MISSION ON MAINSTREAMING RIGHTS OF PERSONS WITH PSYCHOSOCIAL DISABILITIES – NEPAL -1:
A REPORT (16TH-17TH MAY 2012)
BHARGAVI DAVAR 
|Background- Setting up the mission
– A regional perspective
|Mission Description- Meeting with Matrika Devakota and Koshish team
– Meeting with Dr. Surendra Sherchan, Chief of the National mental hospital, Lalitpur
– Meeting with Mr. Subedi (NFDN chair)
– Meeting with Mental Health Foundation team
– Mental Health Policy Group meeting
– Brainstorming meeting (Koshish, MHF, NFDN)
Following the useful Philippines Mission on mainstreaming rights of persons with Psychosocial Disabilities in the frame of the IDA capacity building program of CRPD monitoring, a similar mission was planned to Nepal. Broad objectives for the Mission were set collaboratively after several discussions with Nepalese disability leadership, with support and facilitation of IDA staff  and funded by OSF. Objectives of the Nepal Mission (to be fulfilled in 2 sessions, one in May and the other in July) were to-
- to make preparatory visits and engage various stakeholders on rights of persons with psychosocial disabilities and inclusion (disability coalitions of Nepal; national mental health center; human rights networks; people in governance; other)
- to engage the mental health, disability, and related human rights movement, on the proposed Nepalese mental health bill, which was a matter of some urgency.
- to share regional experiences with Mental health policy group, (policy makers and law drafters)
- to do training / workshop on ‘inclusion’ of persons with psychosocial disabilities within cross disability movement
- to do training / workshop on community mental health program / peer support / alternatives
- to assess further immediate needs of the psychosocial disability group
The mission logistics and organisation have been facilitated by the Mental Health Foundation team.
Setting up the mission
The need for support to CRDP compliant mainstreaming of rights of persons with psychosocial disabilities in the wider disability movement work has been mentioned at several instance in the frame of IDA capacity building activities in Nepal. The Mission objectives took into account the existence of national advocacy or human rights groups in mental health already working at grassroots, and linked with the national disability coalition . I have been in continuing touch with Matrika Devakota since 2010, March, dialoguing about our respective country situations. The members of MHF and Koshish had attended the recent IDA Geneva training. Also the fact that a mental health Bill was also imminent in the country, and in public discussion made the mission somewhat even more needed. While it had been rejected by NHRC, Nepal, and also by the Mental Health Foundation / allies, the mental health Bill, favoured forced treatment and other limitations on full range of rights of people with psychosocial disabilities; and there were many unanswered questions about this Bill.
Nepal is facing instability due to a forthcoming Constitution, and several challenges from interest groups. So timing for the Mission was also considered. Another scenario factored into Nepal Mission timing was the arrival of Gabor Gombos in India for the “ToTal” training in late June, and the offer for him to visit Nepal in July, after this training, settled with Nepalese group by IDA during Geneva training. Full mission was broken into 2 sessions, one meeting in middle of May by Bhargavi, before the Constitution, at the specific request of MHF, Nepal; and one in July, in post Constitution period, with Gabor Gombos’ visit and proposed exchanges with him.
A regional perspective
I, working with a regional perspective since 2010, have divided the world into two parts, mainly for purpose of my having better clarity for my work: (1) countries with mental health acts; and (2) countries without mental health acts. This division also set some perspective for work in Nepal, questions and reflection on priorities for action to be set therein, in continuance of UNCRPD implementation. Many countries of the Asian region did not have Mental Health Act, as discovered in 2010 on a visit to Nepal, and more recently, during the Philippine mission. They may have rudimentary provisions for institutionalisation in the civil code / penal code, but lacking necessary legal / court back up, physical infrastructure, rigor in governance, funding or capacity of state machinery to haul in people with same universality as found in some parts of India, or in other advanced countries. Nepal is another country which, having ratified UNCRPD in 2009, did not have a mental health act; [and was poised for one, falsely believed by some stakeholders, to be a superior policy option and in compliance of UNCRPD].
My travels within India and exchanges with various grassroots groups have also suggested that depending on geography, regions and civic development (rural/urban; middle/low income community), priority may vary: Article 12 and the issue of force is more relevant in urban city development context, where the Indian Mental Health Act applies in huge measure. In outlying and undeveloped city areas, rural India, inner slum areas of cities, and small townships where there are no services whatsoever, Article 12 and related articles are more about rights violations in the community, which can be addressed by community arbitration methods; and do not apply within treatment / medico-legal context requiring interventions from the high courts / apex court. Legal capacity is not a sharp conflict in these regions, as development values are taken for granted in these communities. For example, in Nepal, resistance to autocracy over the years has resulted in a vibrant civil society and governance, converging on values of care and human rights protections.
