Shedding much-needed light on mental health

In southern Nepal, a training in child and adolescent mental health enables health workers to identify, manage and refer cases to specialists to ensure children get the help they need

Ghanashyam Kandel
Health Assistant at the Tulsi Health Post in Mithila Municipality in Dhanusha District, Jyoti Shrestha (right) takes notes as a mother (left) describes her daughter’s symptoms. Jyoti is among 25 health professionals who were trained in managing child and adolescent mental health cases with UNICEF support
UNICEF Nepal/2019/GKandel

15 September 2019

Dhanusha, Nepal: The little girl had come to the health post with her mother. As the older woman described to Jyoti Shrestha – the health assistant in charge of the Tulsi Health Post in Mithila Municipality, Dhanusha District – the various issues that were troubling her daughter, the 10-year-old sat quietly in her chair, saying nothing.

“I could see she was exhausted,” Jyoti says. “They both were.”

That exhaustion was inevitable. For almost half of her young life, the child had been showing signs of what Jyoti suspected, based on that first assessment, was anxiety and convulsions. But she had never been properly diagnosed or treated in all that time.

Instead, the family had been seeking the services of a Dhami or traditional healer and had spent around Rs. 10,000 in the process. Not surprisingly, there had been no improvement in the girl’s condition. “The family was not well off, and this was a considerable amount for them to lose,” Jyoti says. “It was good that they had finally decided to seek medical help.”

After taking extensive notes on the child’s symptoms, Jyoti counselled the mother. She explained to her what she thought might be the problem – emphasizing that this was not something a Dhami could cure – before referring them to a psychiatrist at the Janakpur Provincial Hospital in the same district.

This effort to identify, counsel and refer cases to mental health specialists is a recent addition to the services at the Tulsi Health Post.

It follows closely on the heels of a training on child and adolescent mental health that was organized in the Mithila Municipality by the Province 2 health directorate in February 2019, with technical support from UNICEF and financed by the DB7 Fund.

Health Assistant at the Tulsi Health Post in Mithila Municipality in Dhanusha District, Jyoti Shrestha (second from left) participating in a week-long child and adolescent mental health training organized with UNICEF support.
UNICEF Nepal/2019/GKandel
Jyoti (second from left) participating in a week-long child and adolescent mental health training organized with UNICEF support.

Jyoti was among 25 health professionals who had taken part in the training. Over the course of a week, a team led by Dr Arun Raj Kunwar – child and adolescent psychiatrist at the Kanti Children's Hospital in Kathmandu – had instructed participants on the basics of managing children and adolescents with mental health issues.

“Before this, we did not have the knowledge or tools to recognize and deal with mental health issues,” Jyoti says. “There must have been so many cases that we weren’t able to diagnose or support.” With the training, however, she says they’ve gained a new perspective. “When we come across children who are having learning problems or other symptoms, we’re now able to link these to mental health disorders and neurological conditions, counsel them and help them get the treatment they need,” she adds.

Of course, key to increasing the uptake of the new service is to ensure the community knows about it. As a first step, Jyoti and her colleagues had gone to schools to reach out to teachers and students and encourage them to alert the health post regarding potential cases. In fact, this was how the mother of the 10-year-old girl had come to Jyoti; a student who had attended one of the awareness programmes had advised her to take her daughter to the facility.

For Jyoti, these past few months following the training have reaffirmed her belief in the role health workers can play in transforming communities.

“Many young people who are suffering mental health problems drop out of school because of the stigma and discrimination they face....Especially girls in the community; many are married off much too early, which leads to a lot of distress and emotional problems.”

The training had also covered ways to handle children affected by gender-based violence with great sensitivity and empathy, and Jyoti recalls a recent case where those skills had proved useful. A young rape survivor had come to the health post to seek an abortion, and though the 17-year-old had been reluctant to talk at first, upon counselling from Jyoti and other staff members, had finally opened up about her experience.

“We found out she was being pressured to marry the perpetrator, but she didn’t want to – she wanted to stay in school and study,” Jyoti remembers. The team provided her safe abortion services, as well as giving her their own phone numbers, along with those of the child helpline and local authorities, to use if she so needs in the future. “Last we heard, she hadn’t gotten married and was still going to school,” Jyoti says.

“If we could do more outreach activities, I’m sure we could find a lot of hidden cases like these of children and adolescents who could come live productive lives with the right help,” she adds.