David Sims with the Nepal Association of Clinical PsychologistsWhilst some people see travel as a means of escape, Dr David Sims, Child and Adolescent Psychiatrist for Bradford District Care NHS Foundation Trust sees it as an opportunity to help others and heal wounds.
Working on child and adolescent mental health training projects in Nepal and meeting people overseas has long been a passion for the psychiatrist, who has been giving up his annual leave for the last decade to help others on the self-funded trips.

Elaborating further David said: “In a country that has a total population of 30 million, with approximately 40 per cent of the population, 12 million, under 18, it is estimated that 10 – 20 per cent of these children and young people have mental health issues, with significantly higher rates of suicide in Nepal than in the UK.”

Up to six months ago there was only one child and adolescent mental health services (CAMHS) specialist in the whole of Nepal. David, working with Consultant Child and Adolescent Psychiatrist, Dr Arun Kunwar, is now training an additional three psychiatrists to help bridge the gap when Dr Kunwar retires in the next few years.

David continued: “I’ve been to Nepal seven times in the last 10 years, with faith based medical education charity Prime International, who deliver whole person healthcare training around the world. Most of the GPs that are involved with the charity are around retirement age. During each trip, five doctors go out at any one time.”

During his two-week trips to Nepal, alongside training other healthcare professionals at international conferences, David meets with church leaders, their congregation and school teachers to educate them to dispel the myths, breakdown barriers and encourage people to talk about mental health. Even though a high proportion of people are affected by mental health in the country, a strong social stigma attached to mental ill health means that people experiencing mental health problems often face discrimination in many aspects of their lives.

David said: “One school had four suicides in six months, and by the end of that six months hardly any children were sent there as parents felt there was a problem with the school and kept their children away.”

David Sims teaching at the Centre for Mental Health and Counselling in Nepal

As a result of David’s training, mental health issues are now discussed more openly at school, so young people know where they can go for help. Parents were previously frightened to send their children to school, afraid that mental ill health was contagious; now trained teachers educate parents to dispel the myths and the school is beginning to flourish again. The training is now being rolled out to other schools to help facilitate shared learning.

Church leaders and their congregation now recognise how powerful and effective talking about mental health can be and how asking someone how they are feeling can help support emotional wellbeing.

David explained: “During the trip we spoke to church leaders, particularly about people committing suicide, as the figures for suicide are at least double of those in the UK. The community leaders want to help as there are no mental health nurses, one child psychiatrist, less than 30 clinical psychologists and less than 200 mental health specialists’ in a population of 30 million.

“The community leaders are increasingly becoming aware of the problem of suicide through the number of people they meet. Within our training we’re equipping people to understand about mental health and also to have conversations with those most vulnerable. We work in groups of three, getting people to practice the sorts of conversations they’d have in a session. One of the people on the course left the group at the end of the second day to go talk to someone straightaway who was at risk of suicide. So, it’s a really practical course. The person was able to implement the learnings and hopefully help to save a life. This is why I go back – because every time I go I have conversations about lives that have immediately been impacted. I get to hear how people are recovering. A young man, who is now in his twenties, who we met in a village five-or-six years ago, was one of the most severely mentally ill people I have ever come across. The villagers brought him to the training meeting we were having after they’d heard we were there. We spoke to the villagers and asked them to talk to the boy’s family to get him much needed treatment. The next time we went he was recovering after a period in hospital. He’s now in college, he’s studying and also contributing work wise to his family. These are the stories and people that keep me going back.

“We help to break down stigmas. Talking and listening really makes a difference; for many people it will be the first time they’ve been listened to. We also let people know there are mental health services and psychiatrists that can help.”
A four-month secondment to the UK by Nepalian psychiatrist’s Dr Prakash Thapa was also arranged by David who is training the medic to become a CAMHS specialist. Along with working as a child and adolescent psychiatrist at the Care Trust, David has over twenty years’ experience training healthcare professionals in the UK.

David said: “The rates for mental ill health for teenagers in Nepal are higher than in the UK. Children are admitted to hospital, because they don’t know what to do with these young people, which doesn’t help to tackle the mental health issue. We’re hoping that by equipping people in the community, as well as going to international conferences to speak to healthcare professionals we’re beginning to work at different levels to make a difference.”

Stigma, lack of knowledge and discrimination can trap people in a cycle of illness. With training and education children and young people in Nepal have the potential to live normal and fulfilled lives.