Beyond the stigma : exploring the role of mental health advocates with lived experience, in advocating for better mental health systems and awareness in Nepal : a research report presented in partial fulfillment of the requirements of the degree of Master of International Development at Massey University, Manawatū, New Zealand

Abstract

“There is growing recognition within the international [development] community that invisible disabilities, such as mental health is one of the most neglected yet essential development issues in achieving internationally agreed development goals” (The United Nations, n.d., para. 4). Yet with little expenditure in the Global South on public health, let alone mental health, and lack of awareness and difficulty in accessing treatment, non-governmental organisations (NGOs) are increasingly filling the gap in service provision. The aim of this research is to explore the role and impact of one NGO Koshish and its employees, who are mental health advocates with lived experience, in advocating for better mental health systems and greater awareness of mental health in Nepal. In order to address the aim, there are two research questions which ask 1) How are mental health advocates with lived experience involved in advocacy for mental health in Nepal through local NGO Koshish? And 2) To what extent does active participation of former beneficiaries in advocacy lead to increased awareness and access to mental health services in Nepal? This qualitative research project draws on the case study of Koshish, a mental health advocacy NGO, and its employees who have lived experience of mental illness. This project involved collecting both primary data and analysing secondary sources. As such, data was gathered through semi-structured interviews with key informants and via a thematic analysis of various policy, strategic and operational documents, such as the unimplemented Nepal Mental Health Act and Koshish’s NGO website. The theoretical lens of an asset-based community development (ABCD) approach was then applied to this research to understand how harnessing existing assets and working in the field of advocacy can have a positive impact on government policy and awareness. This furthers our understanding as to how an ABCD approach can be applied in a broader context to other organisations working in advocacy in the hope of creating change for areas lacking government support and awareness. In terms of key findings, stigma is one of the primary prohibiting factors to accessing treatment for mental illness in Nepal. However, those with lived experience of mental illness involved in advocacy are having a positive effect on increasing mental health awareness and the importance of treatment through using their existing assets such as their voices and stories. Despite some gains, barriers are still being faced due to the lack of mental health workers, lack of awareness (largely due to stigma), and no existing mental health act. Overall, the work of Koshish Nepal in the advocacy space has seen some positive changes occurring in Nepal’s mental health sector.