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Annual Report January – December 2018

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Annual Report January – December 2018 CMC-Nepal Community Mental Health and Psychosocial Support Programme Annual Report January – December 2018 Submitted to: Tear Australia, Australia Prepared by: Centre for Mental Health and Counselling – Nepal (CMC – Nepal) Thapathali, Kathmandu Contact: PO Box 5295, Kathmandu, Nepal Email: [email protected] Website: www.cmcnepal.org.np February 2019 Location of the project: This project covers 20 (rural) municipalities of 5 districts from 3 provinces of Nepal as per listed below. Province No 1: Morang: Letang, Ratuwamai and Belbari Municipality Udayapur: Chaudandigadhi, Belaka, Triyuga, Katari Municipality and Rautamai Rural Municipality Okhaldhunga: Likhu Rural Municipality and Siddhicharan Municipality Province No 3: Rasuwa: Kalika, Gosaikunda, Amachhodigmo, Uttargaya and Naukunda Rural Municipality Province No 7: Dadeldhura: Parashuram Municipality, Bhageshowr, Nabadurga, Alital and Ajayameru Rural Municipality. Reporting year: 2018 Name of the project: Community Mental Health and Psychosocial Support Programme (CMHPSS) Short description of project’s current situation: This year is the final year of the fifth phase (2016-2018) of the Community Mental Health and Psychosocial Support Programme (CMHPSP), which was being implemented in Morang, Udayapur, Okhaldhunga, Rasuwa and Dadeldhura districts in the funding support of Tear Australia. This program was implemented in 24 health facilities of 20 (rural) municipalities of above mentioned 5 districts based on the signed a Memorandum of Understanding (MoU) with Ministry of Health and Population (MoHP) at central level and with (rural) municipalities at local level. CMC-Nepal continued backstopping and coaching to the prescribers (medical officers and paramedics) in mental health and non-prescribers (staff nurse & auxiliary nurse midwife) in psychosocial support and counselling in order to build confidence in providing quality mental health and psychosocial service. The senior auxiliary health worker (AHW), health assistants and medical officers are the prescribers who had received training and supervision in mental health and handle the cases with the medication as well. Non-prescribers are mainly ANM who had also received psychosocial counselling training and supervision from CMC-Nepal and involved in providing psychosocial counselling service. Basic trainings in mental health and psychosocial counselling was also organised for the new health workers and refresher training also conducted for the trained health workers of the project areas. At present, 45 health workers, including 7 medical officers are providing mental health service, whereas 33 ANMs are delivering psychosocial counselling service from 24 health facilities. 22 health facilities are found effective in providing mental health and psychosocial counselling service. Non-prescribers have provided psychosocial counselling service to 351 clients (256 new and 95 old) and prescribers have provided mental health services to 4110 clients (1840 new & 2270 old) in this reporting period. The training, backstopping supervision and distance coaching supported to increase the confidence of trained health workers in detection of mental disorder, prescribing appropriate medicine in right dose with adequate education of possible side effects. The self-satisfaction tools used in the research has revealed that the people with mental health problems and their care taker have responded satisfaction with mental health service of health facilities. More than 90% mental patient have expressed positive response with behaviour of health workers in health facility; health workers do listen their problem and service is effective and counselling helped in reducing sufferings and improved daily life functioning. The follow-up of the service recipients (people with mental health problems) at health facilities have been increased significantly (more than 90%) than previous years due to the effects of awareness activities in another project of CMC-Nepal called ‘GBV prevention and response project and community outreach program of Okhaldhunga Community Hospital. Around 65% people, who had received mental health service from the local health facilities, have improved their mental health wellbeing and engaged in routine activities and 35% are still in the follow- ups at local health facilities. 