Nepal Earthquakes 2015: Desk Review of Existing Information with Relevance to Mental Health & Psychosocial Support
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Nepal Earthquakes 2015: Desk Review of Existing Information with Relevance to Mental Health & Psychosocial Support On behalf of: May 2015 Last updated: 18 June 2015 Contributors Luke Aldridge Ian Harper Amanda Nguyen Farnoosh Ali Claire Harrison Tunde Ojo Vincent Tang Salwa Hasan Mark van Ommeren Gabriela Asturias Emily Hurley Shristia Pandey Jura Augustinavicius Malika Iyer Inge Peterson Daniele Besana Mark Jordans Judith Pettigrew Janneke Bexkens Anna Kagstrom Hugo Pigott Arvin Bhana Bonnie Kaiser Jessica Pine Anvita Bhardwaj Jermy Kane Michelle Purcell Urvita Bhatia Aditi Kapoor Sauharda Rai Alexandra Bleile Tasneem Kathree Selina Rajan Natassia Brenman Brandon Kohrt Megan Ramaiya Elena Broaddus Sophie Kortenbruck Hillary Richards Matthew Burkey Naoko Kozuki Tessa Roberts Ewan Cameron Betsy Laird Alexandra Rose Trish Campbell Molly Lasater Soumitra B. Roy Julia Carney Nasiha Linder Reshma Shah Ann Cassano Tatiana Los Navpreet Singh Sujay Chandran Crick Lund Nina Sisodia Liana Chase Katrina Luthy-Kaplan Jordan Sloshower Anna Chiumento Elizabeth MacFarlane James Smith Sienna Craig Roopa Math Jesus Sotelo Silvia Davey April Mazzuca Frances Tan Anne de Graaf Alison McCracken Carlijn ter Weer Annahita Ehsan Kristen McLean Suraj Thapa Anna Fiskin Sally Milne Rachel Thompson Robert Freudenthal Maria Moral Graham Thornicroft Swati Goel Isbella Morton Wietse Tol Claire Greene Maria Munain Jasmine Turner Ashley Hagaman Alexander Muncey Katia Verreault Charlotte Hanlon Sarah Murray Jane Welsh Emily Haroz Laura Nellums Stephen Young Editors’ contact information: Wietse Tol, [email protected] Mark Jordans, [email protected] Brandon Kohrt, [email protected] Suggested citation: Inter-Agency Standing Committee (IASC) Reference Group for Mental Health and Psychosocial Support in Emergency Settings (2015). Nepal Earthquakes 2015: Desk Review of Existing Information with Relevance to Mental Health and Psychosocial Support; Kathmandu, Nepal. Cover photo: Prasansa Subba 2 Table of Contents Contributors .......................................................................................................................................................... 2 Acronyms ............................................................................................................................................................... 5 Executive summary .............................................................................................................................................. 6 1 Introduction .....................................................................................................................................................10 1.1 Rationale for desk review .......................................................................................................................10 1.2 Desk review methods .............................................................................................................................10 2 General context ...............................................................................................................................................13 2.1 Geographical and climatic aspects ........................................................................................................13 2.2 Demographic aspects ..............................................................................................................................16 2.3 Historical aspects .....................................................................................................................................18 2.4 Political aspects ........................................................................................................................................19 2.5 Religious aspects ......................................................................................................................................20 2.6 Economic aspects ....................................................................................................................................21 2.7 Gender and family aspects .....................................................................................................................22 2.8 Cultural aspects ........................................................................................................................................25 2.9 General health aspects ............................................................................................................................26 2.9.1 Mortality, threats to mortality, and common diseases ....................................................................26 2.9.2 Overview of structure of formal, general health system ................................................................30 3. Mental health and psychosocial support context ......................................................................................32 3.1 Mental health and psychosocial problems and resources .................................................................32 3.1.1 Epidemiology of mental health problems in Nepal ........................................................................32 3.1.2 Concepts of the self/ person..............................................................................................................35 3.1.3 Local expressions (idioms) for distress, folk diagnoses, and local concepts of trauma and loss ..........................................................................................................................................................................39 3.1.4 Explanatory models for mental and psychosocial problems ........................................................44 3.1.5 Major sources of distress .....................................................................................................................44 3.1.6 Role of the formal and informal educational sector in psychosocial support ............................46 3.1.7 Role of the formal social sector in psychosocial support ..............................................................48 3.1.8 Role of the informal social sector in psychosocial support ...........................................................50 3.1.9 Role of the non-allopathic health system in mental health and psychosocial support .............53 3.1.10 Help-seeking patterns ........................................................................................................................55 3.2 The mental health system .......................................................................................................................58 3.2.1 Mental health policy and legislative framework and leadership ....................................................58 3.2.2 Description of formal mental health services ..................................................................................60 3.2.3 Coordination of government, private sector, NGOs, and traditional healers in providing mental health care ..........................................................................................................................................61 4 Humanitarian context .....................................................................................................................................63 4.1 History of humanitarian emergencies in the country ........................................................................63 4.2 Experiences with past humanitarian aid in general ............................................................................63 4.3 Experiences with past humanitarian aid involving mental health and psychosocial support .....64 5 Conclusions ......................................................................................................................................................66 5.1 Expected challenges and gaps in mental health and psychosocial support ...................................66 5.2 Expected opportunities in mental health and psychosocial support ..............................................67 6 References ........................................................................................................................................................68 4 Acronyms ACAPS Assessment Capacities Project AF Advocacy Forum Nepal BDS Blue Diamond Society CBOs Community-Based Organizations CMAM Community Management of Acute Malnutrition CMC Centre for Mental Health and Counselling CPN(M) or UCPN(M) Communist Party of Nepal (Maoist) now Unified CPN(M) CPSWs Community Psychosocial Workers CVICT Centre for the Victims of Torture Nepal FCHVs Female Community Health Volunteers GBV Gender Based Violence IASC RG MHPSS Inter-Agency Standing Committee Reference Group for Mental Health and Psychosocial Support in Emergencies IDPs Internally Displaced Persons IFRC International Federation of Red Cross and Red Crescent Societies IOM International Organization for Migration LACC Legal Aid and Consultancy Center LWF Lutheran World Federation MHPSS Mental Health and Psychosocial Support MOHP Ministry of Health and Population, Government of Nepal NGOs Non-Governmental Organizations NHF National Health Foundation OHCHR Office of the High Commissioner for Human Rights OSOCC On-Site Operations Coordination Centre PTSD Posttraumatic Stress Disorder RNA Royal Nepal Army SS Shakto Samuha TdH Terre des Hommes TPO Nepal Transcultural Psychosocial Organization Nepal WFP World Food Programme WHO World Health Organization UNHCR United Nations High Commissioner for Refugees UNOCHA United Nations