ticket for higher education for Nepali students. I would like to share some information about studying psychology in Nepal after SLC.
Intermediate Level
With successful completion of SLC (School Leaving Certificate) exams, Nepali students complete their secondary education and get enrolled for Higher Secondary (grade 11 – 12) education under Higher secondary education Board (HSEB) under Ministry of Education. It offers four streams of studies: science, management, humanities and education. Psychology is taught under humanities and education streams in private colleges. There are limited colleges which offer psychology as one of the major subjects under Humanities.
Another way of studying psychology is by getting enrolled in A level program. A-Level is an Advanced Level GCE (General Certificate of Education) qualification, equivalent to a two-year intermediate level, run under Cambridge…
Prof. Gerard Jacobs retired from his work last month after nearly 3 decades of service to the University of South Dakota and founding/leading the DMHI there.
My wishes for him:
“I wish Prof. Gerard Jacobs peaceful and productive life ahead after retirement, I am sure he will continue to engage himself in meaningful work. I am grateful to him for the training in Nepal in 2015, I appreciate the way he shared the knowledge with us in simple language with a lot of examples drawn from his own experience of working in other disaster areas.
I am also thankful to Jerry for helping me to participate and present my paper in International Congress of Psychology in Japan last year. Jerry, if you are keen on travelling then, please do remember, we are here to welcome you again in Nepal. Namaste!! “
Community-Based Psychological First Aid Training of Trainers was successfully organized on 16-20 November 2015 at Kathmandu. Twenty-nine participants were invited for ToT from the faculties of psychology departments in Tribhucan University (Kirtipur, Tri Chandra and Padma Kanya Campuses), MPhil in Clinical Psychology, TUTH and psychologists/counselors working in various national and international organizations (ICRC, Nepal Red Cross Society, MdM France, TPO Nepal, Chhahari, Koshish Nepal, CMC, CVICT ) helping the earthquake survivors through MHPSS programs. This ToT has further enhanced the capacity of Nepali professionals to respond to emergencies by training the members of the community to support one another and meet psychosocial needs. Such approach is particularly important in our country because there is scarce trained human resource in MHPSS field and community-based interventions are more sustainable and effective.
I would like to thank Prof. Shanta Niraula and Sandesh Dhakal from Tribhuwan University for their support in organizing this training…
Nepal faces the risk of different forms of natural disasters like avalanches, floods, earthquakes, landslides, etc. which can potentially create acute short-term impact on the mental health on individual, family, and community levels which can develop into long-term psychosocial and mental health problems if they are not supported and treated on time[1]. The healthcare systems of Nepal government should include mental health and psychosocial support from the primary level in order to facilitate easier access to the services. Some organizations have tried to integrate MHPSS services in primary health care facilities in few districts as a pilot program [2]. The government needs to take interest in such innovative attempts and replicate the program in a larger scale by considering their feasibility and efficacy.
A damaged house in Dhunchhe, Rasuwa waits for the rebuilding.
Two years after the earthquakes, the adverse impact on physical infrastructure and many aspects of lives is still present in the highly affected districts of Nepal. Majority of the people are still waiting for the government assistance to rebuild their homes. Many people are also in need of mental health and psychosocial services to overcome the adverse effects of the disaster although the level of disorders is low but the distress level among the population is quite high due to different reasons according to the various studies.
Immediately after the earthquakes, there were many national and international organisations providing disaster relief including MHPSS services on the ground which ranged from psychological first aid, community-based psychosocial support programs (psychosocial counseling, support groups, etc), to psychiatric treatment at district headquarter level. The activities covered almost all the levels as illustrated in IASC intervention pyramid [3].
The Red Cross team interacting with female community health volunteers (FCHVs) in Sindhupalchowk about the impact on mental health and psychosocial wellbeing after earthquakes.
As Red Cross staff, I led the team in Sindhupalchowk few weeks after the earthquakes for providing psychological first aid (PFA) service with team members who had also been trained in physical first aid, it was important to be able to provide support both physically and psychologically. Our work involved providing non-intrusive emotional support, coverage of basic needs through coordination with other units, protection from further harm, reestablishing family links and reinforcing local resilience and social support [4].
Two weeks after the PFA intervention in 5 most affected districts, I visited Gorkha and Dhading, for quick review meeting with field teams and visited some sites to interact locally and observe the impact of the service. field visit report [5].
