UNIT IX MHP.pptx
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This document provides an overview of Nepal's mental health programs and policies. It discusses the historical background of mental healthcare in Nepal, from ancient practices to the establishment of the first psychiatric services in the 1960s. It outlines key national policies and strategies, including the National Mental Health Policy of 1996, National Mental Health Strategy and Action Plan 2020, and Community Mental Health Care Package of 2074. It also describes several mental health programs and guidelines, and lists some of the major mental healthcare centers in Nepal.
UNIT IX MHP.pptx
- 1. UNIT IX MENTAL HEALTH PROGRAMME Prepared By: Sapana Dahal M.Sc. Nursing 2nd Year
- 2. Objective At the end of the session, all the participants will be able to explain about Mental Health Programme.
- 3. Contents • Introduction • Historical Background • National Mental Health Policies • National Mental Health Strategy and Action Plan 2020 • Mental Health Gap Action Programme
- 4. Contents • Community Mental Health Care Package, Nepal, 2074 • PRogramme for Improving Mental health carE (PRIME) • Guidelines for Prevention and Management of Psychiatric Illness during Isolation and Quarantine • Mental Health Care Centre in Nepal • References
- 5. Introduction • The current healthcare delivery system is organized as a tiered referral system. • Public mental healthcare in Nepal is coordinated and delivered by the Department of Health Services (DoHS)
- 6. Introduction Contd… • Responsibility of the NCD and Mental Health Section of the Epidemiology and Disease Control Division (EDCD).
- 7. Historical Background Ancient practices (before 1961: the monarchial era) • Mental asylums -first point of contact for those seeking mental healthcare in most nations. • Patients in Nepal - towns in the northern part of India to seek mental treatment
- 8. Historical Background Contd… The era of modern psychiatry After the December 1960: The first psychiatric service in Nepal founded. 1961: Psychiatric out-patient department (OPD) established at Bir Hospital. 1965 :The psychiatric OPD was extended by a psychiatric in-patient comprising five beds, and further increased by twelve beds in 1971
- 9. Historical Background Contd… The era of modern psychiatry In Tribhuvan University Teaching Hospital 1986 : A psychiatric OPD 1987 : 12-bed in-patient psychiatric service
- 10. Historical Background Contd… The era of modern psychiatry 1984 : OPD at Bir Hospital was incorporated into a new mental hospital with 25 in-patient beds at Lagankhel, Lalitpur, the first and only central-level mental hospital in Nepal, popularly known as Lagankhel Mental Hospital.
- 11. Historical Background Contd… The era of modern psychiatry 1983–1984 : some NGOs also started to work in the sector of intellectual disability.
- 12. Historical Background Contd… Community mental healthcare • The history of community mental health services dates to 1983. • The United Mission to Nepal started its mental health programme in 1984 as a 5-year pilot project in Lalitpur, training paramedics to provide a primary level of care.
- 13. Historical Background Contd… Community mental healthcare • After its success, a similar mental health project was launched by the Tribhuvan University Teaching Hospital in 1989 with the support of international NGOs. • The Norwegian organisation Redd Barna (Save the Children, Norway) provided mental health training to teachers and nurses.
- 14. Historical Background Contd… Community mental healthcare • The Narcotic Drugs Control Act was framed in 1976 and amended in 1981 and 1987. • The Drug Abuse and Demand Reduction Project was initiated in 1995 and several demand-reduction activities are carried out by national and international NGOs
- 15. Historical Background Contd… Community mental healthcare • Several rehabilitation centers have been set up by NGOs in response to the problem of drug misuse.
- 16. National Mental Health Policies 1996 : A mental health policy for Nepal was developed by the government. A comprehensive National Mental Health Policy was incorporated in the Ninth Five Year National Plan by the Government of Nepal.
- 17. National Mental Health Policies Contd… • The mental health policy proposes several strategies to develop human resources for mental health services and ensure basic human rights of people with mental illness. • The mental health legislation which ensures the human rights of people with mental illness was drafted in 2006, but its endorsement by the government is still pending.