60% clients in total, who had received psychosocial support/counselling from the health facility, their psychosocial wellbeing has been improved more than 90%. Twenty percentage are still in follow-up sessions and remaining 20% have discontinued follow-up due to more time needed to travel to reach in the health facilities. Around 20% people having symptoms of depression, anxiety disorders and conversion disorder have received both mental health and psychosocial counselling service from the same health facility. CMC-Nepal organised interaction meeting with new elected representatives and government officials of the local level and sensitized them about the need of involvement of mental health and psychosocial counselling services through planning program and budgeting from the local level to sustain mental health and psychosocial service. As it is the final year of the project we more engaged in organizing follow-up meetings with the (rural) municipalities of Dadeldhura, Rasuwa and Morang districts, along with SHGs and DPO representatives. The joint meetings among the Self-Help Group (SHG) members and members of Disabled People Organisations was also organized at (rural) municipality level to seek cooperation and raise the mental health issues collectively, coming in the common platform as psychosocial disability is included under the UNCRPD and current Disability Act (2017). These regular interactions meeting helped to sensitize the elected members of the local government on the need of mental health and psychosocial service and almost 90% of the (rural) municipality had expressed their commitment to support psychotropic drugs and awareness campaigns in mental health through the allocation of funds in (rural) municipality planning and budgeting. The (rural) municipalities of Dadeldhura, Rasuwa and Morang have allocated the budget for the psychotropic drugs and awareness campaigns. SHG of Dadeldhura have been succeeded to receive funds from local governments (Parsuram municipality Rs. 100,000/-, Ajayameru rural municipality Rs. 50,000/- & Aalital municipality Rs. 100,000/-) for the mental health awareness campaigns and purchasing of psychotropic medicines. In Morang district Letang, Belbari and Ratuwamai Municipality is continuing supply of psychotropic medicine since 2018 January. With realising the need of expansion of mental health service in other health facility, the Chuadhangadi municipality of Udayapur Amargadhi Municipality of Dadeldhura and Belbari municipality of Morang allocated the funds for the mental health training of health workers, where CMC-Nepal provided technical support in the training. CMC – Nepal further involved in reducing social stigma associated with mental illness through organizing orientations for the students, mother groups, Female Community Health Volunteer (FCHVs), traditional healers, people with mental health problems and their families. SHG were mobilized in celebration of the world suicide prevention day, world mental health day and disability day. Nearly 50% of total cases diagnosed at health facilities were referred by SHG members, community psychosocial workers (of GBV Prevention and Response Project), mother groups and FCHVs and school students & teachers. CMC-Nepal worked closely with the people with mental health problems, their families, community people and duty bearers to respect, protect and fulfil the rights as stipulated in the Disability Act of Nepal. Four SHG groups were formed in Udayapur and Morang in this reporting period and Mental Health Social Workers (MHSW) regularly attended meetings and provided group sessions, training and backstopping support to 22 SHGs (including 4 new SHGs) in realizing their rights, preparing actions and moving ahead to execute the actions to fulfil their rights as other people. As per our internal observation performed by the SHGs, 6 SHGs from the exit districts (Rasuwa, Dadeldhura and Morang) and 2 SHGs (Udayapur and Okhaldhunga ) from continuing districts seems independent and remaining 14 needs regular support either from CMC-Nepal or DPOs. CMC-Nepal organized exit meeting with the elected representatives and government officials of the concerned (rural) municipalities of Rasuwa, Morang and Dadeldhura and handed over the program to the government. After the consultation and approval from Tear Australia, CMC-Nepal conducted research to find out the effectiveness of the project deliveries i.e. training, supervision, awareness activities and SHG initiatives. The recommendation from the evaluation research is considered during the development of next phase project document especially in strengthening capacities of health professionals. This report has been submitted to Tear Australia. With the constant effort at central level, the Government of Nepal had allocated the programmatic funds for the human resource development and awareness raising in mental health in 7 districts of Nepal. On request of the Primary Health Care Revitalization Division of Department of Health Service (DoHS), CMC-Nepal provided technical support in 3 districts to conduct 2-days orientation in psychosocial support to the ANMs and one day orientation in mental health for the Female Community Health
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