Fighting Stigma

I am Matrika Prasad Devkota, founder and the current Executive Director of KOSHISH-National Mental Health Self-Help Organization in Nepal. KOSHISH both advocates for and provides holistic services for persons who experience mental illness i.e psychosocial disability. My passion began when growing up in a rural village; I could not access treatment for my mental illness. Later, during my university studies in Social Work, I learned that mental illness can be managed. Since 2004, I have been promoting the mental well-being and mental health issues. In 2008, together with other men and women who experienced mental illness, I formed KOSHISH. Since then, I have devoted my life for this cause. My passion for the last 16 years has helped to shape Nepal’s policy for mental illness. Together with other stakeholders, I advocate cross-cutting issues of mental health so that the right-holders are included for effective and meaningful participation at all levels. 

Mental health problem is exacerbated by social stigma and misconceptions. This global problem is faced here in Nepal. KOSHISH seeks to reduce stigma and promote mental well-being in Nepal. One way KOSHISH addresses this issue is by reaching out to the public through the broadcasting positively.   This awareness will help people better understand the mental health issue  of mental well being through weekly broadcasting in the National Television. We  encourage prevention and in  early intervention and mental health treatment. At the same time, KOSHISH wants to work in communities to change attitudes so that they are more favorable towards supporting and healing those needing treatment. Decreasing stigma will lead to the productivity of the person, community and elevate humanity in Nepal.

Nepal has many different cultures; but when it comes to mental illness, each of these cultures shares the same concept. Most Nepalis believe that suffering from mental illness is the same as being mad, and unfit for society. Individuals with severe mental disorders, and their family members, are targets of stigma and discrimination to the point where they hesitate to come forward for appropriate treatment.

The lack of mental health awareness and treatment in Nepal has caused much hardship. Suicide is the leading cause of death in Nepal for women aged 15 to 49. According to recent Nepal police reports, on the average 16 persons died each day due to suicide. In Nepal, approximately 3.64 million people had mental and substance use disorders. At some point in their lives, one in four persons are affected by mental or neurological disorders. Globally, approximately 450 million people face these disorders. Mental disorders are among the leading causes of ill health and disability worldwide. Early diagnosis and promoting well-being will lead to prevention of mental disorder. This problem can be solved through the psycho-social support. According to the World Bank, investing one dollar in mental health will return four dollars.

This project will work to raise awareness against stigma and misconception associated with mental health through media in coordination with the various stakeholders. Celebrities, professional experts, and television personalities who have experienced mental health issues will promote mental well being and reduce stigma on National Television, community radio stations, and Facebook and Youtube.  In addition, the project will promote mental well-being as cross cutting integral part of well being which would help prevention and promotion of the issue rather than tackling only the superficial  problem. The project will emphasize addressing root causes of the  mental health problem and finding the solution in the local context rather than intervening the consequences. The project will focus on Nepal’s local context of our  mental health situation. It will bring into the light and find out the way forward through existing mass media mobilization of Nepal.

KOSHISH comes in contact with people from throughout Nepal who need treatment for a mental health issue. Each of their home communities have differing misperceptions regarding mental health issues. KOSHISH staff assesses  the status of the mental well being of the person and seeks to understand the local community context.  After analyzing the local situation and needs, KOSHISH will develop the support program which includes awareness,  psycho-social and mental health support. KOSHISH staff facilitates the beneficiaries to come together as a formal self help group who can assert their rights after awareness.

Secondly, this project will analyze hidden stereotypes, social discriminatory inhuman practices that is hindering mental and physical well being.  Through the use of national television, community radios, Facebook and Youtube, KOSHISH will seek to communicate positive message to all Nepal households that the mental health is not a taboo rather it is a wrong misconception deeply rooted in the community which can be minimized for the better mental health well being.

Mental illness is largely associated  both with social stigma These persons suffer too much from their community and society. They feel  are unwanted, and live in a vulnerable situation in their community. This project will concentrate on this stigma with mental health issue by bringing public awareness through media highlighting the misconception and the fact. Globally, one person among four persons suffers with mental health issue during some time in their lifetime. This is  directly related with one quarter of  population in the globe however, the issue is still left behind.

