Upskilling staffat indigenous-led projects
The grassroots initiatives that we work with are run by wonderful local people. They have enormous compassion for people with mental health problems but typically don’t have the mental health skills and knowledge needed to provide high-quality support.
Trauma centre for trafficked and abused children, Kathmandu, Nepal
This invaluable centre in Kathmandu provides a safe place for children who have suffered abuse such as gang rape and forced prostitution and are now struggling with debilitating post-traumatic stress disorder.
To ensure these children receive the support they need, we have trained the centre’s staff since 2018 so they can offer effective treatment which is non-confrontational, culturally and age-appropriate, and avoids an over reliance on medication. This treatment includes talking therapies and art and play therapy.
Rescue centre for the homeless, Kathmandu, Nepal
This project supports homeless and marginalised people struggling with severe mental illness such as schizophrenia or severe depression. A significant proportion of its patients are women who have been abandoned by their families because of their mental illness.
Since 2017, we have trained staff on violence prevention and how to prepare people for life after they leave the centre. This includes educating patients about the importance of continuing to take their medication.
In addition, we’ve helped staff to organise group sessions that teach people about different aspects of wellness, including diet, family and social life. And we’ve worked with whole families to help them think about family dynamics, duties and responsibilities and how they can provide the most effective support to a loved one struggling with mental illness.
Dementia charity, Colombo, Sri Lanka
In Colombo, we worked with a charity that focuses on improving the quality of life of people living with Alzheimer’s and other types of dementias, and aims to enhance the wellbeing of their families and carers.
This involved us training and supporting staff to improve the services they offer. These include counselling, a befriending scheme, memory screening, a helpline and a support group for carers.
“Since working with Jaya Mental Health, the staff here feel much more confident supporting those with severe mental health conditions.
We’ve also been able to significantly reduce the use of restraint which has had a really positive affect on staff-patient relationships and the recovery process."
Sangita Laudari, Psychologist
Reaching remote communities
One of the key elements of our work is reaching and supporting people who receive no mental health support at all. Currently, this includes a vital but challenging project in a mountainous region of Nepal that has one of the highest rates of suicide in the country. In the future, we hope to reach many more remote communities across South Asia.
Training female community health volunteers in Ilam, Nepal
In rural Nepal, female community health volunteers (FCHVs) receive basic training before carrying out home visits to convey key health messages, including information about vaccinations, child birth and HIV prevention. Over recent years, this work has significantly contributed to a reduction in child mortality and an increase in the uptake of immunisation.
However, despite mental illness being prolific in rural communities, these health workers rarely receive mental health training. But now, thanks to our supporters, we are changing this. We are training FCHVs in basic mental healthcare and diagnosis, doing all we can to increase their status in their communities, and getting them involved in the shaping and delivery of services.
Already, this project has been so successful in Ilam that the local government has asked us to expand our work into other regions. This project has huge potential to be scaled-up in order to reach rural communities across South Asia.
Establishing mental health walk-in clinics in Ilam, Nepal
In the mountainous Ilam district, we have also established a monthly mental health walk-in clinic that assesses local people and provides them with medication and talking therapies. The people who attend the clinic are typically referred to it by female community health volunteers (FCHV) or hear about it on the local radio.
In addition to running the walk-in clinic, we are also providing specialist training to psychiatrists, nurses and medical students from the Nepal Medical College. The aim of this work is to establish sustainable, long-term mental health support for the people who live in the region.
Similar to our work with FCHVs, the local government in the region has asked us to establish walk-in clinics in other areas of this part of Nepal.
After 6 months of receiving treatment from our mental health walk-in clinic
76%of service users felt valuable and useful
70%of service users felt able to enjoy normal day-to-day activities
Increasing children’s access to mental health support in their communities
As in many areas of South Asia, children in Nepal are at high risk of being affected by factors which adversely affect their mental health. These include poverty, child labour, trafficking and exploitation, domestic violence, sexual abuse, and natural disasters such as earthquakes and flooding.
Despite this very concerning issue, mental illness in Nepal, and especially amongst young people, has been largely ignored. The government allocates less than 1% of its total health budget to mental health, and child and adolescent mental health services receive a negligible portion of this.
