Women more vulnerable to mental illness because of family separation and migration Kathmandu Physical, social and mental health are important aspects of one’s life. If any one of these aspects is affected, then a person cannot be called a healthy being. Compared to physical health, mental aspect of health is often neglected by people. “This is because of stigma associated with mental illness in the general population and even in health professionals,” informs Professor Padam Simkhada, Professor of International Public Health and Associate Dean (Global Engagement for the Faculty of Education, Health and Community) at Liverpool John Moores University, Liverpool. Mental health The higher mental functions of brain such as emotional, thinking, judgement capacity et cetera should be intact to work as a normal human being. Minor mental illnesses such as depression, anxiety or insomnia are very common. But the understanding of mental health is completely wrong here in the country. “Mental illness is referred to as being mad and the person suffering from mental illness is referred to as an unfit for family and society because of the loss of control over self. Here people with mental illness are referred to as being possessed by the spirit or black magic. In addition, people (and family) with mental disorders suffer discrimination and they hesitate to come forward for treatment,” adds Prof Simkhada. Mental health could be of any kind, from anxiety to stress. Depression too is a part of mental health. People suffering from various diseases are also prone to depression and anxiety. Every mental problem is understood as a bipolar disorder and schizophrenia here, as per Prof Simkhada. One suffering from mental illness can function properly if the family and society supports him/her. One can cope with the illness if there is support. So as to highlight the issues and help people understand mental health issues, Prof Simkhada along with Professor Edwin van Teijlingen, Centre for Midwifery, Maternal and Perinatal Health, School of Health and Social Care at Bournemouth University, UK have been researching on Mental Health. “We have been doing researches on maternal health, reproductive and sexual health and general health among others. But as the researches have shown there is an increase in the suicidal rate in Nepali women, we are more focused on mental health,” adds Prof Simkhada. What one must understand is that mental illnesses aren’t permanent. “When one’s relationship doesn’t go well, or someone is stressed because of jobs, there are chances for one to suffer from mental illness. When you are pregnant, your hormones changes, your status in the family changes, losing a job and a not good relationship lead to depression in people and this is quite common here in Nepal,” informs Prof Teijlingen. Though there are cases of mental illnesses, these can be prevented if one pays a little attention. Women more vulnerable  Any person from any age group can suffer from mental illnesses. But in Nepal, women of the reproductive age between 15 to 49 years have the highest rates of suicide and mental health problems, as per Prof Simkhada. “Suicide rate within this group has increased from 22 per 100,000 in 1998 to 28 per 100,000 in 2008 as per a report by National Health Sector Support Program, DFID.”   Factors such as cultural hierarchy, generation gap and high expectation of parents are some of the reasons to blame for growing mental illnesses. “Here the normal behaviour such as befriending the opposite sex too is taken as abnormal activity,” states Prof Simkhada. Globalisation, separation of family, husbands living far from wives, extra-marital affairs, separation and migration are some other reasons. In addition, lack of care especially in rural areas is another reason. “People knowing about mental health is very less here. During our survey in Nawalparasi, we found that the Auxiliary Nurse Midwifery (ANM) too don’t have proper training about mental health. I don’t want to blame them but we found a lack of training here,” adds Prof Teijlingen. Women need psychological counselling. “But the situation here is that there is no one to assist women in delivery. Early diagnosis and treatment aren’t done on time. Nepal desperately needs proper health care for poor people,” shares Prof Teijlingen. Changing status of women The lifestyle of people has changed. They are sending their children to expensive schools. The younger generation is interested in education, learning and in research. This has changed the status of women in society. Women are getting better education. This is good for maternal health but along with the development, stress is increasing. “The dual responsibility of looking after her parents and her in-laws, cooking for children, responsibilities of children, home and jobs, family with different expectations are some of the leading causes of stress in women,” points out Prof Teijlingen. Besides that, there are family issues. Women are dominated here. In the joint family, the husband is supporting his wife. On one level, the couple wants autonomy. “The couples want to live their life in their own way but parents have different expectations from the daughters-in-law. There is a gap between a daughter-in-law and mother-in-law and the husband acts as a mediator, but when he goes abroad, the women face difficulties. This leads to stress in her,” shares Prof Teijlingen. Women of ages between 15 to 49 years have the highest rates of suicide and mental health problems... Suicide rate within this group has increased from 22 per 100,000 in 1009 to 28 per 100,000 in 2008 Research on Mental Health Be it to learn about something or to get an understanding of several issues, research is necessary. It sheds light on issues that haven’t come into the limelight. While helping us to raise questions, research helps us to get ideas and also helps in supporting truths. Whatever be the area, research is necessary and so is the case with mental health. “We even don’t know what number of people are suffering from mental illnesses and to get an exact number of people suffering from mental illnesses, research is necessary. Research helps us to get funds and the medicines necessary for the kinds of mental illnesses. It also helps in making policies looking at the evidences,” exemplifies Prof Simkhada. Research isn’t only about what has been achieved and performed, it also informs about what hasn’t been achieved. “It tells us about what has worked and what hasn’t. So, research is very necessary,” elaborates Prof Teijlingen. However, conducting a research isn’t easy. There are problems of geography, funds, lack of manpower, among others. Research on mental health too is insufficient here. “We lack funds. There is the least exposure of our professors. The budget allocated for the research is being used to provide salaries for the staff of the university,” informs Professor Dr Tirth Raj Khaniya, Vice Chancellor of Tribhuvan University. In addition, the sale of thesis in the market and students not being conscious about the importance of research are some other problems seen here, as per Dr Khaniya. Ways to reduce stress Suicide can be prevented. Proper counselling can prevent anyone from committing suicide. The one who is committing suicide gives signs and symptoms. S/He goes to health workers with another disease. S/He shares with another about the problems. Stress is natural such as in exams, job stress. One can perform better when stressed. But what you must understand is that you should know how long you are stressed, as per Prof Teijlingen. “More than that you must realise that you are more stressed than at other times. If you can’t control the stress for more than two weeks at a time, then you must visit the doctor,” suggests Prof Teijlingen.   Physical exercises too are necessary. “Changing work and work pattern and social relations will help you, but it isn’t that easy,” informs Prof Teijlingen. Giving time to children, changing anti-social behaviour, and stopping the use of drugs will lead to a healthy mental health. Here in Nepal traditional and religious healers are the primary sources of treatment in the community. Mental health services are mostly institution-based and limited to a few hospitals located in big cities. Increase in the number of hospitals, trainings and raising awareness about mental health will help in bringing changes in the condition of mental health. Besides that implementation of strategies for promotion and prevention in mental health, strengthening information systems, evidence and research for mental health too are necessary for better mental health, as per Prof Simkhada.