Dalits and mental health: investigating perceptions, stigma and barriers to support in Kathmandu, Nepal

Abstract

Background In Nepal, caste-based disparities have been identified in mental health. The lowest caste, the Dalits, face the greatest discrimination and have a greater prevalence of depression and anxiety when compared with high castes. Therefore, it is important to understand the Dalit communities’ perceptions of mental health, the barriers faced when accessing support and to identify the causes of stigma. Investigating this should provide insight to help inform anti-stigma policies and develop interventions to better support mental health within the community. Methods Ethical approval was granted by the University of Leeds to conduct this study. Participants were recruited through a Dalit community leader gatekeeper identified by the project host. Purposive and snowballing sampling methods were used. 12 participants gave informed consent and took part in semi-structured interviews. Data was transcribed and thematically analysed by the researcher. Results Perceptions of mental health included mad, incurable, not a real disease, and a strong association with substance abuse. The stigma attached to mental health results in Dalits being outcast from their families and subsequently homeless. This is especially problematic for vulnerable women. Barriers identified that prevent Dalits from obtaining mental health support include financial burdens and a lack of awareness and services. Ways of overcoming these barriers were discussed such as raising awareness and education on mental health. Causes of stigma were identified to be supernatural, religious, cultural, the caste-hierarchy and a lack of education. Conclusions There is a need for official mental health education among Dalits in Kathmandu to help prevent stigma and raise awareness of services. An increase in the training of mental health specialists and the implementation of mental health safe houses is required in Kathmandu to increase the availability of support. Further research into the relationship between caste-hierarchy and mental health is also recommended.