KOSHISH was established and is run by people with past personal experience with mental health disorders. KOSHISH’s motto is “Breaking down the chain of stigma that is associated with own community in national and international level.” From its beginning, KOSHISH has promoted mental well-being through social media.

KOSHISH has always sought to change attitudes on mental illness through media such as television. However, due to lack of resources KOSHISH has not able to achieve its dream. KOSHISH has had a very good network of NGOs that support them with other efforts, but not enough to address this problem of stigma. We believe that with more funding, we can elevate the marginalized cause of mental health in Nepal and globally.  

We are confident that with funds earmarked for destigmatizing society will change Nepal’s society and help make people aware that the mental health issue is a common health condition and to sensitize people to care for  persons faced with mental health problem rather than to discriminate against them. This project has been developed by those of us in KOSHISH, both those with personal experience of mental health disorders, along with our professional staff.

I as the KOSHISH’s Executive Director, am very passionate for this project.  My passion and motivation come from my own personal experience of living with mental health issues, beginning when I was 15 years old. Four years later, my life fully stopped. I was isolated from my community and stayed home for the next 8 years. Without any understanding of mental health issues, my family and community considered me “mad” and unable to function in the village. Eventually, I got the therapy and counseling I needed. I know that most rural villages in Nepal today continue to discriminate against people with mental health disorders and are not aware that treatment is available to help them to become valuable and productive persons in society. My vision is to change society so that no one has to suffer the way I did. A two-year campaign through national television will help Nepal society to understand mental health and work towards prevention and early intervention and change people’s attitudes towards mental health issues.

KOSHISH is a national self-help organization, rooted in the Nepalese community at the grass root levels, bringing hope for the most abandoned and left-behind people who live with mental health disabilities. KOSHISH has become a strong voice with  Nepalese authorities since they speak from their own experience. KOSHISH realizes that  “just asking” is not enough. We need to have strong, demanding voice for change in our society in how they treat those with mental health disorders.

KOSHISH has already demonstrated ground breaking anti-stigma campaign.  In 2013, KOSHISH received the ‘Dr. Guislain International Award’--an international award in the area of mental health for breaking the chain of stigma in mental illness. KOSHISH is running various advocacy and awareness campaigns through social media i.e. Facebook, Twitter, You-tube, Instagram and community radio. In addition KOSHISH advocates for changes in laws that end discrimination to people with mental health issues. Throughout much of Nepal’s legal framework, persons with mental disorders do not have political, cultural or civil rights.  Even though Nepal has signed various international treaties for human rights for persons with  mental health issues;  these are not being honored. KOSHISH has filed Public Interest Litigation against these discriminatory laws and provisions in the Nepal Supreme Court so that Nepal shall abide by these international treaties in order that people with mental disorders have the rights they are entitled to.

KOSHISH partners with the Government of Nepal and international organizations to deliver holistic services to treat and rehabilitate people with mental health disabilities.  

In 2012, the Nepal Government was developing multi-sectoral mental health action plan to align with WHO's 2013-20 plan. Unfortunately, the government focused only on the national mental hospital. KOSHISH advocated that mental health should be integrated with general health. The Government authorities were reluctant to include a multidisciplinary approach or prevention and promotion. The mental health action plan based on the medical model was sent to Cabinet for the approval and without any input from civil society. Fortunately, at the same time, KOSHISH received the Dr. Guislain International Award. This recognition enabled KOSHISH to influence the Government`s Cabinet,  resulting that the draft action plan was sent back for further revision.  KOSHISH then facilitated  this plan to make it more holistic and multidisciplinary. An outcome of the new Multi Sector Action Plan  was that the Government formed Primary Health Revitalization Division (PHCRD) and implemented 6 different programs in 2017/18 including “Awareness Program on Mental Health,” “Community Mental Health Program,” and “Strengthening Mental Health Self-Help.”  Each of these programs focused on the awareness of the mental well-being for betterment of the humanity and we were able to show the importance of the awareness of mental health.

