QUARTERLY NEWSLETTER MAY, 2020 Working to respond COVID-19 Pandemic The World Health Organization declared and also providing free tele-counseling have relapsed their mental health condition, COVID-19 as a global pandemic on March and psychological first aid services to the 12% have requested for immediate supply 11, 2020. So far more than 4 million people general people who are in need through of psychotropic drugs, 1% need emergency all around the world have been infected by existing human resources. KOSHISH has health service, 29% concern about mental the virus. It is more devastating that more been informing the general public about health and psychosocial wellbeing and 6% than 2 hundred thousand people have lost the services that we have provided through concern about psychosocial issues. their lives. The outbreak has created worry Public Service Announcement from the and panic among the general population radio which has reach far and wide across KOSHISH has developed a guideline for which is increasing day by day. and developed and disseminated online and tele-counseling, grief counseling, Information, Education and Communication phone follow-up and suicide prevention In Nepal, so far there are 121 persons and is providing these services in line with infected by COVID-19, however no death is materials regarding COVID through social platforms. Likewise, these information it. KOSHISH has also translated documents reported yet. On March 20, Prime Minister published by WHO to Nepali and shared of Nepal addressed people where he has been shared in various clusters that KOSHISH is part of as well. among its network of government and announced many restrictions to prevent non government organizations. The spread of COVID-19 which later turned into From the inception of lockdown, 559 documents are related to coping with a national lockdown. persons received various psycho-social stress on COVID-19 pandemic, addressing In this context, KOSHISH has initiated support services including psychological social stigma, helping children to cope with emergency psycho-social support for people first aid (PFA), tele-counseling, psycho- stress and mental health and psycho-social who are affected and are vulnerable to crisis education, follow up and referral. Some of consideration during COVID-19 outbreak. in response to COVID-19 pandemic. As an the highlights from the tele-mental health As the numbers are increasing day by day, immediate response, KOSHISH has been and psychosocial support services were that, carrying out follow up of persons with mental 27% lack adequate information regarding KOSHISH is looking forward to reach out health issues and psycho-social disability COVID-19 and safety measures related with to many more people in provision of it's it, 22% need immediate relief support, 3% services.

Mental health and psychosocial impact Highlights from the Services of COVID-19 : A Survey from KOSHISH

