Respectful Life of Mental patients: My dream   

Respectful Life of Mental patients: My dream

Dr. Dhana Ratna Shakya, MD-Psych, MBBS;

Professor / Consultant psychiatrist

Department of Psychiatry, BPKIHS, NEPAL

Email: [email protected]

Dear John,

I got an opportunity to directly observe the mental health system of your country during my recent visit to the United Kingdom. While celebrating the World mental health day with the theme of ‘Dignity in Mental health’ (in October 10, 2015 A.D.), I remember it even more.  I wish to express my hearty gratitude for inviting me for such an educative and inspiring trip.

System with Respect to People:

Every country and system has its own shortcomings and challenges; I am not going to talk about it. I do not mean that you have a perfect system but I mean to say that I saw the nation there with the system providing basic needs, rights and opportunities without apparent discrimination but with dignity. For a Nepalese citizen like me; equal rights and access for all citizens including children, elders, women, adult, villages, cities, minorities, literate, illiterate; and all irrespective of level, class or groups to food, shelter, clothes, water, fuel, education, health, travel, security and information and all other essential things are tempting aspects. I got a chance to see in person these things being securely provided by the law and system. I could observe in every sight the respectful support, service, opportunities, employment, facilities and provisions being offered by the nation on the ground of all these things to those who unluckily fall sick, weak, disabled, unemployed and debilitated. For a psychiatrist like me of a country devoid of even basic services, the health system with due respect to mentally ill people has become a happy dream. I want this to be the destination for my country and people despite innumerable challenges. I want to admire here the system there with due respect and values paid to the people with mental illness.

Inspiring observations in the UK Health system:

Health usually means only physical problems in our place. It generally embraces treatment services for infectious diseases, heart, eye, ear, nose, throat, orthopedic or other similar bodily ailments only. It is amazing to see psycho-social health service system nearly parallel in its function to the physical health system in the UK, as indicated by the World health organization long back in 1948 AD. Health program stereotypically means curative! I got a chance to notice preventive, rehabilitative and promotive programs running almost corresponding to curative ones in your country. It is a virtue of a model health system to embrace every way possible to easy access to social and economic life of every individual, but not in isolation. The intention there of continuous search for a health system acceptable, affordable, and accessible to people and with respect to them has owned a special room in my mind. And the theme of the World mental health day of this year (2015) this day is reminding me of the system with due respect for mental patients. I want to cherish this memory!

Cherished observations in the health service:

A Nepali clinician friend of mine working in the United Kingdom was saying, ‘Respectful approach of service provider towards clients is one of the most important aspects here in the medical education and evaluation system’. Curriculum here itself includes the issues related to the human values and virtues like: professional-client relationship, communication skills and Bioethics. Now, current Nepalese medicine should aim for quality improvement in these respects. Other remarkable thing here is the openness of health system management for human resource as per the magnitude and need of the service extension. When there is adequate man power and effective management, clients will receive due attention and sufficient time on one hand and on the other, there will be no overburden on the honest service providers as in our set ups. Adequate salary and remuneration will persuade people to spontaneously bear their responsibilities. I realized by observation there that the welfare of clients is related to the satisfaction, progress and contentment of the service providers. Another interesting observation there was the remarkable value put on the documentation of the service, their analysis and execution accordingly for the quality assurance.

My respected friend, it is needless to say that every individual has their own needs and circumstances. It is even more important in medicine to assess and identify the individual problems and needs before deciding treatment and intervention.  One can realize that the service providers there put lots of time and efforts in assessing and identifying the problem and needs of help seekers.  Besides insistence on the holistic health, there is a balanced tendency to high risk prevention as well. Early intervention of psychosis is an example of this approach. The mental health system there includes prison, child and adolescent, geriatric, adult and women mental health services. Before reaching such specialty services, there is high reliance on the assessment, diagnosis and management from the family physician in the UK system. Nevertheless, I saw an example of multispecialty service and referral system there.

I felt good about the tradition of seeking excuse by all, both service provider and client for not being able to offer service or to keep up to the promise.  A friend was saying that a client missing his/ her appointment needs there either to pay the fee or to cancel it beforehand. There was a provision of the service fee as per the time duration and extent of the service. The client would be informed priory about the likely time duration and service charge. I saw there that strict rules and regulations and high level of awareness of the clients have made the safe working environment for both the service providers and the clients. 

Multi-dimensional Mental health service:  

British psychiatrist colleagues were amazed to hear that we Nepalese doctors have to see tens of patients in a single day in out-patient setting. Adequate man power there has made possible for a single client to get adequate time and expert service of various specialties in various stages of problem management. One can also get detailed information about the service and treatment. They get prompt service as per the appointment there. I saw during my visit in the ward setting the kitchen for food, bedroom and common room for living, prayer room as per their religious belief, sports, internet, papers, library for study, art or creative activities and social interaction for the in-patients. There was a provision of visiting time and meeting room for the family and friends of the patients; there was no need for family to stay in the ward all the time. I remembered time and again my country and people’s unfortunate condition while I saw remitting and remitted patients being respectfully provided the door-to-door service by the professionals. There are mechanisms to ensure the residence for homeless ill people made possible through various personals and organizations.

Respectful mental health service- Now also our Destination:

Now; high mental health literacy, accessible basic mental health service, friendly behavior of service providers to the clients, sensible responsibility bearing by society and nation towards mentally ill people are our needs too. I feel that a developing nation like Nepal can and should learn a lot from the role played in mental health promotion and the dignity to the needy mental patients offered by the nation. I think this should be a great lesson for current Nepal for mental health field. And its execution has become my dream for my country Nepal and my Nepalese sisters and brothers.

Dear Dr. John*, as you know; there are many Nepalese suffering from mental ailments. And, those people remitted with appropriate treatment are contributing remarkably to all aspects of social life. Almost all mentally ill people benefit from treatment and remitted people are like other ordinary people. Now, we need to work for creating environment for respectful and dignified life for psychiatric patients. The theme of the day of this year (2015) advocates for the dignity in mental health of all and for the respectful treatment of psychiatric patients. Constitution has recently been passed in Nepal, a country reeling under recent series of earthquakes and para-quakes, political instability, adverse circumstances and conflicts. My hearty wish is that no one of the Nepalese citizen loses the human value, respect and dignity offered by the constitution because of mental illness. May all mentally ill people be able to live dignified human life.

Thank you.

Your friend,

Dhana Shakya

(Posted 1.1.075 BS: 14/4/2018 AD)

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Dr. Dhana Ratna Shakya, MD
Editor-in-Chief, J BPKIHS

Head, Nepal National Unit of UNESCO Chair in Bioethics
Professor/ Consultant Psychiatrist
BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal


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