Dr. Dhana Ratna Shakya, Additional Professor, Department of Psychiatry, BPK Institute of Health Sciences (BPKIHS) in Dharan, who conducted a survey among 500 victims of the earthquake in Bhaktapur, reflects, “Through this disaster experience, what I have learned so far is that disasters, as awful as they are, can turn out to be an opportunity for mental health professionals to improve mental health literacy in our communities and sometimes across a whole country.” Indeed, there has been a lot of investment into reinforcing MHPSS services and increasing mental health literacy and awareness among the people [6].
In addition to providing relief and psychosocial support directly, there were also many attempts on capacity building of stakeholders at local levels who could intervene in absence of trained mental health professionals like psychosocial counselors. For example: Many training programs focused on training health workers to include MHPSS component in their regular services to support people visiting the health posts, teachers’ training to provide emotional and psychosocial support to students at school level, and so on. However, there is a question on the effectiveness of short-term (few days) trainings considering they already have enough workload and there is little incentive and supervision to monitor the changes and how they are making use of the knowledge obtained from the trainings.
The health worker providing medicine in district health post.
Trained teacher encouraging students to practice a relaxation exercise at the beginning of his class.
Nevertheless, there have been some reports on the potential misuse of such funding or lack of remarkable results from the MHPSS programs despite heavy expenditure. The critical post by BBC highlighted the immense use of funding for the psychosocial services in the affected districts, mainly Sindhupalchowk and questioned the effectiveness of such programmes which focused on the training of the people [7]. It highlights the need for proper assessment of the psychosocial needs of the people and then after, solid monitoring and evaluation mechanisms in place for the services delivered to show the effectiveness of MHPSS programmes. One of the senior psychiatrists is quoted as saying that after one year of disaster, the psychosocial problems of the people are likely to end which is not realistic given the slow pace and social & political circumstances of the recovery.
We have noticed that disasters tend to aggravate vulnerabilities of rural areas, socially disadvantaged groups, ethnic minorities[8], people living with disabilities, older people, and of women (single women or women who husbands have migrated abroad for work)[9]. In fact, women, constituted a disproportionately high percentage of disaster fatalities. Those who survived, experience risks to personal security, inadequate sanitary/hygiene facilities, exclusion from decision making, and problems in receiving assistance for lack of human resources, information and personal documents [10]. They are also more likely than men to be psychologically affected. Research by Kohrt et al. (2009 & 2012) in rural Nepal has shown gender (female) to be a risk factor for the mental health problems [11a, 11b].
Palsang Lama, Community Psychosocial Worker (ITDS, Nuwakot) is seen here providing home-based counseling session on nutrition to a pregnant woman.
In larger number of cases, persons with disabilities face multiple layers of exclusion and discrimination, such as ethnic woman with disability (visually impaired) who is overwhelmed by hierarchies of gender, caste, and disability, severely limiting her educational, economic, and social opportunities who thus becomes more vulnerable to psychological distress. The woman below from one of the IDP camps is visually impaired who lacked citizenship and disability card, thanks to the psychosocial workers from LACCOS who accompanied her to get them. Now, despite having them, she still lacks opportunities for education and employment.
The visually impaired woman sharing her difficulties of living as a person with disability in IDP camp.
The study on disaster and disability by Lord et al. (2016) has confirmed prior findings that intellectually disabled persons and people with mental health problems are perhaps the most marginalized and vulnerable group in Nepal [12]. The report consists of three thematic sections which consider the mental health and intellectual disability issues. It discusses about intellectual disabilities & caregivers, underreporting of mental disabilities and the post-earthquake mental health gap. There is clearly a lack of disable-friendly MHPSS programs.
The study done by Tewa and Nagarik Awaz (2016) tried to explore the impacts on the lives of women and men of Bhaktapur [13]. The disaster has forced them to break many cultural norms and experience cultural festivals as moments of sadness, and annoyance instead of the reason for joy, and social cohesiveness. On the positive side, the post-disaster conditions allowed for an increase in social harmony, and solidarity as everybody was suffering from the similar consequences. Females worried about forced separation from a joint family into nuclear families, changes in their roles and life patterns in terms of their daily activities, deprivation of cultural activities such as celebrations of festivals and social gatherings with relatives, psychological distress and need to compromise for a lower standard of life. The males worried that their daily routine has changed as they were compelled to work in the kitchen and care for the babies because women had to spend more time fetching drinking water from distant sources. The gender roles were clearly challenged and men also had to participate in the tasks from which they would otherwise refrain from in normal times. Males also admitted the increased intake of alcohol with the misconception that it might help them reduce their levels of stress.
