Community Mental Health Initiatives of HFN

​​Background: Almost one quarter of the Nepalese people suffer from some form of mental illnesses. Nepal has only one psychiatric hospital and the number of currently working psychiatrist is less than 60 in Nepal. About 4 in 5 people with serious mental illness do not receive any mental health care in low and middle income countries including Nepal. There are only 1.5 psychiatric beds per 100,000 population (only 112 psychiatric beds in government hospitals and 327 such beds are in private hospitals in Nepal), and the concept of psychiatric rehabilitation is still foreign in Nepal.  HFN has been running different health projects in Dang district of Nepal. The district with more than half million population does not have even a psychiatrist neither has any specific mental health services. Witnessing the dire need of mental health services in Dang, HFN has incorporated community mental health services in our existing projects. 

HFN provided  psychosocial counseling training  to the community health workers in our project sites. Psychosocial counselor Ms Bhumika GM and Yashoda Oli have been providing individual and group counseling services at the HFN clinic and communities. We have been providing mental health awareness programs in local schools and communities in regular services.
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Maternal Mental Health project: Smile Mothers
HFN has been implementing maternal mental health project since January 2019.   
As of October 2019, total 88 pregnant women and 366 post-partum mothers were screened for depression and anxiety by HFN team. Out of 88 pregnant mothers 28 had anxiety and 16 had depression.  Out of 366 post-partum mothers, 51 had anxiety and 19 had depression. HFN psychosocial counselors have been providing individual counseling to all the mothers with anxiety or depression in the communities. HFN has been providing free health services to all the mothers because of the ongoing support from HFN supporters and members.
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Psychiatric care and rehabilitation center is under construction (please click here for progress report)
In collaboration with a local organization, Movement for Inspiration Nepal (MOFIN), HFN has been actively working on establishing the a psychiatric care and rehabilitation center in Kuirepani, Dang with financial assistanve from ANMF. A team of mental health experts in HFN crafted a psychiatric care and rehabilitation plan targeting people with serious mental illness who are left without any support in rural communities of Nepal.

Detailed project plan for the psychiatric care and rehabilitation center
Basic health care: Severe mental illnesses are risk factors for many chronic medical conditions including infection, malnutrition, diabetes, dyslipidemia, hypertension and cardiac diseases. To address the medical issues of the residents, HFN medical team, in coordination with MOFIN volunteers and local hospital, will evaluate their health condition every month, and will provide appropriate treatment.  

Psychiatric care: A trained mental health team led by a physician will evaluate the residents every week and will provide treatment plan. A psychiatrist will supervise the mental health team, and will provide consultation regarding psychiatric care on a weekly basis. HFN will provide psychiatric care and rehabilitation training to existing HFN local health team in Nepal (a health assistant, a nurse and a physician) and 4 rehabilitation staffs (to be hired) so that they can identify imminent risk factors associated with severe mental illnesses, get immediate consultation from a psychiatrist, and refer them to a center with psychiatric facilities if needed. HFN will also provide monthly refreshing training on psychiatric care and rehabilitation to the staffs and health team.  

Psychosocial training: This program will be led by a trained psychologist. The recovery staffs comprised of one social worker, one nurse and two administrative personals will be part of the psychosocial skill training team.  This training will include daily groups focusing on the concept of recovery and exploring and promoting individual social skills, and weekly individual sessions promoting the concept of hope and recovery and supporting residents to reach individual recovery goals. The program will also utilize cognitive behavioral therapy (CBT), motivational interviewing (MI) and supportive psychotherapy techniques to support psychiatric rehabilitation. The local psychiatric rehabilitation team will receive ongoing training and supervision from HFN experts on mental health.

Transitional program on rehabilitation to the community: The rehabilitation team will coordinate the transition process with the support from families, relatives or concerned local agencies to make sure the residents completing rehabilitation in the center have appropriate level of support to make smooth transition back to the community. Once they have plan, they will be supported to be transferred to their own communities. If the residents do not have any place to go, they will be supported to find place to live independently. HFN will hire 2 health assistants and provide psychiatric rehabilitation training who will be the frontline community mental health workers to support transitional program. The graduate residents will be supported for their recovery plan via weekly home visits for initial 4 weeks followed by monthly home visits for 6 months. The community mental health workers will receive weekly supervision from a rehabilitation leader and relevant clinical support from HFN clinical team.

Psychiatric  training to the general health care professionals: As part of improving psychiatric care in general medical settings, we aim to provide basic psychiatric care training to the primary health care providers including physicians, nurses and health assistants working in local hospitals and primary health centers. HFN psychiatrists will provide the ongoing training focusing on identifying, treating and referring the people with common mental illnesses.