- 18. National Mental Health Policies Contd… Policies • To ensure the availability and accessibility of minimum mental health services for all the population of Nepal by the year 2000 • To prepare Human Resources in the area of Mental Health in order to provide for the above mentioned Mental Health Services.
- 19. National Mental Health Policies Contd… Policies • To protect the fundamental human rights of the mentally ill in Nepal. • To improve awareness about mental health, mental disorders, and the promotion of mentally healthy lifestyles, in the community by participation of community structures, and amongst health workers.
- 20. The 2017 Draft Mental Health Policy In 2017, the MoHP drafted a mental health policy in line with Nepal's constitution, ensuring the right of every Nepalese citizen to mental and psychosocial health and guaranteeing the right to remain mentally sound and live a dignified life
- 21. The 2017 Draft Mental Health Policy Contd… Aim: • To ensure readily available and accessible basic mental health services for all • To train the necessary workforce to deliver mental health and psychosocial services • To protect the fundamental human rights of people with psychosocial disability and mental illness
- 22. The 2017 Draft Mental Health Policy Contd… Aim: • To promote public awareness of mental health and combat stigma against mental illness • To develop and manage health information systems and research
- 23. The 2017 Draft Mental Health Policy Contd… • It proposed allocation of funding at federal and provincial level based on burden of mental illness, to be used for promotional, preventive, and remedial and rehabilitation activities.
- 24. The 2017 Draft Mental Health Policy Contd… It envisaged a mental health division set up under the MoHP and the establishment of a separate mental health unit in each government- run hospital.
- 25. The 2017 Draft Mental Health Policy Contd… Mental healthcare facilities would play a coordinating role, engaging with the community to promote mental health and ensure that people's mental health needs were assessed and addressed.
- 26. National Mental Health Strategy and Action Plan 2020 It provides a more comprehensive description of Nepal’s plans for mental health care. This strategic Action Plan describes the provision of free primary care mental health services for all parts of the country.
- 27. National Mental Health Strategy and Action Plan 2020 Contd… Objectives • To transfer long-term hospitalized patients/clients with a predominance of social needs (approximately 30% of patients/clients hospitalized at psychiatric inpatient aftercare providers) to the community
- 28. National Mental Health Strategy and Action Plan 2020 Contd… Objectives and simultaneously reduce the number of aftercare beds at psychiatric inpatient aftercare providers by 1,200 by 2022 • To set up health and social field teams to provide care and rehabilitation for deinstitutionalized people with mental illness – by 2022 this means 30 Mental Health Centres (MHC)
- 29. National Mental Health Strategy and Action Plan 2020 Contd… Objectives • To provide housing for deinstitutionalized persons with mental illness in the community. • To present how the division of competencies for health and social services will be ensured, including cooperation at the level of the Ministries of Social Affairs and Health and a contribution to the funding of the reform from the health and social budget
- 30. National Mental Health Strategy and Action Plan 2020 Contd… Key components • Integration of mental health at Primary Health Care level • Strengthening mental health at Secondary Health care level • Service user engagement in policy development and planning
- 31. National Mental Health Strategy and Action Plan 2020 Contd… Activities In fiscal year 2074/75 Community based Mental health program has been started at 6 districts (Panchthar, Mahottari, Dolakha, Lamjung, Kapilvastu, Kanchanpur).
- 32. National Mental Health Strategy and Action Plan 2020 Contd… Activities In FY 2075/76 Mental health program was scaled up in 14 districts as 2 districts per province (Morang, Terathum, Parsa, Sarlahi, Sindhupalchowk, Makawanpur, Syanja, Parbat, Arghakhanchi, Gulmi, Jumla, Kalikot, Doti and Darchula).
- 33. National Mental Health Strategy and Action Plan 2020 Contd… In FY 2076/77 Mental health program was scaled up in 21 districts as 3 districts per province (Khotang, Taplejung, Sunsari, Saptari, Dhanusha, Siraha, Dhading, Sindhuli, Lalitpur, Mustang,Baglung, Nawalparai – East, Pyuthan, Palpa, Dang, Salyan, Jajarkot, Dailekh, Dadeldhura, Bajhang and Baitadi).
