CMC-Nepal Community Mental Health and Psychosocial Support Programme Semi-Annual Report January – June 2019 Submitted to: TEAR 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 August 2019 Location of the Project: This project covers following 15 (rural)municipalities of the two provinces. Province No 1: Udayapur: Chaudandigadhi, Belaka, Triyuga, Katari Municipality and Rautamai Rural Municipality Okhaldhunga: Molung, Manebhanjyang, Chisangkhugadhi Rural Municipality and Siddhicharan Municipality Karnali Province: Surkhet: Panchpuri, Lekbesi, Gurvakot Municipality and Chingad Rural Municipality Jajarkot: Bheri and Nalgad Municipality Reporting year: January – June 2019 Name of the Project: Community Mental Health and Psychosocial Support Programme (CMHPSS) This is the first year of the sixth phase (2019-2021) of the Community Mental Health and Psychosocial Support Programme (CMHPSP), which is being continued in Udayapur and Okhaldhunga district and extended in Surkhet and Jajarkot districts in funding support of Tear Australia. CMC – Nepal has been continuously maintained the collaboration with the Ministry of Health and Population (MoHP) and Department of Health Services (DoHS) and its divisions mainly Epidemiology and Disease Control Division (EDCD) and National Health Training Centre (NHTC) at central level and with the Ministry of Social Development at provincial level. CMC-Nepal has signed Memorandum of Understanding (MoU) with all fifteen (rural) municipality to implement the project and the concerned (rural) municipalities also contributed funds to work in partnership in this project. In the changed federal context, CMC-Nepal is actively collaborating with local and provincial government to make them aware on mental health and psychosocial issues and increase their ownership to continue and sustain mental health and psychosocial service from the selected health facilities of the above mentioned (rural) municipalities. OUTCOME 1: Community people have increased access to mental health and psychosocial service at local level CMC-Nepal worked at 4 local level of Surkhet and 2 local level of Jajarkot districts to develop access of mental health and psychosocial service. CMC-Nepal contributed to increase access in additional 6 health facilities of those (rural) municipalities. 8 medical officers and paramedics of the selected health facilities of Jajarkot and Surkhet districts received mhGAP training in this reporting period. This training was organized by Ministry of Social Development of Karnali Province in technical support of CMC-Nepal. CMC-Nepal has made continued effort to strengthen the knowledge and skills of trained health workers of Udayapur and Okhaldhunga districts in mental health and psychosocial support. Mental health clinical supervision and Continued Medical Education (CME) was continued in all project districts to further build the confidence in diagnosis and treatment of people with mental health problems. The supervision conducted by the psychiatrist provided face to face interaction opportunity on the difficulties faced by the trained health workers and further built their confidence on the case management. Mental health service is available in 13 health facilities of 13 (rural) municipalities and CMC-Nepal will develop access in 3 health facilities in the second half of the year. Trained health workers provided mental health services to 3645 clients (1738 new & 1907 old) from their respective health facilities. Psychotropic medicine is made available by the local and provincial level government in 85% of health facilities which covered 70% of total demand. Similarly, trained nurse and Auxiliary Nurse Midwife (non-prescribers) provided psychosocial support to 45 clients in Udayapur district. Gender Based Violence (GBV) Prevention and Response Project, implemented by CMC-Nepal in Udayapur and Okhaldhunga contributed not only in the creating awareness on the importance of mental health and psychosocial health, but also provided mental health and psychosocial counselling service from the One-Stop Crisis Management (OCMC) centre and visiting families. 136 health workers of other than the referral health facilities and ward chairperson received 2 days mental health orientation in 5 (rural) municipalities of Surkhet and Jajarkot districts. The concerned (rural) municipalities organized this orientation in their own funding, where CMC-Nepal provided technical support. They identified and referred 61 people with mental health problems for mental health and psychosocial service in referral centre. Mental Health Social Workers (MHSW) visited 24 families and provided psycho-education and psychosocial support. They also provided psychosocial counselling service to 57 clients through health facilities and home visits. OUTCOME 2: The people with mental health problems and their families are able to work with communities and network with local government and DPOs to respect, protect and fulfilling their rights. CMC – Nepal involved in raising public awareness by organizing orientation and training in mental health and psychosocial issues to the people with mental health problems and their family members, members of women cooperative and mother groups, FCHV local stakeholders where 434 community members received such orientation in mental health and stigmatization. In the project district, including old areas nearly 20% of total cases diagnosed at health facilities were referred by mother groups, women cooperative members, FCHVs and members of SHG. Furthermore, CMC-Nepal conducted orientation to the student, teacher, child club member and CBOs on suicide prevention focusing on early signs and symptoms of suicidal thought and support and care to the persons with suicidal thoughts. 921 students (girls 522 and boys 399) from 9 schools of 6 municipalities of Surkhet and Jajarkot districts received basic orientation in suicide prevention. One peer group in each school is formed and started to capacitate them to know more about the risk of suicidal thoughts and referral mechanism for suicidal cases. Students and teachers have been sensitized in mental health issues and taught to contribute for the protection and fulfilment of the rights of the persons with psychosocial disabilities. In Udayapur and Okhaldunga districts, Mental Health Social Workers (MHSW) directly worked directly with Self Help Groups (SHG) to empower and make them able to work with communities and network with local government, DPOs to respect, protect and fulfil the rights of the persons with psychosocial disability. MHSW regularly provided management and technical support through attending monthly meeting and reinforcing their knowledge and skills on resource mapping, local fund raising and extending networking with DPOs and other related organizations for advocacy and lobby with the local government to continue mental health service, along with the supply of psychotropic medicine. In Udayapur, joint meetings among DPOs and SHGs were organized and those meetings prepared joint action plan to raise awareness in mental health and psychosocial issues and advocate with the local government to mainstream mental health and psychosocial issues in policies, programs and budget. In new project district, MHSW involved in process of formation of SHG through regular interactions and meeting with the people with mental health problems and their family members and in consultation with health facility and local level. OUTCOME 3: Government of Nepal upscale community based mental health program at national, province and local level CMC-Nepal activity engaged to organise the interaction meeting with local and provincial level government in order to sensitize them in mental health issues and ensure their cooperation in project implementation and its sustainability through the allocation of budget in mental health. Furthermore, CMC-Nepal arranged project monitoring visits, along with the participation of duty bearers from the local and provincial level in as part of advocacy and lobby to mainstream mental health into the health, education and development agendas. The regular interactions, meeting and their involvement in project monitoring provided opportunity to the elected representative and government officials to think horizontally and plan programs and allocate budgets in mental health as an initial initiative. As per agreed while signing partnership agreement, the five-municipality contributed NPR. 581,298 (Bheri municipality-156,426, Nalgad municipality-163,000, Gurvakot municipality-92,900, Lekbesi municipality-75,550 and Chingad rural municipality 93,422) for mental health orientation to the health workers, psychotropic medicines and awareness campaigns. Similarly. Ministry of Social Development of Karnali Province contributed NPR 320,000 for mhGAP training for medical officers and paramedics, mental health clinical supervision and psychotropic medicine. This mhGAP training was provided to the health workers of 8 districts of Karnali province in order to upscale community based mental program. 12 local government has included mental health in their annual programs of the year 2019-2020 and allocated budget in a range of NPR 200,000-400,000. CMC- Nepal continued its effort at central level also to integrate mental health into the existing health care delivery system through involvement in development of 10-years