My (Matrika Devkota) leadership with  the mental health issue began through my own life experience. I was able to overcome the stigma and began sharing  my own story and along with other like-minded people.  I started KOSHISH, the first pioneer organization established and run by people with firsthand experience of the  mental health problem. My leadership started with passion, combined with multi-disciplinary professionals in the team consisting of psychiatrists, psychologist, social workers, nurses, layers and other management expert working towards promotion of mental health. With this wonderful team we  created  holistic community-based mental health services that are replicable to other places in Nepal.  

I  network and advocate on behalf of people with mental health disabilities to government ministries, National Human Rights Commission, National Women Commission, the judiciary, members of parliament, and other politicians. Now, the mental health and psychosocial disability issue have become relevant in Nepal.  Nepal, as signatory to the United National Convention on the  Rights of Persons with Disabilities, Universal Periodic Report (UPR) and in Voluntarily National Review (VNR) is now following through on its treaties through my efforts. 

This project will be associated with larger KOSHISH's long term broader advocacy and awareness program. Since its beginning, KOSHISH is raising awareness public sensitization program through its social media  and working for mainstreaming of mental health and psychosocial support into general health and beyond the health services i.e in education, social security, livelihood etc. This project will focus on more public awareness through Television about positive message about mental health and psychosocial well being.  The project will provide as added value as the national weekly program will be broadcasted nationwide. It will be a great catalytic avenue for the cause. 

This project addresses the need of awareness on Mental Health and Well-being using the medium of mainstream media (TV). A TV program will be produced and broadcast on weekly basis. These shows will also be disseminated through online platform and social media.

This program will be first of its kind, as a show of this magnitude, specifically focused on Mental Health and well-being has not been put forward to the Nepalese audience. The issues being raised in the program will be based on issues of mental health and well-being in the local context and drawn from the experiences and research from our targeted communities. These shows will also highlight the stories and struggles faced by them and place it before the duty bearers and make them responsive and responsible towards them. The live audience as well as those watching from home will also have the opportunity to put their concerns forward with the duty bearers during these shows and the duty bearers will address their concerns. This, we hope will bridge the gap between the right holders and duty bearers and the discourse on mental health and well-being will find space and importance that it requires.

The theory of change is represented on the image below:-

The project currently serves audiences from different count as through online and broadcasting medium. Through regular radio programs, Public Service Announcements, Informational Videos. In the next two years, the project will reach out to all the sector as we will be broadcasting throughout the nation. In Nepal, 70% households have access to television in which Nepal Television share the most subscription. In the five year time span, the project will reach out to all the nation and international sector as we will be both broadcasting and available in online. 

The project has set a goal to reach the wider coverage all over the nation to promote the mental health and well-being. This project would bring positive aspect in the life of people who have been deprived of the fact of mental health and well-being. We have set a goal to eradicate the stigma that exists in our society by promoting mental health well-being. The current scenario of mental health is kept unseen in the society through this project the measures of unseen scenario will elevate with measures to reduce stigma and prioritizing the mental health. Within the next year, the general public and duty bearers has increased the knowledge about mental health issues and duty bearers would understand the need to reduce the stigma related to the mental health. Within the next five years, the government stakeholders will implement the strategic plans and address the issues related to the mental health

The barriers that might impact on the project

• Financial: This project requires large budget to produce high quality shows to be broadcasted on national television.
• Technical: The technology is developing fast and as a result, it becomes difficult to keep up with the newest developments. Hence sometimes the technological advance may become a barrier. In addition to this, the cost of technology is sometimes very high.
• Legal: The government of Nepal has media bill against the issue against the government through media.
• Cultural: People have stigma against the matter of mental health in the society. They are stigmatized to openly talk about the mental health issues. Also, people are form different background like ethnic group, language, religion.