- 34. National Mental Health Strategy and Action Plan 2020 Contd… FY 2077/78 No budget was allocated for strengthening of previously scaled-up districts.
- 35. Mental Health Gap Action Programme Launched by WHO in 2008 and the mhGAP Intervention Guide in 2010 with the aim of providing evidence-based clinical guidance to PHC workers for detection, diagnosis and treatment of mental disorders in primary care. It comprised intervention packages to be implemented at community, health facilities and health service organisation levels
- 36. Mental Health Gap Action Programme Contd… Community-level intervention packages Community sensitisation programme, case detection in the community by using the Community Informant Detection Tool (CIDT), treatment adherence support through home-based care and community counselling.
- 37. Mental Health Gap Action Programme Contd… The health facility level packages : Training and supervision of healthcare providers to detect, diagnose and treat mental disorders based on the WHO mhGAP Intervention Guide. The health organization level packages : Human resource mobilisation, procurement and supply of psychotropic medicines and referrals for specialised care
- 38. Article A study conducted on Process evaluation of a district mental healthcare plan in Nepal: a mixed- methods case study concluded the following barriers and facilitating factors:
- 39. Article Contd… Health organisation level Barriers • Mental health not being a government priority, no mental health focal unit/person in the MoH, and lack of basic psychotropic medicines in the free drug list.
- 40. Article Contd… Facilitating factor • Use of evidence-based intervention packages, particularly the WHO recommended mhGAP intervention guidelines. • Supportive role of the district public health office (DPHO) and psychiatrists in the district hospital .
- 41. Article Contd… Health facility level Barriers • low mental health literacy among PHC workers • heavy workload among PHC workers • frequent transfer of the trained health workers • mental health stigma among service providers
- 42. Article Contd… • lack of adequate physical facilities • particularly lack of private rooms for consultation • lengthy and complicated drug procurement and distribution process lack of a mental health supervision system in primary care
- 43. Article Contd… Health facility level Facilitating factors • Supportive role of the MoH and DPHO, motivation of PHC workers to learn about mental healthcare • Procurement of new psychotropic medicines through PRIME
- 44. Article Contd… Facilitating factors Initiation of case conferences by psychiatrist for mentoring and clinical supervision of the trained health workers.
- 45. Article Contd… Community level Barriers • limited mental health awareness • low perceived needs for mental healthcare and high level of stigma
- 46. Article Contd… Facilitating factors • Involvement of FCHVs • Use of CIDT as a strategy to increase demand for services • Mobilisation of a new cadre of psychosocial counsellors to deliver psychological interventions in the community.
- 47. Community Mental Health Care Package, Nepal, 2074 • The MoHP developed the Community Mental Health Care Package Nepal, 2074 in 2017 to facilitate implementation of the 1996 National Mental Health Policy. • It is guided by the principles of integration of mental health into primary care and the WHO Mental Health Gap Action Programme.
- 48. Community Mental Health Care Package, Nepal, 2074 Contd… The package is developed for standardization and uniformity in capacity building of non- specialized mental health professionals ensuring the availability and accessibility of integrated mental health and psychosocial support services (MHPSS) within the primary health care system of the country.
- 49. Community Mental Health Care Package, Nepal, 2074 Contd… National Health Training Centre of the MoHP has developed four different training modules for building the capacity of non-specialist service providers.
- 50. Community Mental Health Care Package, Nepal, 2074 Contd… General Objective To facilitate integration of mental health services into the primary health care delivery system of the country. Specific Objectives • To define the mental health and psychosocial support service packages at different layers of primary health care system
- 51. Community Mental Health Care Package, Nepal, 2074 Contd… • To define the minimum standard of the MHPSS services at different layers of primary health care system • To set the standard of the training packages and manuals for training and supervision of health workers and community volunteer like FCHV.
