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. Mental health is not in the priority of the government of 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 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 any even a psychiatrist neither has any specific mental health services. Witnessing the dire need of mental health services in Dang, HFN has started incorporating community mental health services in our existing projects. Integration of Mental Health in HFN Clinic · Psychiatric care training to the HFN health team o Three physicians and a nurse received one-day training by a psychiatrist in training Dr Binita Dhungel in October 2017 o Two Physicians working in HFN clinic received a follow up webinar training from Shreedhar Paudel, MD, a psychiatrist working at Harvard Medical School in November 2017 · Psychosocial counseling training to the community health workers o FCHVs working in Saudiyar VDC, Dang received 3-day training from a psychologist Ms. Anuradha Acharya Mental health services integrated into the HFN clinic o HFN finalized the treatment protocol for Depression, Anxiety and Alcohol use disorder o Physicians trained on basic psychiatric care started mental health services in the HFN clinic in November 2017 ·
Community mental health services in HFN project sites o Psychosocial counselor Ms Bhumika GM was hired in February 2018 who has been providing individual and group counseling services at the HFN clinic, and mental health awareness programs in local schools and communities Psychiatric care and rehabilitation center In collaboration with a local organization, Movement for Inspiration Nepal (MOFIN), HFN has been actively working on establishing the proposed psychiatric care and rehabilitation center in Kuirepani, Dang. 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. - HFN raised about $15,000 from fundraising campaigns through social media and a fundraising dinner - MOFIN had a plot of land for the proposed center - America Nepal Medical Foundation (ANMF) agreed to provide $30,000 for the project - The local government approved the construction of the building for the center - HFN team assigned Mr Giriraj Paudel to coordinate, supervise and monitor the process of building construction - The building of the rehabilitation center is already in the process of construction Project summary: In collaboration with local organizations, local stake holders and other organizations, HFN will establish a psychiatric care and rehabilitation center in Dang. People with serious mental illness who are homeless, are left out by the family, or are locked or restrained by the family will be offered the free residence, and will be provided basic physiological needs. The residents of the rehabilitation center will be provided basic health care services besides ongoing psychiatric evaluation, treatment and rehabilitation. People with serious mental illness will get necessary support to utilize their skills and help them rehabilitate back to community.
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.