What might be the implications of COVID-19 on mental health and psychosocial wellbeing? 22% To understand the mental health and psycho-social impact of COVID-19 and lock-down on people living in vulnerable condition Need immediate including persons with disabilities, KOSHISH is conducting two relief support surveys at the same time. The surveys are related with assessment 27% 3% of Psycho-social impact of COVID-19 Outbreak and Lock-down Lack adequate Relapsed mental among general population and Mental Health and Psycho-social information on health condition Well-being of Persons with Disabilities in Times of COVID-19 COVID-19 and safety Outbreak and Lock-down. measures The results and recommendations from these surveys will create 1% baseline and generate evidences for future interventions and Need emergency advocacy to scale-up mental health, psycho-social support and health service counseling for people living in vulnerable condition, including persons with disabilities. KOSHISH aims to promote psycho-social 12% 29% well-being and provide support in areas which are considered as red zone for COVID-19 infection by the government of Nepal through Need psychotropic Concern about existing local network of National Federation of Disabled-Nepal. medication mental health and psychosocial wellbeing Moreover, KOSHISH is planning to scale-up psycho-social rehabilitation service for referral cases of persons with severe and 6% profound mental health condition and psycho-social disability. KOSHISH is also exploring for collaboration with like-minded Concern about organizations to work in both psycho-social support and specialized psychosocial issues mental health services. Psychological First Aid provided to construction Interaction Program on Suicide Prevention workers The construction workers at An interaction program on "National health problems. The presentation municipality of , arrived Mental Health Strategy and Action was followed by discussion where, from different part of country had been Plan" from the perspective of suicide one of the participants Mr. Madan severely affected by the sudden lockdown. prevention was organized by KOSHISH, Bhatt, shared "measures should be National Mental Health Self-Help taken to strengthen Tele-Mental Along with accommodation and health Organization with the organizations Health and hotline services in mental problems, they began to have psychological working in the field of Suicide Prevention health domain/services to expand issues. They were found to have fear at Entrance Café, Bakhundol on 18th and facilitate access to mental health about contagious virus, being deserted at March, 2020. services." the work place, anxiety about extended lockdown and food expenses. The main objective of the program Similarly, Sandesh Dhakal, a senior was to collect suggestions and psychologist from Tribhuvan University, As soon as the state of laborers was made recommendations on the current draft said that suicidal thoughts and ideation known to Palungtar Municipality, health of National Mental Health Strategy and are the result of the interaction between division in collaboration with KOSHISH Action Plan prepared by the government an individual and the society rather provided psychosocial support. Psychologist to make the document more focused in than the shortcomings of the individual Saraswati Mishra, from KOSHISH provided terms of strategy and issues of suicide alone. He also stressed that the focal psychological first aid (PFA) to the 17 prevention. Mr. Madan Bhatt, Executive Ministry to look after the issue should workers to address their fear, anxiety and Director of Health Foundation Nepal, Mr. be Ministry of Health and Population dilemma. The program was facilitated by Sandesh Dhakal, Senior Psychologist of rather than Ministry of Home and Community Psychosocial Worker Bipin Tribhuvan University, Dr. Kamal Gautam, affairs. It stigmatizes people and this is Ghimire, who further provided information Executive Director, Mr Pitambar Koirala, also a reason why suicide is considered and contact details of local bodies working Senior Program Chief, and Senior Project as a crime despite being caused due to for relief in the emergency. Along with Coordinator Ms. Parvati Shrestha of TPO the mental health conditions. the assurance of free health service by Nepal, President of TSOP Mr. Narendra municipality and instruction of deputy Thagunna, Mr. Bishnu Prajapati from Pitambar Koirala, from TPO Nepal, Mayor, Pampha Basel to the construction CMC and Advocate Sharmila Parajuli shared that while talking about suicide, contractor to bear expenses of the laborers and Mr. Binaya Pandey from KOSHISH it is only associated with awareness. food without cutting of wages, the workers were present in the program. However, there is not much talk about were relieved. One of the worker Pradip Rai awareness including quality services, so The program was facilitated by stated, now he can be relaxed and want to it seems that there should be programs Dr. Kamal Gautam by highlighting thank KOSHISH and municipality. to take this issue forward with the preliminary result of National Mental participation of multi-stakeholders. Health Survey. According to the Survey Medication suported for the conducted with 1647 participants, 13% At the end of the program, all the persons in need at Tanahun of the population had suicidal ideation participants stressed on the need to KOSHISH with support of CBM provided and 20% of children have mental health bring special programs for suicide the emergency psychotropic medicines to problems. Almost 80% of the mental prevention and awareness and to Shuklagandaki Municipality and Bandipur health problems starts before age 18 include them in the forthcoming Rural Municipality of Tanahun district and among the 10 leading cause of National mental health strategy and to distribute for about 30 persons with disability, 4 are associated with mental action plan with priority. mental health issues who have finished stock of their regular medicine. The municipalities coordinated with KOSHISH for requirement of medicine for the people living with mental health issues in those area. KOSHISH had sent PSA message about COVID-19 to Shuklagandaki municipality and and broadcast the message through local FM stations. Mr. Damodar Regmi, representative of a disabled people's organization, RECED, coordinated in the process of distributing the medicines. “In this difficult situation, this issue was completely blown away from our mind but I would like to thank KOSHISH for supporting the medicines for those people living with mental health issues and reminded us about how important it is in this situation.” said Mr. Regmi. Interaction Program on the Rights of Persons with Mental Health Condition

KOSHISH conducted two different interaction programs on the role of local level in the promotion of mental health and psychosocial disability. A total of 62 people including local people's representatives, employees of health, education and women's branches of the concerned municipalities, representatives of health organizations and other stakeholders were present in the programs held in Dudholi Municipality of Sindhuli and of Gorkha on February 28 and March 10, 2020 respectively. programs. The program was facilitated out that the disability identity cards The programs were organized with by Social Worker Manju Chhetri and should be easily accessible to those the objective of sensitizing the Psychologist Deepak Neupane of with severe mental health problems. people's representatives about the KOSHISH. mental health problems and the Chairperson of Gorkha Municipality rights of persons with psychosocial During the interaction session, Rajaram Pant shared the idea of disabilities and to motivate the Chairperson Mr. Ghanshyam Raut joining hands with KOSHISH in the stakeholders to include mental and and Vice Chairperson, Ms. Balkumari upcoming programs for the rights of psychosocial support programs in the Adhikari of Dudholi Municipality people with mental health problems. requested KOSHISH to provide the policies, programs and plans of the Likewise, Ishwori Regmi, head of list of persons with mental health municipality. health department of the municipality, problems in Dudholi Muncipality and The program held at the meeting hall of committed to make all possible efforts said that they have been providing Dudholi Municipality was presided by as per their need and assured that 6 types of psychotropic drugs to the Mr. Ghanshyam Raut, Chairperson of they shall immediately arrange free people and will provide additional Dudholi Municipality and the program medicines in the coming days at organized at Gorkha Municipality medicines at the health branch of the free of cost. Binod Dawadi, doctor at was chaired by Mr. Rajaram Pant, municipality for them. Gobinda Prasad Chairperson of Gorkha Municipality. Pahadi, Chairman of Ward no. 9, Gorkha Hospital, proposed to appoint The current state of mental health emphasized the need for establishing a psychiatrist to the hospital as the and the efforts being made in its a support system for people with mental health problems are very management were presented in the psychosocial disabilities, and pointed sensitive issues.