To change this unacceptable situation, we are constantly exploring how we can increase children’s and young people’s access to mental health support in their communities.
Training school nurses (starting 2020)
In 2019, the Nepalese government allocated 430 qualified nurses to schools across the country. This new role is of great significance for school-age children, and especially those living in rural areas. This is because a school nurse is often the only qualified health professional a child, as well their parents, teachers and sometimes whole communities, have access to.
Certainly, the introduction of the school nurses is a positive step in the right direction. However, because they typically work in isolation, receive very little support and lack mental health support skills, the nurses are currently unable to provide effective support to children and young people with mental health and emotional problems.
Thankfully, the Nepalese government has also identified this issue and asked us to train all the nurses so they have basic counselling and mental health nursing skills. A hugely important programme of work that we will begin in September 2020.
340,000Every year around 340,000 Nepali adolescents attempt suicide
430school nurses
21,500children
7provinces
We are training over 430 school nurses in life saving healthcare skills, reaching out to some 21,500 children and adolescents across the 7 provinces of Nepal.
Empowering nurses to improve mental health support
In South Asia, nurses (who are predominantly female) are often best placed to provide direct mental health support to people and shape services so they are as effective as possible. But in the region, nurses, and especially psychiatric nurses, are greatly undervalued and sit at the bottom of a hierarchy of decision-making power that’s dominated by doctors (who are predominantly male).
To change this situation, we are providing mental health training to nurses and campaigning for decision makers to involve them in the shaping of services.
Training general and psychiatric nurses in Gokarneshwar, Nepal
At a large training hospital in Gokarneshwar, we run training programmes for general and psychiatric nurses that help them to meet the emotional and mental health needs of their patients. This includes us teaching nurses how to communicate effectively with their patients to establish trust and rapport, and how to help patients become more invested in their own recovery.
We have also worked with the hospital’s psychiatric nurses to advance their understanding of different therapies, because medication was previously the only treatment on offer. From 2018, this has included an art therapist from Jaya Mental Health holding sessions for patients. Initially, their work was met with scepticism; but after witnessing how it helped people to explore their thoughts and feelings, the therapy has been well received by staff on the psychiatric ward.
On top of improving the direct support provided by female nurses, we’ve encouraged and trained these women to be active decision makers rather than passive receivers of instructions; and we’ve created opportunities for them to work with key decision makers so they can influence and shape mental healthcare services.
Overall, we believe this programme of work has the potential to totally transform mental healthcare and recovery in Nepal if it becomes embedded in hospitals throughout the country.
“As nurses, our experience is not always recognised and appreciated by others. Jaya Mental Health has helped me realise that I am of value to myself and others.”
Rekha Karanjit, Staff Nurse
“Jaya Mental Health helped me understand the importance of offering person-centred care on the ward. Being a good listener and caring towards those we work with can really make a difference in their process of recovery”
Pratikshya Rai Staff Nurse, Psychiatric Inpatient Unit
Increasing mental health awareness to protect vulnerable people
In South Asia, a lack of education and awareness means stigma and prejudice still surrounds mental illness. This frequently leads to people, including healthcare professionals, ostracising and discriminating against those with a mental health problem.
This is why we are working hard to ensure healthcare professionals, key decision makers and the general public understand and recognise the causes, symptoms and support options for mental health problems.
Training healthcare staff in Rawalpindi, Pakistan (starting Spring 2021)
According to the World Health Organisation, the prevalence of mental health disorders in Pakistan is steadily rising against a background of growing insecurity, economic instability and terrorism. The recent Covid-19 pandemic has made things worse. In addition, mental health care infrastructure is dilapidated and, in some cases, inhumane.
Despite the high incidence of mental illness, the vast majority of healthcare staff working across Pakistan’s health services are unable to diagnose or treat mental health problems, and many discriminate against patients with mental illness.
To improve this situation, we will deliver mental health awareness training to hospital-based healthcare professionals – this will include identifying mental illness, providing effective support, understanding the challenges of mental illness and the associated stigma and discrimination.
As a result, patients who have mental health problems will have their needs assessed and be provided with support that will improve their quality of life.
Be part of our journey