- 52. PRogramme for Improving Mental health carE (PRIME) • PRIME was a (2011-2019) eight-year multi- national research project funded by DFID (Department for International Development) UK to consortium partners in five countries (South Africa, Uganda, Ethiopia, India and Nepal)
- 53. PRogramme for Improving Mental health carE (PRIME) Contd… The overall aim of PRIME was to generate world- class research evidence on the implementation and scaling up of treatment programs for priority mental disorders in primary and maternal health care contexts in low resource settings which could be widely adopted by policy makers and practitioners.
- 54. PRogramme for Improving Mental health carE (PRIME) Contd… Focused on the four mental disorders which contribute to the greatest overall burden of disease; alcohol abuse, depression (including maternal depression), psychosis and epilepsy, and for which there was evidence of cost- effective interventions.
- 55. PRogramme for Improving Mental health carE (PRIME) Contd… PRIME developed an integrated a mental health care plan (MHCP) comprising packages of mental health care for delivery in primary health care and maternal health care
- 56. PRogramme for Improving Mental health carE (PRIME) Contd… It has been used to advocate for psychotropic medications for the free drugs list; develop a national level mental health curriculum for health workers; and provide input into the revision of the national mental health policy.
- 57. Guidelines for Prevention and Management of Psychiatric Illness during Isolation and Quarantine • Developed by the Psychiatric Association of Nepal. • To facilitate psychiatrists, other health care workers and policy makers to address the psychosocial aspects of Isolation and Quarantine
- 58. Guidelines for Prevention and Management of Psychiatric Illness during Isolation and Quarantine Contd… Focused on delirium, anxiety, depression ,grief, pre-existing psychiatric disorders, cognitive disorders, substance use disorders.
- 59. Guidelines for Prevention and Management of Psychiatric Illness during Isolation and Quarantine Contd… Promotion of mental health during quarantine and isolation which can be achieved through keeping isolation and quarantine as short as possible provide as much information as possible about the disease condition.
- 60. Guidelines for Prevention and Management of Psychiatric Illness during Isolation and Quarantine Contd… Providing adequate supplies, plan to reduce the boredom and provide communication, providing special attention to health-care workers and appealing for altruism.
- 61. Mental Health Care Centre in Nepal • Mental Hospital, Lagankhel • Transcultural Psychosocial Organization (TPO) Nepal • Aasha Deep Nepal • Centre For Mental Health And Counseling- Nepal (CMC- Nepal)
- 62. Mental Health Care Centre in Nepal Contd… • KOSHISH • The Centre for Victims of Torture (CVICT)
- 63. Mental Hospital, Lagankhel • Mental Hospital, Lagankhel is the first government mental hospital in Nepal. • It was established in 1985 and operated with 25 beds. • In 2003, the hospital extended its total beds to 50; there has been no further expansion. On average, 175 patients visit the OPD daily, many of them requiring admission
- 64. Mental Hospital, Lagankhel Contd… • Oral Substitution Therapy was started in 1994 and phased out in 2002.It was again restarted in 2011. • Telephone hotline service was started from July 1, 2010. • Community mental health program was started from February 2010 in Dhading and Nuwakot
- 65. Mental Hospital, Lagankhel Contd… • Extended outpatient service was started in 2068 jestha. • Emergency service in the hospitals was started from November 16, 2012. • Ambulance for service is available from 2014. • EEG service was started in 2014.
- 66. Mental Hospital, Lagankhel Contd… • General OPD ticketing Hours – 8:30 AM to 12 PM • Extended OPD ticketing Hours – 3 PM to 5 PM • Emergency – 24 hours (OPEN)
- 67. Transcultural Psychosocial Organization (TPO) Nepal • Non-profit, non-governmental organization, affiliated with Health Net TPO Netherlands located at Baluwatar, Kathmandu, Nepal. • Leading psychosocial organization
- 68. Transcultural Psychosocial Organization (TPO) Nepal Contd… Focused to develop local psychosocial, mental health and conflict resolution capacity and systems that promote community resilience, quality of life and self-reliance through education, research, service delivery and advocacy.
