The outbreak of the Maoist insurgency resulted in the death of 15,000 people, thousands of disappearances, the displacement of over 150,000 people. As in every violent conflict, both of the conflicting parties, the Maoist People’s Liberation Army and the Royal Nepal Army, faced tremendous loss, making both of them victims. The Nepali government signed a peace accord with the Maoists, to put an end to a decade-long bloody war. However, Nepal is now facing a mountain of issues to achieve nationwide establishment of positive peace.One of the pressing problems is the social reintegration of the former child soldiers, which counts for over 6000, and in most cases, they are unwelcomed by their families and communities since they have committed serious atrocities. Witnessing the cruel moments during the war, former child combatants often have severe mental health problems, such as Post Traumatic Stress Disorder (PTSD), anxiety, depression, and function impairment. Unsurprisingly, mental disorders are not only the problem for former child combatants. It is said that more than 20 percent of the population in Nepal had symptoms of mental health disease, mostly caused by the memory of the conflict but also by social problems such as domestic violence. Whether from the shock of that or not, suicide is the leading cause of death among young women in Nepal recently. However, there have been no specific studies on the causes of suicide yet, which shows the nation’s indifference toward mental problem.
In Nepal, trauma healing is one of the aspects that are totally overlooked as a nation. When we visited Nepal this year, we were able to meet with some of the government officials, and visited over 30 NGOs in order to see its post-war peacebuilding process. Most of these organizations seem concerned about gender disparities, domestic violence, human trafficking, corruption, education, impunity…but unfortunately none of the organization spoke a word about “trauma” or “psychological disorder,” and this really left me an unpleasant feeling.
In order to challenge the status quo, professional mental treatment should be offered by government, however, the mechanism has not yet been settled enough. According to research, there are more than 4,000 health posts and 75 district hospitals run by the government within the country, but none of them have a unit for mental health. Furthermore, there is scarcity of professional human resources and service disparities between urban and local areas. The cost of anti-psychotic medication is so high that it is unaffordable for most war-affected families. Many families outside the capital have no option but to travel to other countries, such as India, for treatment but this as well impoverish the families due to their high medical costs.
Why are mental health issues so neglected in Nepal? It is true that generally speaking, mental treatment approach receives a low priority because it is difficult for the third parties to understand the suffering of the patient, and it is hard to make a diagnosis of the patients’ full recovery. In addition, people prefer to prioritize things that can be clearly visualized as achievements, such as development of infrastructure. This is especially the case when the country is stepping forward to create new nation after conflict. As a result of these situations, politician and humanitarian personnel, and even a psychiatrist, cannot comprehend to the depth of the wounds of the war victims in Nepal. War is hell, but without a doubt, once the conflict is over, most of the citizens return to the “everyday” routine and enjoy the absence of violence. Nepali people just want to erase the past and keep going, neglecting the things that remind them of war.
Other than these conditions, as government officials say, there is money constraint to provide mental support as well. It is said that less than 1 percent of the nation’s budget on health was allocated for mental health spending. Considering the significant number of patients, there is a huge imbalance in its expenditure. The field of mental health has always lost the competition of “prioritization” for distribution of money. Speaking of the governmental approach, lack of legal support to patients is also a problem.
This does not mean that no law was enacted regarding people’s mental health, but it is more like the problems of implementation. More than 15 years ago, the Nepal government formulated its first mental health policy in 1996, called National Mental Health Policy, which ensured the availability and accessibility of mental health services for all Nepal citizens and to raise awareness about mental health, mental disorders, and the promotion of mentally healthy lifestyles. Adding to that, in 2006, the law called Mental Health Treatment And Protection was established to prevent mental disease, to mitigate psychosocial problems and to rehabilitate persons with mental illness in the society. However, both of them were not effective enough to improve the situation. Seeing the idleness of the government, NGOs are considered as the last hope for mentally ill patients. But even among them, only a few NGOs target their work on the mentally disabled population, and most of them don’t receive enough financial support, which make their programs insufficient.
Then how can we prioritize the mental health issues among others? The important thing is to consider mental health as an important aspect of democratic development, since most post-war countries are obsessed with development. But how is mental rehabilitation being linked to democratic development? It is necessary to view that to promote citizen’s mental health is essential prerequisites for economical growth and sustainable development. And in order to achieve this, there are needs for development strategies to create proper citizens who possess healthy psychological state.
Developing the mechanism for mentally ill patients, does not only contributes to material benefits or changing of their self-perception. It also helps them to become citizens with the ability to identify problems as their own and tries to solve these by resorting to their own measures. That is, they are urged to consider themselves as responsible democratic subjects. This is the characteristic that Nepali people are lacking. If they can achieve this, they can transform themselves from whom just waiting for a savior to change everything for them to actively participate in the political arena with their own claims. I believe that this will surely promotes the peacebuilding process in Nepal.
Kaori Ambo was in Nepal for a two-week field course titled “Challenges to Peacebuilding in Nepal” led by Dr. Pushpa Iyer of the Monterey Institute of International Studies. Kaori’s blog is part of a series of reflections by Dr. Iyer and her students on the challenges to building peace in this country after a decade long war. -Ed.
About the author: Kaori Ambo has graduated from Monterey Institute of International Studies at May 2012, acquiring a degree in International Policy Studies with a focus on Conflict Resolution. Her area of interest include, children's rights, trauma healing, justice issues and health issues.