Mental Health in an Unequal World

A client, 18 years of age walks in my cabin for the therapy along with his parents. The client presented with the major concern of fearfulness, difficult to breathe, restlessness, multiple somatic problems, low mood, withdrawn, decreased interest, excessive use of e-gadgets (Mobile/TV/Laptop/IPAD) suicidal ideation and plan. The client was diagnosed with mixed anxiety and depression. During the interview, client reports about the ongoing family issues between his parents and other family members at home. In a separate interview with the client’s parents, they accepted about having the conflict due to stress about their child.

After the overview, it came to light that the family were going through financial crisis, resulting problem in between couples, which was displaced on their child. The anger and frustration was poured on the client with criticism, resulting low self-esteem and worries. Finally, after couple of months, anxiety and depression were successful to take over the client.

In above case, we can see generational gap, family issues, financial crisis which are all parts of this unequal world. This inequality may lead to mental health issues and disorders. Each individual is different. People have created discrimination out of these differences. Therefore, we have an unequal world in terms of social and financial status. But mental health is a neglected topic. Often considered taboo. Thanks to the pandemic that we are now recognizing and acknowledging its importance better than ever. Certainly, ignorance isn’t bliss in this case.

If we look into the statistic view of mental health issues in Nepal, the first epidemiological field survey conducted in the Kathmandu Valley in 1984 estimated the prevalence of mental illness to be around 14%. The recent pilot study of the National Mental Health Survey reported the prevalence of mental disorders to be 12.9%.3 Suicide (16%) was the leading cause of death among women of reproductive age, with 21% of suicide occurring below the age of 18 years. In comparison with other countries, suicide among women (20 per100 000) is higher than among men in Nepal (3rd highest cause of death among women versus 17th highest among men). According to study (Risal et al (2016), Anxiety and depression in Nepal: prevalence, comorbidity and associations BMC Psychiatry), prevalence of anxiety was 22.7 % and of depression 11.7 %. There is higher rates of mental disorder in Nepal is rising every single day. Global crisis like COVID has added the additional issues and risk for mental health disorder. Hence, we can clearly understand that mental health issues are increasing every single day, not only in Nepal but worldwide.

Nepal on the other hand being a developing country has been always facing the financial issues for systemic health services. In the year 2020, the government of Nepal allocated 6.15% of its total budget in Health Sector and only 0.2% in Mental Health Sector. According to the data, there are only 200 psychiatrists and 3 child psychiatrists in Nepal. 30 registered Clinical Psychologists. The number of psychiatric nurses are even fewer i.e. 50. The number of psycho-social counsellors and community based psycho-social workers are less than 1000. There are only 500 psychiatric beds and 25 In-patient psychiatric facilities. This data suggests that Nepal lacks the manpower and facilities for psycho-social support. These factors add burden for nation and also put tons of risk for those who are out-crying for help and who do not get the much needed service.

The primary factor for any mental health issue is Stress or suffering, which is omnipresent, both scientific and psychosocial world. In terms of science, the past few decades have seen nearly 80,000 papers published on the topic, ranging from the effects of stress on the genome and cellular functioning to its impact on physical and mental health. The effects of stress on a social and cultural level is similar too. In a psychosocial sense, it is also omnipresent. At some point in life, all humans will suffer, illness, bereavement, and death. Most will suffer stress in their family, work, or spiritual lives. Some will suffer from poverty, hunger, and torture. Human beings level of happiness depends upon how they cope with stress and how our resilience to it. Psychologists describe these resilience factors at the individual level, in terms of coping skills, social support, and temperament, but anthropologists remind us that how societies and cultures are organized which have a great impact both on the nature and types of stressors individuals must face in their daily lives and on the types of resources they can draw upon.

Looking at the risk factors, we all human beings go through different phases of Life. These phases sometimes become stressful.

Life transitions: Passing from one life condition or phase to another can be stressful. Examples: moving to a new community, becoming a parent retiring from a career, etc. Difficult timing Events that happen earlier or later in life than usual or expected. Examples: having a child at 15 years of age and entering college at 40.

Ambiguity: A lack of clarity in a situation. Examples: unclear information for a worker about a function or task and for a patient about his or her health status, treatment options, or prognosis.

Low desirability: Some circumstances are undesirable to most people in virtually all respects. Examples: losing one’s house in a fire and getting a traffic ticket.

Low controllability: Circumstances that seem to be outside the person’s behavioral or cognitive influence. Examples: low behavioral control, such as not being able to do anything to prevent instances of back pain; low cognitive control, such as not being able to stop thinking about a traumatic experience. (Sources: Lazarus & Folkman, 1984; Moos & Schaefer, 1986; Paterson & Neufeld, 1987; Quick et al., 1997; Suls & Mullen, 1981; Thompson, 1981.)

Along with the individuals’ differences to cope up with stressors, these pattern of stressors is profoundly affected by their (sub) cultural context too. There are two ways in which culture can affect the experience of stress. First, certain stressful life events can be seen as normative— that is, most individuals in a given culture or cultural sub-group will experience a particular event at specified times in their lives. Adolescent puberty rituals are one example of a normative life event, retirement is another. Second, by differentially allocating social resources such as family, friends circle, social status, community. These culture pattern also affects the types and levels of stress that individuals are likely to experience.

Hence, to reduce these stressors working on their daily life hassles, increasing their individual resources to cope better and following their adaptive ways of living may help promote their happiness and satisfaction. These factors, in overall, will enhance one’s psychological wellbeing. Psychological well-being is quite similar to other terms that refers to positive mental states, such as happiness or satisfaction. Experiencing Positive emotions and feelings of happiness is psychological well-being. However, this is a subjective matter. (Diener, 2000) Researchers also have found that the absence of distress doesn’t necessarily indicate a person’s has better psychological well-being. People with better psychological well-being report feeling capable, happy, well-supported, and satisfied with life. Feelings of wellbeing are fundamental to the overall health of an individual, enabling them to successfully overcome difficulties and achieve what they want out of life.

The primary ways to attain psychological well-being is to follow these simple healthy life style; maintaining their balanced diet, sleep and exercise. Moreover, having a flexible structured routine, family support, being with closed ones, talking to loved ones maybe some other techniques to attain psychological well-being. Even if these simple techniques doesn’t help them achieve their mental well-being, seeking for bio-psycho-social support is very important.

Mental health is as important as physical health. So, one should not be ashamed to seek help. It is rather a brave step to take and ask for help. There are toll free numbers that provides psycho-social support and facilities for the needy ones available online. Mental health issues can be easily treated if one asks for help. Therefore, “Be brave and ask for HELP!” We all ought to remember that “No Health without Mental Health”. Let’s all of us be part to promote for our well being and support each other in need.

Writer: Rampukar Sah

Editor of the Article: Sumana Sharma Rajopadhyaya

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