- 69. Transcultural Psychosocial Organization (TPO) Nepal Contd… Aim Promoting psychosocial well-being and mental health of children and families in conflict affected and other vulnerable communities.
- 70. Transcultural Psychosocial Organization (TPO) Nepal Contd… Vision and Mission Supporting peace, reconciliation and local capacity by improving psychosocial and mental health care in areas of chronic crisis and post conflict situations.
- 71. Transcultural Psychosocial Organization (TPO) Nepal Contd… Major activities and services • Research • Psychosocial intervention/program design and management • Capacity building • Clinical/ Counseling services • Advocacy
- 72. Transcultural Psychosocial Organization (TPO) Nepal Contd… TPO Coverage Professional staff of more than 40, including program/ project managers, a research team of 15, a training team of 10, clinical/counseling staff, and administrative, finance and support staff.
- 73. Transcultural Psychosocial Organization (TPO) Nepal Contd… TPO partners Works in partnership with multilateral, INGO and local organizations including UNICEF, UNHCR, Save the Children US, Nepal National Human Rights Commission (NHRC), CERI, World Education, International Committee of the Red Cross (ICRC), International Rescue Committee (IRC) and MS Nepal.
- 74. ASHADEEP NEPAL Established in 1991 as a non-profit and non- governmental, voluntary social organization located in Sundarijal ,Kathmandu. It started its work in partnership with the Sisters of Nazareth to release men and women who were in jail solely due to their mental illness
- 75. ASHADEEP NEPAL Contd… • Agreement with the Directorate of Jail Administration in 1995 to stop the imprisonment of mentally ill people without criminal offenses in jails of Kathmandu valley. • 34 out of the 46 mentally ill women from the prison were treated and rehabilitated in the first year.
- 76. ASHADEEP NEPAL Contd… • Currently it provides care to patient with total capacity of 40 beds in which 20 for male and 20 for female patients. • Separate male and female ward present with separate toilets and bathrooms. • Patients can be admitted for 3- 6 months duration only and taken by family members as per rule of the institution.
- 77. ASHADEEP NEPAL Contd… Vision: Vision of a healthy society where all can live with dignity, justice and respect. Objectives: • To treat people with mental health problems and rehabilitate them
- 78. ASHADEEP NEPAL Contd… • To provide psycho social support to family of mentally affected • To educate people on the importance of mental health • To motivate people to live with dignity and respect
- 79. ASHADEEP NEPAL Contd… Areas of work • Residential Program • Day Care Program • Outreach Program • Family/guardian counseling • Family Welfare • Public Awareness • Training
- 80. Centre for Mental Health and Counseling- Nepal (CMC- Nepal) Non-governmental organization established in May, 2003 located in Jitjung Marg, Thapathali , Kathmandu.
- 81. Centre for Mental Health and Counseling- Nepal (CMC- Nepal) Contd… Working in mental health and development by providing mental health and psychosocial services and by imparting training for developing human resources in mental health and psychosocial counseling.
- 82. Centre for Mental Health and Counseling- Nepal (CMC- Nepal) Contd… • Embedded at all levels of that system, from the smallest village to the district hospital right through to government policymakers. • Over two decades of work, they have expanded across 42 districts. • 12 medicines are free for psychiatric patient.
- 83. Centre for Mental Health and Counseling- Nepal (CMC- Nepal) Contd… Mission To promote mental health and psychosocial well- being of the people living with mental health problems in Nepal, especially children and women, by working closely working with the Line Ministries
- 84. Centre for Mental Health and Counseling- Nepal (CMC- Nepal) Contd… to develop human resource and with communities and community-based organizations to create public awareness and community empowerment.
