Mental health in Nepal
Mental health is one of the least prioritised areas in the health care sector of Nepal. There is one national psychiatric hospital in Kathmandu run by Nepal Government, and three smaller psychiatry units in other hospitals. A few civil society organisations also run programmes and clinics providing mental health care, with a focus on awareness raising and psychosocial counselling and support towards access to medical care. Even with all these efforts, the majority of the population are still deprived of basic mental health services which impedes their quality of life.
The most challenging thing for many people with mental illnesses is that they are not accepted by family members and society, and people living with psychosocial disabilities often experience discrimination.
CBM and KOSHISH in partnership
In addressing the issue, CBM Nepal is working with KOSHISH, a National Mental Health Self-Help Organisation/ Disabled Peoples’ Organisation with the objective of improving the quality of life of people with psychosocial disabilities through early identification of mental illnesses, access to affordable treatment, support for social integration and livelihood security. The partnership started from 2010 and this was an important step in mainstreaming mental health and psychosocial issues in Nepal. CBM in partnership with KOSHISH is advocating and supporting user groups to challenge discrimination. A large part of our work is also to help and empower people to enjoy their fundamental human rights as envisaged by the UN Convention on the Rights of People with Disabilities (CRPD) and the Constitution of Nepal.
Mental health is one of the priority areas of work of CBM in Nepal, with a focus on empowering service users, enabling them to speak up for their rights, facilitating their active participation and capacitating the existing health workers. We are integrating community based mental health care into existing health systems of the government.
KOSHISH is actively working to rescue people who are locked up or chained, and left abandoned on the streets, by providing them with short term residential rehabilitation care and integrating them in their own communities. These interventions have helped people with severe mental illness to lead an independent life.
In addition, KOSHISH together with other mental health actors advocates with government to review existing mental health policy so as to be aligned with CRPD and also to integrate mental health and psychosocial services in the Primary Health Care system of Nepal. As a result, mental health is now included in the National Health Policy, the National Policy and Plan of Action on Disability (NPPAD), and the Nepal Health Sector Support Programme (NHSSP) of Ministry of Health.
Emergency response project following Nepal earthquake
After the Nepal Earthquake in 2015, CBM worked on emergency mental health and psychosocial support with KOSHISH. The project was implemented in 4 municipalities of Bhaktapur district. The overall project was divided into four clusters based on the availability of government health facilities. Appropriately trained human resources were in place to deal with people with mental health needs, and conduct Psychosocial First Aid (PFA). This project supported communities to build resilience, and obtain treatment for mental health conditions that emerged as a result of the trauma of the earthquake. The following are the major activities carried out during the time:
- Tailored Psychological First Aid (PFA) for people in distress
- Out-patient mental health services through the provision of clinics in primary health care centers
- Ensuring a regular supply of psychiatric medicine
- Linkage and referral to more specialised services where necessary
- Formation of Self-Help Groups
In total, over two thousand people benefited from the services over the 10 months following the emergency, and KOSHISH is now working with CBM’s support in a follow-up phase of the programme.