Also, no organised user survivor or ‘mad liberation’ networks in the region, not because of lack of political sharpness or lack of awareness about human rights, but because there is no overwhelming medico-legal context or sharp conflict on force or legal capacity. The constitution makers of Nepal are strongly human rights orientated. A sense of victimhood by the mental health system is not generally found in places where there is no mental health act and no institutional culture. Advocacy in the region needs to consider local culture and context, and people’s choices of identity and advocacy in present times, was a view shared in Nepal also.
– Meeting with Jagannath Lamichhane
– Meeting with Matrika Devakota and Koshish team
– Meeting with Mr. Subedi (NFDN chair)
– Meeting with Dr. Surendra Sherchan, Chief of the National mental hospital, Lalitpur
– Meeting with Mental Health Foundation team
– Mental Health Policy Group meeting
Day 1, May 15th
1) Introductory meeting with Jagannath Lamichhane to go over the next 2 days schedule
In this meeting, plans and objectives were discussed, and finalised. I started to understand the local context of mental health and disability advocacy; the key actors and their roles; major concerns of people with psychosocial disabilities; scope of available services in Nepal; opportunities in the present political scenario; and the work of MHF and Jagannath. Particularly, we discussed the significance of the Policy Group meeting scheduled for the 16th evening; and preparation / agenda setting for that.
Day 2, 16th May
2) Meeting with Koshish (10 AM -11.30 AM) –
We (NeerPrakashGiri of MHF and Bhargavi) visited Matrika Devakota and his team in Koshish office. We discussed recent developments in Nepal on the draft disability legislation and the mental health Bill. Matrika was closely involved in both these efforts, even though Koshish has been more involved in grassroots services.
He has expressed concerns about the MH Bill and did not agree to the present draft. He shared news about various other Nepalese initiatives in mental health, largely devoted to providing medications. NGOs and INGOs are infinite in Nepal, and also government was very accessible. So each NGO had a chance to go and meet various ministries by themselves: Unlike India, where government is inaccessible and there is no option except collaboration, Nepali NGOs are not forced to collaborate which might not give incentives for coalition building. Some research projects were also on, in Nepal, conducted by some world renowned psychiatrists. It did not seem that Nepal is completely bereft of mental health services; but may be predominantly medical / service driven, without any advocacy interest or without any awareness of UNCRPD, without much linkage to disability sector. There were also many counsellors linked to welfare NGOs, but did they work with egalitarian values? Not many mental health DPOs. He suggested that in July visit, Bhargavi could take a 2 day training workshop on sharing experiences on developing community mental health services / peer support / alternatives, while spreading awareness about expectations from services in the UNCRPD / post-Constitution era of Nepal. We also discussed co-operation and having synergy between efforts of MHF and Koshish with each other, and with the larger advocacy movement in Nepal. Matrika Devakota gave open offer for such collaboration. We talked about July visit by Bhargavi (6-8 July) and Gabor Gombos (9-10 July), and Koshish has offered support. We discussed the objectives of this next visit. Kesar of Koshish sang an UNCRPD song for us in Nepali. It was also interesting to see that while many staff were users, they were encouraged by the organisation to take up mental health studies, and so, they were also aspiring to be mental health professionals of the future. This trend of young users choosing a psychology / social work specialty is found in India also, with full departments of teaching coming up, several young psychologists on FB pages, encouraging and dialoguing about such a career choice. We may want to consider the consequences of such ‘mainstreaming’ of disability activists within the university system and traditional services, as there is a message in this for user survivor advocacy for the future.
