Narrative Approaches for Community Detection of Mental Health Problems in Chitwan, Nepal
Historically, assignment of mental health diagnoses has relied more on completion of top-down checklists of symptoms that are administered by trained health professionals. . This approach may be problematic due to its limitations on the fact that they are developed in different settings and lacks the local touch. Community-based detection approaches that provide agency to patients and community members may be a viable alternative to the standard biomedical approach. Highlighting this, we developed a culturally contextualized, picture based narrative instrument called the Community Informant Detection Tool (CIDT) for the detection of five common mental health problems in Nepal – epilepsy, alcoholism, depression, psychosis and behavioral disorder.
This study describes the stepwise development of the tool. First, a draft tool consisting of narrative descriptions of each 5 disorder using symptom descriptions grounded in local language was developed in collaboration with 25 mental health professionals. Anyone with some degree of match with the picture- narrative and identifying with “need for support” and/or “functional impairment” was deemed to be at risk for having the identified mental health problem and advised to seek clinical services. Second, two rounds of qualitative data collection consisting of key informant interviews and focus group discussions were conducted with purposively selected community informants (n=31). These methods assessed the comprehensibility and applicability of the tool, and specifically identified possible improvements that could be incorporated. Upon integrating these recommendations, a pilot survey (n=105) was conducted to assess the feasibility of the tool. The survey findings indicated that all five vignettes were feasible and comprehensible in the detection of community individuals. Nearly 75% of the sample considered the tool feasible and easy to understand. Further, all respondents were willing to use the tool to identify persons with mental illness.
As Patel  states,, paying attention to cultural nuances facilitates accurate detection and help seeking behaviors among persons with mental illness. As a feasible and comprehensible instrument, CIDT is a narrative-based tool that may be used by lay community members with low literacy levels.
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