To overcome the barriers, we will pursue different plans. We have been uploading different videos through online media and occasional TV PSAs. From these experience, there are much learning to pursue to overcome the barrier. There are some basic strategies that can implement the effective process of considerations to be made for different ethnic groups of people. As there are different cultures and follow several basic values of society. Hence, it is a must that this project must take different cultures into account.

We are currently working with government ministries in the strategy levels i,e ministry of Health and Population, Ministry of Women Children and Senior Citizen; with constitutional bodies i.e National Human Right Commission and National Women Commission etc lobbying with mental health and psychosocial support services. In addition, we are also working UN bodies like World Health Organization, Unwomen and United Nation Population Fund. We are also working with with direct technical cooperation with UNFPA and with UNWOMEN in mental health and psychosocial supports for Gender Based Violence Survivor. 

We are working with Norwegian NGO called HimalPartner https://www.himalpartner.no/  in Mainstreaming mental health through self advocacy, Felm, Finland https://felm.org/working in the harmonization of legal framework related with mental health and psychosocial disability. In addition, we work with CBM International https://www.cbm.org/  in promoting disability inclusive community mental health and psychosocial supports into the three districts of western part of Nepal. In addition, we work with North American Organization: Mennonite Central Committee https://mcc.org/ in reintegration and rehabilitation of abandoned women with mental health issue into their own families and communities. Those organizations are providing capacity building of the organization KOSHISH and as well as in some level of national advocacy and creating model services those can be replicated  by government in future. We do also accept government offer grant in small scale. 

In addition, we work together with civil society organization working in human right health, education, disabilities so on in raising the integration of mental health and psychosocial supports as cross cutting issue. 

We are running nonprofit organization which has been working in the field of psychosocial disabilities and mental health since more than decade. Working for the protection and promotion of the right of person with psychosocial disabilities. It has been working both in the policies and grassroots level following twin track approach. It primarily concern with Advocacy and service delivery. With the increasing of our relation with stakeholders, local communities and policy maker we are also able to increase our service in the large sector as a non-profit organization.

For financial sustainability we have partners who are working with us from the starting of the organization. KOSHISH has purchased its own land and has started to collect fund for the construction of the building for transit care. We have been working with the government in close collaboration for the public private partnership and have received continuous financial support over the years and working towards strengthening it further. As part of therapeutic activities our beneficiaries are involving in beads making, souvenir and handicrafts materials from which certain amount of fund can be collected. For the organization development and human resource development we have been investing in the staffs and stakeholders who help us to strengthen the capacity of organization and for fund raising. Sharing of resource with government and individuals we can generate some funding which can support for sustainability of the organization.

The ELEVATE PRIZE seems that it is designed for my passion and cause that need to be scaled up for the broader humanity that people with mental health issues are and that, the psychosocial condition are part of human diversity.

We would like to have a dignified and quality life like any other people. However, the stigma and misconception related with the mental health issues is very high. From many years, I  was dreaming  to have a mental health awareness campaign through the television as it would be very  efficient as this can reach almost to every houses hold. We would like to promote positive message of mental well being in the perspective of people with lived experience of the mental health issues. If we are selected for this prize we would be able to make our dream into reality.

The elevate prize and its network would greatly upgrade platform to raise the issue as mental health and psychosocial support are not luxury but a necessity like food, drinking water and shelter. We need your professional mentorship and capacity building to fulfill this dream.

With the money that comes with the Elevate Prize we can work to de-stigmatize the mental health /psychosocial issues from the national levels to the grass root levels using media as a medium of communication.

We desire to get the global priority for the issue of the mental health across the health, education social security, inclusion as a cross cutting issues, beyond the realm of health into the economic and social rehabilitation. For this purpose, we wish to have partnership with other like minded  government/non- government  entities including Regional development Banks, UN Bodies, etc. as also other stakeholders and enterprises having the Corporate Social Responsibility.

We would like to partner with National Televisions of like National Television of Nepal, Kantipur Television, Media Production Houses, National  Daily Magazines etc. We would like to promote mental well being and psychosocial  support.