3) Meeting with Mr. Subedi (12 noon – 12.45 PM) –
While very busy, Mr. Subedi the new chair of NFDN found the time to meet with us briefly and offered his co-operation on inclusion. I had questions about the law, which Mr. Subedi clarified. There is only 1 mental hospital in Kathmandu. There was no law guiding admission and discharge. The penal code may have provisions for incarceration of people who were considered public nuisance. Such people were taken to police custody / prison under police escort. This is not a health admission but a criminal admission. As shared by Matrika at another point, police were involved in admission into private / public treatment centers, but with no specific legal mandate. Mr. Subedi was not aware of any other law except penal code under which people are admitted. There is no knowledge how people get admitted in private facilities. Probably illegal or ad hoc detention, or under some guidelines, as the case with Philippines. Civil code was also mentioned by another NFDN lawyer in the context of lock up in local custody as public nuisance by state machinery. There is no separate guardianship law, but it is a small provision under civil code. Many would-be lawyers trained in India from the beginning; just like Indian would-be lawyers trained in the UK to become barristers. So many laws were reflective of Indian law. Incapacity clauses do exist in various civil and criminal laws, ‘cut pasted’ from India. Though not a British colony, the Nepalese legal system contained the reflected glory of Indian legal tradition in terms of incapacity. As Mr. Mukundaji further clarified, such ‘obsolete’ provisions are there, but ground level social practice does not follow these laws. Courts are generally progressive. For parallel report process in Nepal; or activism in the post – Constitution / UNCRPD period, contesting these laws will be important, as suggested by Mr. Subedi. Being a prominent disability leader and a lawyer in Nepal, Mr. Subedi has already taken up cases relating to people with psychosocial disabilities before the supreme court. Mr. Subedi did not consider that a huge effort will be needed to change these old laws in the new era of Nepal, both new human rights inspired Constitution and UNCRPD being very strong motivating factors. He shared news about the NFDN, their openness on inclusion, and his co-operation and full support for training on inclusion; and his support in organising such a training in July.
4) Meeting with Chief of the National mental hospital, Lalitpur (2 PM – 3 PM):
Jagannath, Matrika, NeerPrakashGiri and Bhargavi visited Dr. Surendra Sherchan, consultant psychiatrist and director, mental hospital, Lalitpur. We did not see the old hospital structure, but the new one, which was clean, and friendly. No grand cages or grills, no high walls, no asylum smell, and small sized. It is situated in a busy commercial city area of Kathmandu. Koshish has their centre right opposite the hospital, and works in liaison with the hospital. The only mental hospital in Nepal, it comes under the Ministry of Health and Population.
There was very proactive exchange with this doctor, who felt very much a part of changes in the country right now, and is working closely and actively with the authorities. He is the key person in drafting the present Mental health Bill for Nepal. He gave his serious opinion that he and his peers want to learn from ‘advanced countries’ and felt a gap, that there was no mental health law in Nepal. He considered it a sign of being modern, to have a mental health law. That was the inspiration for the new law. There were instances in his work when as doctor, he did not know what to do, and felt need for a law to guide him. We talked about the present dilemmas of countries where a mental health law exists; particularly in India, which has inherited colonial legacies from advanced countries. Such laws have resulted in expansion of neo-colonial institutional facilities and abuse of power by professionals in the country. So these laws are not ‘modern’ in the way we expect. In India, advocates are demanding repeal of the law and taking out the penal / humiliating aspects of the institution centric law; as in other parts of the world. I shared our vision and advocacy for community mental health and support systems available at local level – (circles of care, group and peer support, neighbourhood alert systems, mental health within overall development / community building activities, conflict reduction and peace building strategies, door to door support, addressing exclusion at community level, trauma informed services, a huge range of traditional alternatives, etc.) This community approach to mental health is also regionally and culturally more relevant, as in our region, we move in groups / collectives; and do not have a highly individualised view of our selves. UNCRPD emphasis on interdependence is a spiritual aspiration that can be fulfilled in the region because of the traditional support systems which are still intact. While not diminishing the role of tertiary care, the doctor’s scope of authority in his society itself is sufficient to build a good and supportive client – doctor relationship; no further law was needed, as such a law divides communities, breaks the collaborations and builds mistrust and paranoia in society as a whole. Such a law builds suspicion of any person being ‘crazy’, so a community has to watch out for each other going ‘crazy’ and turn them in.
We also brought up the issue of operational costs of running a full blown mental asylum culture in a country and running the Mental Health Act machinery; and that in our region, largely poor nations, building asylums will wholesomely deplete the national treasury. India experience was shared. What perhaps the country could consider is making a mental health policy which will provide guidelines for community based services. Dr. Surendra Sharchan listened very attentively; asking many critical questions; and considered attending the Policy Group meeting in the evening. He also welcomed more information and capacity building on a mental health policy for Nepal, in which he looked forward to regional collaboration. He requested more information on such community based services in India; and was very much willing to join others on a field visit in the fall of 2012, to Pune, to visit Bapu Trust community services. He was also keen to be part of the July programs if time permitted.
