Paper short abstract:

This research investigated two questions through an ethnographic case study of a community mental health programme in Kathmandu: 1) What are components of a 'thick' social approach to mental health in Nepal?; 2) How does such an approach impact on people with mental health problems?

Paper long abstract:

Mental health in Nepal has long been neglected at policy and practice levels. Formal services almost exclusively emphasize biomedical interventions with limited attention to social dimensions and interventions.

The current research investigated two questions: 1) What are components of a 'thick' social approach to mental health in Nepal?; 2) How does such an approach impact on people with mental health problems?

The paper develops an ethnographic case study of one community mental health programme, Chhahari Nepal for Mental Health (a second case study is currently in development). This involved analysis of programme documentation, case notes, participant observation of programme activities and interviews (n=17) with clients and their family members and programme staff.

A 'thick' social approach is characterized by a process of relationship building between workers and clients that draws on 'deep' knowledge of context and family dynamics. Interventions emphasize a 'slow' approach to build trust and engagement both with clients, family members and wider social and medical systems. A holistic approach emphasizing values of 'care', 'respect' and the complementarity of social and biomedical interventions was crucial to positive mental health outcomes for clients. This holistic working permitted a humanizing of mental health problems, better quality of life for clients and caregivers, increased acceptability of mental health care, and improved medication management.

This research is set within wider global mental health debates about the nature and hierarchies of 'evidence'. Our case study approach suggests the value of evidencing 'practice experience' to better understand the 'mechanisms' that enable mental health outcomes.