Regional waveSeptember 9, 2012, 7:57 pm
By Jagannath Lamichhane, The Kathmandu Post
It is an overrated statement, the South Asian Region is home to most of the developing world’s poor. According to the World Bank, about 571 million people in the Region survive on less than US$1.25 a day, which accounts to almost half of the world’s poor. There are hundreds of reports focusing on the poverty, gender, health, malnutrition, children, inequality, illiteracy, exclusion and so many other issues of South Asia. Billions of dollars in aid money is spent on the alleviation of these issues on the premise that fundamental rights of humans must be protected.
But despite the fact that most of the leading problems in the region are directly linked to a range of mental health problems, there isn’t a single report that speaks about the state of mind and the mental health of the population living in the region. The piles of reports produced both by state and non-state actors simply ignore or exclude mental health as a component of society. That’s why the exclusion of mental health is a grave question to be raised in South Asia both politically and socially.
Since time immemorial, mental health problems have remained stigmatised, ignored and unaddressed in the region. Mental health problems in South Asia, as well as most other parts of the world, traditionally associated negatively with superstitious and religious beliefs of sin and curse. In Nepal, the first legal code of 1856, the Muluki Ain, went as far as to codify that those with mental health problems be tied on a leash to a nail. In many respects, that is the form of treatment many sufferers still receive. The wider social and political domains continue to have the same old impression of mental health, perceiving the issue as petty and irrelevant.
People may argue that mental health issues are internationally neglected, not just regionally. And to some extent, that argument holds weight. Considering that mental health advocacy has really only found a voice around the globe in the past few decades, many of the problems faced in the developed world with regards to mental health stand true in South Asia as well. But the degree of neglect is much deeper in South Asia and the voices for advocacy are relatively newer.
However, internationally, in the last six years, some positive signs have surfaced. In 2006, The United Nations adopted the Convention on the Rights of Persons with Disabilities (CRPD) which included mental and psychosocial disabilities as one of the disability categories. By introducing this international legal code, a century-long unequal social, political, economic, civil and political reality based on discrimination, has gotten some respite.
Likewise, in 2008, the Movement for Global Mental Health started. The Movement played an incredible role in bringing mental health issues into the international platform whether by organising global mental health summits every two years or publishing the Lancet Series on Global Mental Health (published every five years starting from 2007, 2011) raising the mental health issues of low and middle-income countries. The Movement has been successful in creating a new global wave, particularly in third world countries. The formation of the SHARE (South Asian Hub for Advocacy, Research and Education on Mental Health) itself is a result of the Movement and the CRPD.
In a true sense, for the first time in the history of human civilisation, we can feel an awakening in the region on the need to advocate mental health issues. However, there are old and new dilemmas — how do we advocate these issues to ensure greater rights and quality treatment of those affected? Amidst the sea of poverty in the region, how do we prioritise and work towards preventing and promoting mental health issues?
In my experience, in the underdeveloped and developing world, advocacy is possible through three layers: government, civil society, and donors. But the poorer the country, the greater its dependence on foreign aid to directly and indirectly carry out a lot of the advocacy work. For instance, in Nepal, 60 per cent of the development budget is dependent on foreign aid. In such a scenario, if the donors lack interest, it is difficult to bring issues, including mental health, into the mainstream. As for the government, policies are easily created as a result of advocacy, but non-implementation of the policies is a systemic flaw, not only in Nepal, but the entire underdeveloped and developing world.
On the surface, in Nepal, political party manifestos, the constitution and government policies are progressive and inclusive due to continued pressure over the years from civil society and non-state actors. These policies and political perspectives are regularly improving and updated as and when advocacy mechanisms are strengthened. The situation is similar in the region. But, the greatest challenge to advocacy has been translating accomplishments in policy formation into action.
In Nepal, I have, along with others, worked towards greater acceptance of mental health and psychosocial disability issues through the press and policy-level dialogue. This has been fruitful indeed, but still the implementation of the existing policy on mental health is yet to be felt on the ground. Likewise, some prominent politicians have advocated that mental health be given due importance in the national health policy, disability bill and other social protection schemes, but the challenge of implementing the policy once it is formed will be far greater than having a mental health component in the national health policy. Policy doesn’t translate into action in this region. And that fate is one that is suffered by many policies aimed at improving society.
In South Asia, policy advocacy is not sufficient. What is need now is advocacy for action to go alongside the former.
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