FEATURED STORY

Mental Health in Nepal

A Lifelong Struggle with Psychosis

This is the story of Rita, a 34-year-old mother of three, who has battled psychosis for most of her life. Her struggles started as a young girl, but worsened after she stopped taking her medications when her husband moved to India to find higher-paying work.

As a child, Rita competed against her younger sister at school, but she failed the ninth grade, even as her younger sister jumped ahead of her into the tenth grade and beyond. Rita felt humiliated. She confided to her mother that she was unable to concentrate on her studies, but her mother told her not to worry about the possibility of failure and to continue to study.

When Rita was in the 12th grade, she suddenly began showing symptoms of severe emotional stress including staring, having no interest in talking, poor appetite, and insomnia. Her father took her to Patan Hospital in Kathmandu where doctors started her on medication.

When she married and moved to her husband’s house, he was aware she was on medication. At first, her daily life went well and she had her husband’s support. However, when her husband went to India for better-paying work he asked her to quit the medication and she complied.

Once off the medication, Rita's condition began to deteriorate. She shouted at neighbors, stopped cooking, experienced difficulties in just getting through the day, and began neglecting her children. As she continued to worsen, her mother brought her back home to live. There, despite her mother’s best efforts, Rita refused to restart her medication.

Her mother eventually placed Rita in a rehabilitation center in Kathmandu and after two years and some improvement, Rita returned to her mother’s home, but her condition started worsening again.

One day, home-based care workers (HBCW) from Transcultural Psychosocial Organization (TPO), one of International Medical Corps’ implementing partners for mental health in Nepal, visited her home. The HBCW’s, who provide psychosocial case management and follow-up in people’s homes, encouraged Rita’s family to visit the local primary health care center for treatment. Her mother didn’t believe that such care could be available nearby.

A counsellor from the local clinic visited Rita’s home and started building a trusting relationship with the family after hearing about her case from the HBCW’s. Almost two months later Rita’s father took her to the primary health care center, where the resident health professional diagnosed her as having severe psychosis and started her immediately on appropriate medication.

During the psychosocial counsellor’s home visits, Rita’s mother expressed the belief her daughter’s condition stemmed from sins committed during a previous life and that she needed to care for her grandchildren who were suffering under her daughter’s care. Today, the counsellor and HBCW are regularly following up on the case, explaining to Rita and the family about the causes and effects of mental illness, along with treatment options and the myths, and the stigma that are associated with the condition.

In the counselling process, there have already been four sessions conducted with this family, during which the counsellor encouraged family members in understanding how important their support for Rita is to foster improvement. Meanwhile, Rita’s HBCW has followed up more than a dozen times and plans to continue these visits.

Currently, Rita’s father confirms her condition is improving because of regular medication and family counselling. Her mother is now supportive, making sure Rita takes her medication regularly and offering encouragement. In such an environment, Rita has improved to a point she recently joined a patient support group.

Photo by Dirk Gilson