The long term goal of this innovation is to develop a cadre of primary health care workers (medical officers, health workers, community based psychosocial counsellors, female community health volunteers) who are able to recognize priority mental health problems and then provide appropriate interventions (e.g. psychotropic medication, basic emotional support, focused psychosocial counselling) and referral. This program is being implemented in the Dhading, Sindhuli, and Gorkha districts to promote psychosocial well-being of the population as well as ensure integrated and coordinated provision of psychosocial and mental health services into primary health care. This is accomplished through collaboration with local partners, the Transcultural Psychosocial Organization Nepal (TPO Nepal) and the Integrated Community Development Campaign Nepal (ICDC Nepal).
The program has the following objectives:
Regular coordination meetings with local stakeholders such as Ministry of Health and Population, District Health Office, District Development Committee, Village Development Committee, Women Development Office, local police, local political leaders and non-formal community leaders will be conducted to:
- Facilitate interagency coordination related to the provision of psychosocial/mental health services, building psychosocial capacity and directly providing psychosocial services, as recommended by the Inter-agency Standing Committee (IASC) guidelines4 and contextualized specifically for this emergency setting
- Help share common challenges, lessons learnt and best practices and making recommendations related to provision of mental health and psychosocial services
Several categories of prescribers (medical officers and health assistants), non-prescribers (health assistants (HA), auxiliary health workers (AHW), auxiliary nursing midwifes (ANM), mother and children health workers (MCHW)), community psychosocial workers/home based care workers, female community health volunteers, and psychosocial counsellors will be trained in mental health and psychosocial issues. Regular supervision and refresher trainings will be provided accordingly.
- In total, 120 prescribers from 52 health facilities in 3 districts (3 district hospitals, 8 primary health care centres and 41 health posts) were trained for 9 days using a standard package of training on mhGAP HIG5 training on mental health (contextualized for Nepal), basic psychosocial support, screening, assessment and management of the six priority disorders identified for this program
- In total, 130 non-prescribers from 76 health facilities in 3 districts (3 district hospitals, 8 PHCCs and 65 health facilities) will receive a 5-day training on psychosocial support topics, such as the general concept of mental health and priority disorders in the post emergency context of Dhading, Gorkha and Sindhuli, basic psychosocial support (knowledge and skills), screening and assessment of mental health and psychosocial issues, reducing stigma and referral.
- Community Psychosocial Workers and Home Based Care Workers will receive a 20 days course on common mental health and psychosocial problems and the six identified priority disorders (Depression, Suicide, Alcohol Use Disorder, Epilepsy, Psychosis and PTSD). They will identify mental health problems using the Community Informant Detection Tool (CIDT)6, assess the needs of the patient and his/her family, provide basic psychosocial support and refer to prescribers, non-prescribers and psychosocial counsellors. The HBCWs will be following up with the patients that are seen by the prescribers. They visit them in their homes to assure medication compliance and to provide psycho-education to the family members.
- Female community health volunteers (398 in Sindhuli and Gorkha, and a target of 225 in Dhading) will receive a 2 day basic training on mental health issues, the use of the CIDT and referral options.Some FCHVs will be hired as home-based care workers for the project and receive a one-day refresher training based on identified problems and challenges
- Community based psychosocial counsellors (17 in total, of which 2 existing staff of Integrated Community Development Campaign) have received a 12 day refresher training on focused psychosocial support using training modules that are endorsed by National Health Training Center.
- The clinical supervision of prescribers will be conducted once a month by the psychiatrist of TPO Nepal where prescribers are encouraged to make case presentations and discuss issues related to assessment and management of the case such as: history taking, making diagnosis, prescription and side effects of the drugs. The psychiatrist will provide feedback and finalize the diagnoses and management plans. If there aren’t enough case presentations, role-plays will be conducted to practice assessment and management plans.
- The non-prescribers will be clinically supervised by TPO Nepal's clinical supervisor to help them manage cases. The district based counsellors will also be supported and supervised by the district clinical supervisor by holding case conferences every month and running care for care givers workshops for the counsellors. The counsellors will conduct monthly supervision of FCHVs, Home Based Care Workers and Community Psychosocial Workers to ensure that screening tools are properly filled in and regular efforts are made to identify people needing mental health and psychosocial support.
Provision of mental health and psychosocial support services
- Screening and assessment of affected community members by FCHVs
- Provision of pharmacological treatment of mental health problems by prescribers.
- Provisions of individual, group and family counselling by psychosocial counsellors who provide problem-focused psychosocial counselling support to vulnerable children, women and families in addressing a range of issues such as moderate anxiety, stress or depression, social isolation, poor parenting skills, family conflict, domestic violence, and so on.
- In order to increase the access and coverage of mental health services, several community based anti-stigma campaigns, awareness programs and psychoeducation sessions will be organized using Information, Education and Communication (IEC) materials. In Dhading, there is a weekly radio program that is broadcasted with information about mental health and psychosocial issues and the services that are provided in the program.
To boost the morale of patients/family members and to sustain the recovery, a self-help group for stabilized mental health patients and their family members will be formed at the community level and they will be provided with seed money to undertake income generating activities.