Number of people increased to get 3 received Disability ID Card mental health OPD service The staff member of KOSHISH has been able to KOSHISH has provided two events of mental health facilitate persons with psychosocial disability to receive OPD service for the persons with mental health and Disability ID Card from Siranchowk Rural Municipality. psychosocial issues at Palungtar Municipality and During the month of March, 3 persons including 2 Siranchowk Rural Municipaltiy of Gorkha district on 15th women from Harmi, Jaubari and Gankhu of Siranchowk March, 2020. Psychiatrist Dr. Barsha Shrestha facilitated received red and blue catagory of disability id card. the OPD where 40 persons were registered in the two The Community Psychosocial Worker of KOSHISH Mr. events of OPD service. The number of persons have been Jagadish Dhakal reported that there has been ongoing significantly increased to receive mental health OPD coordination with all ward offices of Siranchowk Rural service with the implementation of Inclusive Community Municipality to facilitate for identification of the Mental Health Program in Gorkha. persons and distribution of disability id cards. 4

Discussion on integration of Mental Health in General Health Services

KOSHISH conducted a discussion health problems can start under the said that rather than psychiatrists, program on the inclusion of mental age of 14 years in Nepal, all should people who claim as psychiatrists health in general health with the work together to change the negative are providing counseling and are Ministry of Health and Population on attitude towards mental health by prescribing medicine. One cannot 24th March, 2020. expanding integrated and multi- be psychiatrist or consultant by going Dr. Roshan Pokhrel, Director General of sectoral mental health services. through 3 months of training on the Ministry of Health and Population, Mahendra Shrestha, spokesperson of psychology. We need to set the criteria Spokesperson Mahendra Shrestha, the Ministry of Health and Population, which helps us to differentiate who can various physicians working in the said that after two or three years provide counseling and who can be Epidemiology and Disease Control at least one hospital in all 753 local called consultant. He emphasized that Division, Health Services Department, levels should start providing mental / if a person wants clinical treatment, the Directors working in various Divisions psychosocial health care as primary specialist should give him medicine. under the Ministry of Health and health care services so that common Population and other staff were present After that, he should seek other services problems can be addressed at local as well, if necessary. Similarly, all the in the program. level. participants in the program stressed The main objective of this program Director General of the Ministry of on the need to extend mental health was to find ways to provide mental Health and Population Roshan Pokhrel services to all levels. health services through the existing health services and to motivate all the bodies of the Ministry of Health to give Meeting to collect suggestions on the draft of importance to the services including mental health treatment. mental health strategy KOSHISH conducted a meeting to collect suggestions on the draft mental health Matrika Devkota, Founder Chairperson and Executive Director of KOSHISH, strategy prepared by the Ministry of Health and Population, Government of Nepal opined that mental health services on 27th January, 2020. The meeting was attended by staff from the KOSHISH and should be started in at least one of the experts working in the field of mental health. The meeting decided to review the hospitals in each state by providing draft and work on the suggestions with special focus on prevention and promotion manpower including psychiatrists, measures in addition to overall service provisions and submit the suggestions to the social workers and psychologists. He Ministry of Health and Population. added that more than 50% of mental

Capacity building training to staffs members working in field office

With the objective of enhancing Community Psychosocial Workers (CPSW), the introduction of mental health and social mobilization and advocacy skills Psychologists, Project Coordinator and psychosocial wellbeing, causes of mental of KOSHISH's staffs involved in the Finance Officer participated the training. health issues, identification of psychosocial implementation of inclusive community The training was focused on mental issues, how to stay healthy and making mental health program, 6 days capacity health and psychosocial support, social available of the support services were building training was conducted at mobilization and advocacy. The Project Besishahar, Lamjung from 27th February to Coordinator Mr. Dipak Neupane facilitated discussed. Similarly, Disability Rights 3rd March, 2020. Total 14 staffs including the session on social mobilization where Activist Mr. Tikaram Poudel and Planning Officer of Besishahar Municipality Mr. Megendra Pokharel facilitated the sessions on disability rights and advocacy. Illustrating about the difficulties faced by persons with disabilities, Mr. Poudel discussed about the need of improvements on the certain provisions related with rights and entitlements of the persons with disabilities. Mr. Pokharel ilucidated about the process of formulation of annual action plan and budget in local levels. He also discussed about the importance of planning to achieve the intended results in the project. 5

