Dr David Sims, Child and Adolescent Psychiatrist for Bradford District Care NHS Foundation Trust, has been using his annual leave to work on child and adolescent mental health training projects in Nepal.
Young people's mental health in Nepal
David says: “In a country that has a total population of 30 million, with approximately 40% of the population, 12 million, under 18, it is estimated that 10-20% of these children and young people have mental health issues, with significantly higher rates of suicide in Nepal than in the UK. The rates for mental ill health for teenagers in Nepal are higher than in the UK. Children are admitted to hospital, because they don’t know what to do with these young people, which doesn’t help to tackle the mental health issue. We’re hoping that by equipping people in the community, as well as going to international conferences to speak to healthcare professionals we’re beginning to work at different levels to make a difference.”
Up until six months ago, there was only one child and adolescent mental health services (CAMHS) specialist in the whole of Nepal. There are no mental health nurses and fewer than 30 clinical psychologists.
Mental health stigma
Even though a high proportion of people are affected by mental health in the country, a strong social stigma attached to mental ill health means that people experiencing mental health problems often face discrimination in many aspects of their lives.
“One school had four suicides in six months", says David. Parents became frightened to send their children to school, afraid that mental ill health was contagious. "By the end of that six months, hardly any children were sent there as parents felt there was a problem with the school and kept their children away."
As a result of David’s training, mental health issues are now discussed more openly at school, so young people know where they can go for help. Trained teachers now educate parents to dispel myths surrounding mental illness and the school is beginning to flourish again. The training is now being rolled out to other schools to help facilitate shared learning.
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"Within our training we’re equipping people to understand about mental health and also to have conversations with those most vulnerable. We work in groups of three, getting people to practice the sorts of conversations they’d have in a session. One of the people on the course left the group at the end of the second day to go talk to someone straightaway who was at risk of suicide. So, it’s a really practical course. The person was able to implement the learnings and hopefully help to save a life.
"In a village five-or-six years ago, we met a young man, now in his twenties, who desperately needed mental health support. He was brought to the training meeting we were having after his family heard we were there. The next time we visited, he was recovering after a period in hospital. He’s now in college, he’s studying, and also contributing work wise to his family. These are the stories and people that keep me going back.
“The community leaders are increasingly becoming aware of the problem of suicide through the number of people they meet. We help to break down stigmas. We also let people know there are mental health services and psychiatrists that can help.
David, working with Consultant Child and Adolescent Psychiatrist, Dr Arun Kunwar, is now training an additional three psychiatrists to help bridge the gap when Dr Kunwar retires in the next few years. A four-month secondment to the UK by Nepalian psychiatrist Dr Prakash Thapa was also arranged by David, who is training the medic to become a CAMHS specialist. During his two-week trips to Nepal, alongside training other healthcare professionals at international conferences, David meets with church leaders, their congregation, and school teachers to educate them to dispel myths, break down barriers, and encourage people to talk about mental health.
"Talking and listening really makes a difference", says David. "For many people it will be the first time they’ve been listened to."