Ashok Khatiwada, 26, (name changed) believed he was ready for anything when he joined the Maoist army. But things changed when he was badly wounded in battle. With a fractured leg and no medication, he stayed with his friends for several months. Somehow his father found him, and convinced the Maoists to let him take his son away for treatment.
Ashok's leg healed, but he couldn't recover from the trauma. When he stopped talking for an extended period of time, his family took him to the Mental Hospital in Patan. He was diagnosed with Undifferentiated Schizophrenia, a condition triggered by stressful life events.
Ashok is not alone. There are thousands like him who are reliving the horror of the war everyday. Up to one third of Nepalis are believed to suffer from mental health problems, according to Pashupati Mahat, Senior Clinical Psychologist at the Centre for Mental Health and Counseling. But the conflict may have significantly upped the number.
Kabin Man Dangol, Clinical Psychologist at TU Teaching Hospital, says that cases of Post Traumatic Stress Disorder (PTSD) have become increasingly common following the war. "War brings into play stress-inducing events, increasing vulnerability to several mental disorders," he says. A 2008 study by Brandon A Kohrt and others at Emory University in the US showed that the rate of PTSD is twice as high among child soldiers in Nepal compared to those never conscripted.
Peace may have been achieved on paper, but society takes longer to recover from the lingering effects of war. "The culture of violence, increase in criminality and the nationwide rise in depression and suicide may be linked to the after-effects of the war," says Jagannath Lamichhane, mental health activist.
Nepal brought out a Mental Health Policy in 1997, which aimed to make services available to the general population by 2000. Ten years down the line, little has been achieved. Less than one per cent of the total health budget is allocated for mental health in Nepal.
Most of this budget goes to the 50-bed Mental Hospital in Patan. The facilities are too meagre to accommodate growing demand. There are only 32 psychiatrists and a handful of clinical psychologists and psychiatrically trained nurses in the country, mostly in cities.
Experts say mental health services need to be integrated into the immense infrastructure and human resources available to Nepal's primary health care system. Primary health care statistics show that 20-30 per cent of patients, while showing only somatic symptoms, have diagnosable psychiatric disorders. If mental health services were available at the primary level, with training and supervision for existing health workers, access would be improved considerably, and early diagnoses could help reduce cases of severe mental illness.
Whatever little the government invests in mental health is largely concentrated on providing psychiatric treatment and support. Prevention could go a long way. Says Jagannath Lamichhane: "If the government is proactive in providing psychological counselling and support to vulnerable groups such as conflict-affected people, susceptibility to mental illness can be reduced by half."
NEED IN NUMBERS
* Nepal's population: 28 million
* Nepalis with mental health problems: 7-8 million
* Number of hospital beds for mental patients: 50
* Number of psychiatrists: 32
* Proportion of health budget for mental health: 1%