Reintegration of Marginalized Women with mental health issues

With the aim of supporting the most participants are treated well and supported The local government stakeholders of the marginalized people, especially women by their family members and community area of reintegrated beneficiaries have living with mental health issues by providing people. One of the participants said, "My become more positive to the issues of them with mental health treatment family’s perspective about me has changed; mental health and psychosocial disability and rehabilitation services, KOSHISH now they take care of my personal hygiene, after rounds of lobbying and advocacy in partnership with Mennonite Central respect me, and treat me as an equal." meetings. It was in those meetings with Committee has implemented the transit government stakeholders, KOSHISH sought Livelihood support has also helped the care service in Lalitpur. The 3 years of the and received their commitment to work for participants to be independent and make project was started on April 2017 and the the rights of the people with mental health some income for themselves. All the cycle has been completed on April, 2019. problems and psychosocial disabilities. participants who were provided goats are Through its intervention KOSHISH has been The project has impacted positively on the able to take good care of them. They all are able to bring about a gradual change in life of many beneficiaries as well as people in engaged in rearing goats and earning an the perspectives of the community people their communities. The community people income from the sale of those goats. They and the key stakeholders and garner their are sensitized and aware about mental have also been able to increase the number support for issues related to mental health. health problems which has contribute to from the goats given. One of the participants reduce the stigma related with mental shared, "I received not only goats but a The achievement from the project has health. While following up on participants, means for living my life independently shown in the figures below. the outreach workers found that most of the without seeking other people’s help." 123 119 19 1406 104 330 Marginalized women with Recovered women and Women are earning from Persons in the Reintegraed women were Government mental health condition girls reintegrated in their Livelihood support and communities have followed up via home visit representatives and communities. Remaining having adequate family increased knowledge in their communities. government staffs rescued and provided 4 women are undergoing and social support. on mental health and through Advocacy treatment at Transit Care treatment at Transit Care psychosocial wellbeing meetings Centre of KOSHISH. Centre. through psychoeducation.

Community Orientation on Suicide Prevention

Kalika Mother's Group of Udipur, Besishahar of Lamjung presentation and discussion followed by role play and district conducted a Women Empowerment and Leadership practical. The participants shared that they feel this training Development training where KOSHISH was requested was very important and useful for them and also need to take over a session to provide knowledge on mental further trainings so that they could gain more knowledge to wellbeing, mental health and psychosocial issues and suicide contribute for community awareness. prevention on 19th February, 2020. The Project Coordinator/ Psychologist Mr. Dipak Neupane and Psychologist Mr. Piyush At the end of the session, the participants were unanimously Gautam presented in the training to facilitate the requested agreed on that the suicide can be prevented, as before the session. Total 67 women members of Kalika Mother's Group training they thought that the suicide is a destiny of a person participated in the training. The methodology was verbal which cannot be changed. 6 MAY, 2020 My happy family : it's never too late

I am Devaki Devi Chaudhary. I live in Udaypur with my five children. My children are my world. . Twelve years back, two of my daughters started experiencing mental health conditions which crashed my world and my family scattered. I sought help from traditional healers but everything went in vain. Unwillingly, I was obligated to lock my daughters in a room where I KOSHISH KOSHISH KOSHISH KOSHISH used to tie my younger daughter's leg with a rope; imagine what might have gone through a mother's heart. After many dark years, I got to know about KOSHISH from my neighbor. After few assessment, KOSHISH started treatment of my daughters in Transit Care Services Center. Initially, I had no trust on the treatment and I hesitated to send my daughters to the Center. health condition improved. I cried farming. She takes care of the home Eventually, having no recourse I sent with happiness, looking at their in my absence. Whereas, I am relieved my daughters to the KOSHISH Center. transformation in mere four months. that my younger daughter can at least KOSHISH staffs used to communicate They were no more the same miserable take care of herself now. My daughters with me about my daughter's health girls. They look happy and different. are living examples for everyone in the on regular basis which helped me to My elder daughter is recovering faster community who once thought that overcome my hesitation and lack of than my younger one but I am more my daughters are burden. This was all trust toward KOSHISH. positive towards their recovery now. possible with the effort of my neighbor My daughters spent four months in My elder daughter supports me in and KOSHISH. I will always be grateful transit care Center and their mental every household works and vegetable to them.

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