5) Meeting with Mental Health Foundation team (3.00 PM – 4.30 PM):
Jagannath, NeerPrakashGiri, and others were present at the MHF meeting in the afternoon. MHF people do not relate to ‘user survivor’ term, and prefer ‘psychosocial disability’. They are not anti-psychiatry, though they are against medical domination. Not much to talk about ‘medical domination’ in Nepal with only around 60 psychiatrists, many of them having left the country. They did not have many dilemmas about using medication, needed medication at grass roots level also; but felt social care must not stop with just that. They emphasized need for alternative services over which they themselves had control and choice. A large part of this discussion was regarding the relationship of MHF and local organisations with the WHO (MH-GAP), the Global Mental Health Movement, led by doctors; and on the other hand, global user survivor advocacy through organisations like WNUSP. MHF is talking about the sheer non-availability of capacity builders in the field of human rights and advocacy, particularly on conduct of research and preparing analytical questions for studies on advocacy; and what the leaders of GMHM offer is research capacity. So even though the MH GAP and GMHM are led by medical doctors, MHF is convinced to collaborate with them. They also feel that who the collaborators should be, cannot be dictated at global level; but must be decided at local level. They are surely open to dialogue on this, and are looking for regional or global expertise to build the lacking skills on research on advocacy.
6) Mental Health Policy Group meeting (6 PM – 8 PM):
Mr. Subedi, Hon. Ms. Arzu, Hon. Ms. Swapna, myself, and Jagannath were scheduled to speak that evening, with an hour’s time allocated for open house. MHF had done an outstanding job in bringing together key people from various sectors and the Ministries into the same room that evening. It was a stunning turnout of high profile people, with the Secretary from Prime Minister’s office; 2 Parliamentarians; a member of the Planning Commission; Dr. Sherchan chief of the mental hospital and his peers in psychiatry; a higher level officer from the NHRC; key disability coalition leaders; INGO country representatives; and the press. The health secretary was to attend, but was busy with a Standing Committee meeting, as were other public figures who were to join the meeting. He pointed our attention however towards an insightful article that he wrote in a national daily about developing community health services. The attendance was even more impressive in light of the emergency situation in Nepal vis a viz the forthcoming new constitution; and several members had to skip and jump over the crowded rallies and protests to reach the venue on time. MHF has been highly successful in establishing dialogue platform with government with the MH Policy Group, and MH Policy Group occupies already good public space and visibility in Nepal on mental health related developments. Jagannath will share full minutes of this meeting in the coming days.
My presentation- a summary
I shared India experience of having to advocate with 2 separate ministries; approximately 200 civil incapacity laws; 3 rights oriented disability laws; 1 neo-colonial mental law; a handful of policies and various new laws in the making; several policy guidelines and program documents.
I talked about some key challenges we faced in India, beginning with ‘who are we?’ Traditionally we were the subjects of health ministry, with disability sector not paying much attention to us. Luckily, the ‘mental disabilities’ group shifted to the jurisdiction of the disability department over a decade ago and were already somewhat integrated. People with psychosocial disabilities are in medical control fully and captured within the neo-colonial mental health law. We now expect disability universe to include us. Shifting a whole constituency to another Ministry is a most difficult challenge, particularly when we are not organised into an interest group. Patience and dialogue are the key words over here, in this region, for people with psychosocial disabilities.
Also, there were identity issues, which I also found in Philippines and Nepal: in India we still say ‘people living with a mental illness’ as ‘user survivor’ is not a term that a lot of people identify with. We are yet to identify with ‘psychosocial disability’ even within our constituency. We have to engage seriously with the disability movement also and we cannot expect, overnight, without any effort from our side, that they will include us. Skill building for inclusion is necessary. We have to share why we consider our experience a disability experience. In India many groups still ask, why are we in disability category? Just saying ‘UNCRPD says so’ helps a little, but more engagement is necessary with this question in the regions.
Second challenge has been, ‘Do we have all rights available to all persons with disabilities, and on equal basis with others?’ When we set up dialogue platforms through NAAJMI in India, everybody could agree that a range of socio economic rights should be ensured; but civil political rights, right to self, right to autonomy and decision making, were not allowed. In India there were over 150 laws which denied legal capacity. Earlier, we used to think this exclusion applied only to ‘insanes’ and ‘imbeciles’. However, legal incapacity laws applied on all people with disabilities: ‘leprosy cured’, ‘contagious leprosy’, ‘epileptics’, ‘those with physical and mental infirmity’ or ‘defect’. This is also found in Philippines, though not to same extent: the ‘deaf mute’ were disqualified in law over there. So we found many deaf and children with mental disabilities inside the asylum in very oppressive conditions. Indian constitution makers ignored the incapacity provisions in law when they conducted law reform exercise after we became a republic. India made a constitution when a human rights language was not available. Nepal is making a constitution in a human rights inspired era. They can consider reforming the incapacity laws, the few that exist, so that mistakes of India, made in the fading aura of colonial rule, are not repeated.
