Introducing and providing sustainable mental health as an integral part of community health service-30 years experiences

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1 Introducing and providing sustainable mental health as an integral part of community health service-30 years experiences Pashupati Mahat, Ph.D. Clinical psychologist CMC Nepal Glob-Vac Conference

2 Nepal: a glimpse o Total Population: 27 million (CBS,2011) o Geographically : Mountain, Hill and Terai, o Country -Federal state waiting new constitution; transitional phase o There are 103 caste and ethnic groups, speaking 92 languages (NHDR 2009) 2

3 Mental health Situation of Nepal o Estimated prevalence rate >20% of total population (7 to 8.4 million people) o No epidemiological survey in mental health problems o 17% death due to suicide in women of reproductive age (MoHP/SSMP, 2009) o Risk factors include post-natal and pre-natal depression, experience of violence, gender of baby, family tension, migration, workload, poverty etc.. o GoN priority to mental health-16 /20 rank, not integrated in existing primary health care service o GoN endorsed mental health policy in 1996, no legislation o Human resources-80 psychiatrists, 18 Cl. Psychologists, 36 psychiatric nurses 3

4 Mental Health History Mental hospital established in 1964 by 1984 United Mission to Nepal (UMN) started a community mental health program in South Lalitpur district-pilot program 28% patient visiting PHC service have diagnosable mental health problem (Depression, anxiety etc), (Wright & Nepal, IOM journal) Department of Psychiatry - in first University hospital-1986 UMN MHP and Dept Psychiatry upscale community mental health program in 12 districts ( ) Training, awareness activities in community, supply of psycho-pharma UMN- MH Project phased out in

5 Mental health initiatives CMC-Nepal o CMC-Nepal is a national NGO, working in mental health and psychosocial field since 2003 o Main aim o Develop human resources for primary mental health services o Health workers, NGOs and CBOs o Advocacy for integration of mental health into primary health service o Sensitization on mental health- mental health well being and illness 5

6 6

7 Mental Health work in Community o Mental health services expanded in 32 districts >800 paramedics and 200 doctors trained Paramedics and school teachers trained in supportive counselling skill 47,099 people received mental health services from PHC facilities ( ) 7

8 Mental patients in PHCs , 5% 3687, 8% 12120, 26% 6979, 15% 4520; 10% Depression Anxiety Disorders Psychosis Epilepsy Conversion disorder Other Mental Illness 17596, 37% 8

9 o Gender differences o 63% female o 26% depression- 68% female o More suicides reported in female o Violence, war, burden of work, loneliness, poverty, stigma o Mental health workers- 65% male 9

10 Mental health perception o Caused by external factors (attribution) o Most patient turn to faith healers (traditional healers) o Reluctant towards modern medicine o Unavailability o New fear with medicine o Privacy, not listened well, no respect (control vs trust) o Stigma- family and society 10

11 Mental movements o Mental health problems listed in to HMIS PHC service, medicines in PHC level o Self help group movement-awareness, service demand o Training courses in MH adopted by MoH, practice of allocating budget for training o Psychological interventions for special groups- Excombatant (minors), PLHA, trafficked women, women working in entertainment area, brick-kiln (women and children), migration women and children, marginalized group o Mental health listed in long term health plan-ncd o Mental health legislation -draft 11

12 Mental health need assessment of freed bonded labor 12 workers in Eastern Nepal Evidence based research Efficacy of mental health services in PHC services , 2010 (CMC-N) Factors affects in using MCH services by mother of low birth weight child ( ) Fear, shame, domestic violence at home Trust, listening, acceptance, encouragement for good care practice QOL, coping skills and mental distress among caregivers of disabled children Prevalence study of children mental health problems Maternal mental health and child development-ongoing

13 Challenges o Research in mental heath o Prevalence in wider population, children, marginalised groups o Human resources o Serving attitude in mental health workers o Empowering people having mental health problems o Networking- share and compliment best practices- advocacy, awareness o Funding very low in government, donor agencies 13

14 Photoes- Mental Health Activities Mental Health Exhibition Advocacy Campaign Mental Health Services Provided by Health Worker National Level Mental Health Workshop 14

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