Nepal’s immense beauty and diversity are evident in its geography, culture and people. However, a history of significant disasters, civil war and ongoing economic instability have created conditions of hardship for many young people. More recently, the strict lockdowns implemented as part of the public health response to the COVID-19 pandemic will have long-term economic and social impacts for Nepali children and adolescents.
I met Dr Bhushan Guragain, Medical Director at the Centre for Victims of Torture Nepal in 2015, months after the devastating Gorkha earthquakes. We worked together with partners from China, Hong Kong and the United States, to develop the Study on Adolescent Resilience after Disasters, a mixed methods assessment of mental health among more than 4,200 adolescents in disaster-affected communities. The findings revealed high levels of post-traumatic stress disorder, depression and anxiety symptoms among adolescents who lived through the 2015 earthquakes in Nepal. Daily hardship was a key factor associated with ongoing mental health difficulties.
Despite the high levels of need, there are currently very few psychological services for children and adolescents in Nepal. There are no psychologists employed in government schools, and limited opportunities for child-focused psychotherapy training. To address this gap, the Australian Psychological Society funded an Intercultural/International project grant to support professional development for psychologists working at the Centre for Victims of Torture, with a goal to broaden opportunities for adolescent mental health support.
The Centre for Victims of Torture (CVICT) is a non-profit, non-governmental organisation established in Kathmandu in 1990. CVICT supports the rehabilitation of torture and trauma survivors, and promotes the advancement of a human rights framework in development, healthcare and government policy. The only centre of its kind in Nepal, CVICT provides professional medical, psychological and legal services using a holistic and multidisciplinary approach to intervention.
CVICT provided trauma-informed care for torture survivors throughout Nepal’s brutal civil war, and led psychosocial response and recovery efforts following the 2015 earthquakes. Their current programs include community-based psychosocial capacity building programs in rural and remote areas, intervention and crisis support for survivors of gender-based violence, advocacy for prisoners and outreach mobile health clinics.
I was delighted to host two psychologists from CVICT, Phanindra Adkihari and Sachita Adhikari, at Curtin University in Perth for a week in July 2019. Phanindra and Sachita presented their work to staff and students in the School of Psychology, highlighting the impact of psychological services in the districts in which they work, and the importance of community partnerships in program delivery.
During their trip, we met with clinical psychologists from Perth’s major hospitals, and leading child and adolescent mental health experts at Curtin University. We discussed the range of issues facing young people in Nepal, learnt about best practice for child psychotherapy in Australia, and exchanged strategies for improving adolescent mental health outcomes.
In particular, we addressed issues concerning high-risk behaviours, safe social media use among adolescents and parenting skills. Phanindra and Sachita met with Honours and postgraduate students at Curtin to discuss developments in psychology in Nepal, the risks facing young people and important family- and community-level protective factors.
In addition, we met with the Building Bridges project team to develop skills in co-design, with a view to implementing intervention co-design workshops with adolescents and parents in Kathmandu schools. Learning from the Building Bridges team’s successful experience in using co-design workshops to improve mental health services for young Aboriginal people in Perth, we adopted the principles of participatory action and trust building in our plans for services development. The week’s meetings provided important opportunities to gain insight into the experience of trauma among young people in Nepal, which informed the collaborative development of a school-based psychological intervention plan for adolescents experiencing mental health difficulties in Kathmandu.
Upon their return to Nepal, Sachita and Phanindra met with CVICT’s psychosocial team to discuss new strategies for working with adolescents. The outcomes of our discussions were translated into CVICT’s ongoing gender-based violence programs and training in rural areas. CVICT plays an instrumental role in providing crisis care for survivors of family and domestic violence, most often affecting women and girls. Children and adolescents are often caught in cycles of violence, and CVICT’s work supports safe recovery for young people in rural and remote communities.
Incorporating adolescent-focused evidence-based strategies into their work, Sachita and Phanindra were able to expand the impacts of our grant to support psychologists working with young people affected by trauma across Nepal. In addition, Phanindra and Sachita have initiated partnerships with school principals in Kathmandu, with a possibility of supporting the delivery of adolescent mental health interventions following the COVID-19 pandemic.
The APS Intercultural/International Grant has been invaluable in strengthening our partnership with CVICT Nepal, supporting professional development for Nepali and Australian psychologists, and fostering adolescent-focused psychological interventions through CVICT’s current programs. In addition to ongoing project plans, our collaboration continues through the newly formed Asia Pacific Disaster Mental Health Network, funded by the World Health Organization.
We are grateful for the opportunity to work together to inform sustainable mental health services and training programs, and translate research findings into psychological practice. It is our hope that these developments will have real and sustained impacts for young survivors of trauma and violence in Nepal.