The question Nepal is facing now is not, what kind of mental health law is necessary; but whether a mental health law is at all necessary; and whether a policy might not better serve the purpose. There could be a public debate on this question.
In India, mental health law is a kind of net to catch and institutionalise people perceived to be of ‘unsound mind’, falling through various incapacity laws. So actions made on incapacity, lead to further actions on deprivation of liberty, through incarceration. Mental health law serves many vested interests in India, and private agencies find it profitable to simultaneously exercise legal incapacity law and mental health law to haul people into a private or public institution. With every divorce filed on insanity petition, at least 1 forced institutionalisation and a few shock treatments, along with the karmic label of ‘schizophrenia’, comes free!! This way, both lawyers and doctors in India make much money.
We must appreciate that nowhere in the world, is there a ‘progressive’ mental health law, which does not have colonial, penal baggage. Where no regulation exists in countries such as India, such laws exists in perverted forms today to serve the profit motives of private asylum business, leading to overwhelming rights violations. Nations without such a law in post UNCRPD period must closely examine this baggage and its consequences on countries, before adopting them as ‘more advanced’ policy option. To make a decision whether Nepal needs a mental health law or not, please study India / advanced country situation.
The world presently is divided into 2 regions: those with mental health laws, and those without. For countries without a mental health law, Article 19 of UNCRPD is an immediate and cost effective option, because they don’t have to bear the cost of bringing down old perverted, normative structures. Mental health can be a part of overall community development.
I shared Bapu Trust experiences on developing community support systems and alternative services within an overall context of development and human rights.
I ended by sharing the advocacy in India for a comprehensive disability legislation covering all rights of all persons with disabilities; advocacy for a mental health policy and also reviewing mental health rights, under the right to health bill. This is also a possibility for Nepal.
Mr. Subedi spoke about his experiences in court with mental health issues; and the need to work more on reducing stigma and enforcing rights through the courts.
Reflections and outcomes:
While the law drafters in the group were bit defensive about the legal draft, some members, especially Ms. Arzu, was plainly outspoken against the human rights atrocities being planned by the state under the new mental health bill. Being trained in clinical psychology, she shared her experiences of working in a psychiatric institution (in India) and was firmly against making a choice in that direction. Others such as Disability and Human rights Center, the NHRC spokesperson, DHRC, and Renu from the Nepalese women’s disability network, also raised questions about the bill. The Secretary from the PM’s office affirmed their interest in a comprehensive legislation for all people with disabilities. The Planning Commission member invited the group to hold a meeting with the PC soon as he was keen to hear about community based services. The health secretary’s article was cited by Jagannath to enlighten the future pathway towards community care. Ms. Arzu summarised the strong view of many of the group members to take up the question floated in the meeting whether Nepal needs a mental health law, or a policy; and that a community view of mental health must be favoured and pursued for the future, as THE way forward. She, being chair of MH Policy Group, as well as a well respected parliamentarian, made her intent amply clear to the Policy group. Jagannath and I also shared news about the forthcoming exchanges in July, which were very much welcomed to keep the dialogue going and facilitating future actions.
Dinner was arranged by MHF, in which everyone participated.
Day 3: 17th May 2012.
