Out of the shadows

  • Natural disasters, like the April earthquake, can result in mental health issues for five to ten percent of the affected individuals

Mar 4, 2016-

The earthquakes last year left approximately 9,000 dead and 22,500 injured. Thousands of people were left homeless without water, food or road networks to reach such resources. The people of Nepal continue to encounter aftershocks to this day including the one on February 4, with the epicentre in Sindhupalchok district and a magnitude of 5.5 on the Richter scale. Scientists predict more aftershocks as well as earthquakes of larger intensity, especially in Kathmandu and western Nepal. The aftershocks continue to make people live with a heightened sense of vigilance.

Post-earthquake, most of the media focused on death tolls or physical injuries. Mental health problems, such as post-traumatic stress disorder (PTSD) and depression, resulting from the earthquakes received limited attention. Scholars attribute this to the stigmatisation of mental health problems throughout the world, but especially in the Nepali community. Claire Bennett, a co-author of a book on international volunteering, published an article in The Guardian in where she notes “the mental and emotional impact of an earthquake is the other invisible disaster. 

Arguably, issues of mental health are always invisible—always something embarrassedly swept aside in favour of problems easier to acknowledge and talk about.”

The World Health Organisation (WHO) noted that there is only one government-run psychiatric hospital in Nepal. Less than three percent of Nepal’s national budget is allocated to health, and only one percent from this goes to mental health. 

Shishir Regmi, a psychiatrist, indicates that the stigma of mental illness in Nepal is very evident, as it is a mark of “shame, disgrace, or disapproval.” There is a common belief, particularly among those residing in Nepal’s rural areas, that mental illness is due to supernatural causes, bad fortune, evil spirits andfamily or social conflicts. Although mental-health providers are becoming more aware and common in the country, the biological causes of mental illness is not accepted, even among the educated masses.

Post disaster concerns

PTSD, anxiety and depression are the primary mental health consequences of natural and man-made disasters. People with PTSD, the most commonly observed condition, go through horrible experiences like nightmares and recollections. They also suffer from sleep disorders and hyper vigilance. Anxiety, depression and other medical conditions frequently come along with PTSD. The symptoms are similar: Anxiety, inability to relax and lack of concentration. Moreover, memory and concentration have been found to be influenced by all of these disorders.

The WHO estimates that natural disasters, such as the Nepal earthquakes, can result in mental health issues for approximately five to ten percent of the individuals impacted by the disasters. Nevertheless, it is assumed that many cases remain unreported and thus the data do not give a full picture of the situation. People in Nepal are fearful of returning to their homes after the earthquakes and even if they have returned, they are living in a constant state of fear due to the aftershocks. Psychological damage inflicted on the Nepali people by this disaster is present and real, as there have been a number of suicides or attempted suicides following the earthquakes.

Future threats 

Since the earthquakes, mobile mental health clinics have been increasingly utilised in Nepal in order to reach out to the affected persons, especially those from remoter areas. Those mobile clinics are a good start, yet the mental health consequences of earthquakes continue to be overlooked in the country. Due to the stigma and invisibility of mental health symptoms, there is limited academic literature on mental health issues faced by the Nepali people in the wake of the earthquakes.  

Researchers underscore the importance of focusing on mental health following a disaster, as it impacts a large number of individuals in a short period of time. Mental health conditions decrease people’s quality of life and can significantly impair their functioning. They are not able to work or take care of themselves and others. And, if untreated, mental health issues become chronic and can lead to more serious medical conditions in the future. 

The Nepali people have been living in fear for the past several months. Due to the chronic fear, they are at an increased risk of serious medical conditions down the road. Such prolonged stress leads to continued elevation of circulating hormones that suppress the immune function and activate the autonomic nervous system. These hormones are beneficial in situations where short-term stress can help individuals survive, like running away from a bear due to fear. However, sustained elevation of this hormone can produce significant changes in the brain and affect learning and memory. Moreover, due to the limited psychiatric and psychological treatment available in developing countries like Nepal, these individuals are at an increased risk of such metal illness even long after the disaster. 

Recent literature suggests a strong association between dementia and depression, and scholars have found that PTSD can also play a role in this. Dementia is a disorder characterised by cognitive or behavioural symptoms that involve significant cognitive impairment. PTSD is also associated with an increased risk of dementia and other aging-related diseases. 

Need for attention

Mental health conditions can significantly alter peoples’ quality of life. Following a natural disaster, this becomes even more serious, as mental health consequences affect large populations; yet the availability of resources may decrease as a result of the disaster. Mental health conditions are kept secret in many places around the world, and as they go untreated, these individuals experience detrimental health consequences several decades later. The impact on the mental health of the Nepali people has already become evident following the earthquakes, and it is unsettling to think of how many are silently suffering mental health symptoms. Thus, the government and concerned health authorities need to allocate resources to mental health services and invest in the mental wellbeing of the Nepali people. Not only can such efforts decrease current suffering, but can also prevent serious medical conditions later. If left untreated, the current mental conditions resulting from the earthquakes can lead to an alarming number of Nepali people across several generations being plagued with dementia and other debilitating disorders. The government must take preventative measures when planning for the future, as the future of the country is dependent on the abilities of its people. 

Bhattarai is a PhD candidate in Psychology at the University of Kansas, US 

Published: 04-03-2016 08:56

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