The study done by TPO and IMC in three most affected districts: Gorkha, Sindhupalchowk and Kathmandu showed depression among 34.2%, anxiety among 33.8%, PTSD among 5.2%, alcohol use problems among 20.4% and prevalence of suicidal ideation of 11%. It reveals there were high levels of distress but low levels of disorders and functional impairment after four months of the disaster. It also showed that support for mental health problems was provided mainly by traditional healers, religious leaders and staffs mobilized by national and international organizations [14]. The alcohol use problem was prevalent as a negative coping as mentioned in the study above conducted in Bhaktapur. It would be interesting to revisit them and see how they are faring after twenty-four months of the earthquakes.
One of the major learnings of this disaster for Nepal have been to include MHPSS aspect into disaster preparedness in the future. The agencies coordinating disaster relief need to integrate MHPSS services while providing support for the basic needs as psychosocial support needs are equally important as food, drinking water, shelter, and emergency medical aid. Like Dr. Dhana said above, disaster has also brought some opportunities in MHPSS field, awareness has increased among people regarding mental health issues and resources have also been developed in context of disaster and other situations. The mobile app with helpful information has been developed by TPO Nepal [15].
Mobile App Screenshot. Also available in web version: manosamajik.com.np
Post Disaster Recovery Framework 2016-2020 of Government of Nepal published by National Reconstruction Authority has envisioned the provision of psychosocial services in education and health sectors under Strategic Recovery objective three: Restore and improve access to services, and improve environmental resilience (p. 8) [16]. Ministry of Health has recently endorsed the revised National Mental Health Policy of 1997, it will go into implementation once it is approved by the cabinet of Nepal government [17]. With that in effect, Nepali people will have improved access to MHPSS services from formal sector in normal times as well as disaster.
References:
Government of Nepal, Ministry of Home Affairs. Nepal Disaster Report 2015
Neumayer, E., & Plumper, T. (2007). The Gendered Nature of Natural Disasters: The Impact of Catastrophic Events on the Gender Gap in Life Expectancy, 1981–2002. Annals of the Association of American Geographers , 551-566.
Halvorson, J. P. (2007). The 2005 Kashmir Earthquake: A Perspective on Women’s Experiences. Mountain Research and Development, 296-301.
11b. Kohrt, B. A., Hruschka, D. J., Worthman, C. M., Kunz, R. D., Baldwin, J. L., Upadhaya, N., … & Jordans, M. J. (2012). Political violence and mental health in Nepal: prospective study. The British Journal of Psychiatry, 201(4), 268-275. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3461445/
Lord, A., Sijapati, B., Baniya, J., Chand, O., & Ghale, T. (2016). Disaster, Disability, & Difference: A Study of the Challenges Faced by Persons with Disabilities in Post-Earthquake Nepal. Published by Social Science Baha and the United Nations DevelopmentProgramme in Nepal: Kathmandu.
Tewa & Nagarik Aawaz. (2016). A Gendered Look into Bhaktapur’s Recovery and Rebuilding: An Applied Research. Kathmandu, Nepal.
Kane, J. C., Luitel, N. P., Jordans, M. J. D., Kohrt, B. A., Weissbecker, I., & Tol, W. A. (2017). Mental health and psychosocial problems in the aftermath of the Nepal earthquakes: findings from a representative cluster sample survey.Epidemiology and Psychiatric Sciences, 1-10.
Autism is a neural developmental disorder characterized by impaired social interaction and communication, and by restricted and repetitive behavior. The symptoms become apparent before a child is three years old. Autism affects information processing in the brain and it is not yet well-understood condition of the brain. It is said to be not curable but the symptoms are manageable with proper interventions. It is one of three recognized disorders in the autism spectrum (ASDs), the other two being Asperger syndrome, which lacks delays in cognitive development and language, and pervasive developmental disorder, not otherwise specified (commonly abbreviated as PDD-NOS), which is diagnosed when the full set of criteria for autism or Asperger syndrome are not met.
I did my internship in Autism Care Nepal last year in March where I met children with autism in the day care facility. It was wonderful to see the children and how they behaved as if they were living in separate worlds within the same space we…
Palsang Lama, Community Psychosocial Worker (ITDS, Nuwakot) is seen here providing home-based counseling session on nutrition to a pregnant woman.
The visually impaired woman sharing her difficulties of living as a person with disability in IDP camp.