Brainstorming meeting (NFDN, Koshish, MHF)
A meeting in MHF office was planned. However, the day was declared a ‘bandh’(strike severely impacting road traffic), so there was much uncertainty. MHF team and I decided to meet anyway, even if we had to walk to the MHF office. Mr. Mukundaji from NFDN joined us; also Matrika and Susmira from Koshish. We did not have a planned agenda for the meeting, as some others from the disability network did not turn up, due to emergency situation. The press meet was also cancelled, because of the bandh. A few points discussed in the day were:
a) What is community mental health model? There is the WHO given medical model of CMH, and a social model which we can develop in compliance with UNCRPD. Medical model (also followed by several NGOs in Nepal) kept to identification of disorder, providing medical service in community, and referral to hospital for tertiary care. A social model of care would be comprehensive, with strategies of
- Understanding community needs (marginality; resilience) through research
- Assessments using psychosocial tools
- Developing mental health as a strategy of overall community development
- Provision of different types of community services (counselling, psychotherapies; resourcing creativity and spirituality; sports, theatre and play; group support and peer support systems; home based psychosocial support; neighbourhood alert systems particularly to intervene in case of extreme states and victimisation of people with disabilities; fostering inclusion through awareness activities; linkages with various local social services and authorities; other social, legal and medical referral services)
- Human resources to be sourced from community itself, to enhance ownership of the work and to leave behind capacitated people in the community with good exit policy
b) The nature of peer support – moving from formal systems of care, to develop indigenous informal systems of care is not unknown in our region. Communities in the region are rife with ‘groups’ and altruists who contribute to community development. Self help and self determination are values inculcated in the region through various NGO and CBO efforts. In Bapu Trust, we started such peer groups without knowing if people who come from poorest of backgrounds will favour this. However there is overwhelming support for such peer groups. We do not have a particular ‘programmatic’ view of such support systems as it is in ‘study’ process. For example, many women suffer from joint pains and embodied distress. While talk is useful, we have used more embodied forms of therapies such as yoga, exercise, diet and arts based therapies. To extinguish the ‘expert – client’ divide, people who provide the services are chosen and trained from grassroots and they engage with the slum communities on daily basis. Matrika also suggested training on Peer support as used in the advanced countries. We remembered Chris Hansen’s peer support program and decided to touch base with her once again on this.
c) We also discussed at length role of MHF in the region and that of Nepal DPOs in mental health globally. MHF occupies a very critical and influential position within Nepal. Nepal constitution building process is of utmost historical importance. Nepal being a new democracy offers opportunities for implementation of UNCRPD unlike other countries. Politically highly favourable for mental health advocacy with a vision for very tangible results. Building capacity of MHF for Nepal, and even for the region will be a significant contribution at present times.
d) We talked about the July program. Jagannath is unable to contribute to this process from mid- June until mid July, due to personal reasons. We felt it would be very important for Jagannath to be available for the program on community mental health services, as the policy group seems to be moving in that direction. Here is the suggestion for IDA to consider new option based on available budgets: CMH training in August, not July as planned.
e) NFDN will take up responsibility for the training of Gabor Gombos. A small committee of Mr. Subedi / Mukundaji, Matrika, Renu will co-ordinate. Jagannath is available for back end or online support, if any. NFDN is in an ideal situation to organise this, as the cadres may need targeted intervention on the topic of inclusion, as we did in the Philippines.
f) The group was enthusiastic about a visit to India and to Bapu Trust services in August, and they will also invite other key people such as Ms. Arzu and Mr. Sherchan.
On 17th evening 6 o clock news, Kantapur TV showed substantial coverage of the Policy group program. Jagannath’s article was also published on 18th morning, in Kathmandu Post.
1) Finish the other (somewhat changed) objectives of the 2nd part of the IDA supported mission, including
- (9th and 10th of July) 2 day training by Gabor Gombos in July on “Inclusion” with cross disability alliance
- Audience with Gabor Gombos with Mental Health Policy Group in July
2) Facilitate mental health policy group to develop a community mental health policy for Nepal
- 2 day training on community mental health , towards development of a draft policy for Nepal in August
- Following this training, in September, a field visit for key people (up to 6-7 people in all) from sector to Pune, to visit our Urban Mental Health Program. Bapu Trust / NAAJMI can also suggest to bring other people from the country working as key resource persons (3 or 4 people from NAAJMI networks) on community mental health, to share their inputs. This could be a Nepal – India regional exchange on community mental health.
 Director, Center for Advocacy in Mental Health / founder, Bapu Trust, India; Co-founder, NAAJMI, India; Member, National Disability Network India; Member, DPI. Thanks to: Bapu Trust, NAAJMI, NDN and DPI for support of my work in the region.
 Thanks to: Mental Health Foundation; Koshis; NFDN
 Thanks to: Alexandre Cote, of IDA
 Only MHF and Koshish were members of NFDN
 Hungarian Human Rights Defender; Member, UN treaty body on the UNCRPD; WNUSP / ENUSP member
 Thanks to: MHF / Jagannath Lamichhane offered to take a lead in co-ordinating and setting plans for this visit.
 (a lot from old world and little bit from new world)- Goffman called them ‘total institutions’; Latour uses the term ‘hybrid’ institutions.
 (e.g. a woman seen as ‘unsound’, is often put in an institution through MHA, before husband files a divorce on grounds of insanity).