- 85. Centre for Mental Health and Counseling- Nepal (CMC- Nepal) Contd… Vision People in Nepal become aware of mental health issues and persons living with mental health, and psychosocial problems live a dignified life and enjoy their rights to health services
- 86. Centre for Mental Health and Counseling- Nepal (CMC- Nepal) Contd… Programme • Community Mental Health and Psychosocial Support Programme (January 2022 – December 2025) • School Mental Health Program (January 2022 – December 2025) • Psychosocial support in SaMi (Safer Migration) Project Phase III (2019-2022)
- 87. Centre for Mental Health and Counseling- Nepal (CMC- Nepal) Contd… • Inclusive Community Mental Health Programme (January 2020-December 2022) • Psychosocial Counselling to Conflict Victims (CVs) (September 2021 – July 2024) • GBV Response Project in COVID-19 in Nepal (1st September 2021 to June 2022)
- 88. Centre for Mental Health and Counseling- Nepal (CMC- Nepal) Contd… • Psychosocial Support in GBV Prevention and Response Project – II (July 2021 to June 2024) • Promotion of Child Mental Health & Psychosocial Wellbeing in Community (February 2021 to December 2024 ) • Human Resource Development Unit (HRDU)
- 89. Centre for Mental Health and Counseling- Nepal (CMC- Nepal) Contd… Human Resources • Clinical psychologist (36) • Psychiatrist (200) • Psychiatric nurse (75-80)
- 90. KOSHISH Nepal • Established in 2008 as a National Mental Health Organization located in Kusunti, Lalitpur. • Working in the promotion of mental health and psychosocial well-being in Nepal.
- 91. KOSHISH Nepal Contd… It aims to create model recovery oriented person centered mental health services, which includes mental health and psychosocial support (MHPSS) in health as well as beyond the health system (i.e. social protection, employment, etc).
- 92. KOSHISH Nepal Contd… It conducts the advocacy and awareness program, community empowerment approach, MHPSS during emergency and crisis.
- 93. The Centre for Victims of Torture, Nepal (CVICT) • Non-profit, non-governmental organization that rehabilitates victims of torture, advocates the eradication of torture and promotes human rights within Nepal. • Established on 15 December 1990. • Located at Bansbari, Kathmandu.
- 94. The Centre for Victims of Torture, Nepal (CVICT) Contd… Provides professional medical, psychosocial and legal services to Nepalese men, women and children who are victims of torture, trauma associated with torture or inhuman treatment.
- 95. The Centre for Victims of Torture, Nepal (CVICT) Contd… CVICT has been providing comprehensive rehabilitation services for victims of torture and other human rights abuses to restore their human dignity .
- 96. References • Rai Y, Gurung D, Gautam K. Insight and challenges: mental health services in Nepal. BJPsych international. 2021 May;18(2). • Singh R, Gupta AK, Singh B, Basnet P, Arafat SY. History of psychiatry in Nepal. BJPsych International. 2022 Feb;19(1):7- 9. • Luitel NP, Jordans MJ, Adhikari A, Upadhaya N, Hanlon C, Lund C, Komproe IH. Mental health care in Nepal: current situation and challenges for development of a district mental
- 97. References Contd… • Gupta AK, Joshi S, Kafle B, Thapa R, Chapagai M, Nepal S, Niraula A, Paudyal S, Sapkota P, Poudel R, Gurung BS. Pathways to mental health care in Nepal: a 14-center nationwide study. International Journal of Mental Health Systems. 2021 Dec;15:1-9. • Nepal WHO Special Initiative for Mental Health Situational Assessment. Available from : https://cdn.who.int/media/docs/default- source/mental-hea Ith/special-initiative/who-special-initiative-country- report.
- 98. References Contd… • National Mental Health Strategy & Action Plan 2077.Available from: https://publichealthupdate.com/national-mental- health-strategy-action-plan-2077/ • Available from : https://www.tponepal.org/ • Available from : https://www.cmcnepal.org.np/ • Available from: https://www.koshishnepal.org/ • Available from: https://sujenman.wordpress.com/2010/09/20/ngos- hospit als-related-to-mental-health-psychology-in- nepal/
- 99. THANK YOU