Establishing mental health walk-in clinics in Ilam, Nepal
In the mountainous Ilam district, a region that has one of the highest rates of suicide in Nepal, we have established a monthly mental health walk-in clinic that assesses local people and provides them with talking therapies, social support, and if they need it, medication. Via Jaya’s free mental health walk-in service, we brought mental health specialists to the region for the first time in its recent history. The people who attend the clinic are typically referred by local female community health volunteers (FCHV) or hear about it on the local radio; some walk over four hours to access this clinic.
So far, we have supported over 226 people but continue to receive growing levels of referrals showing there are still unmet needs in the local community.
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
Training local staffand volunteers
In rural Nepal, health assistants (HAs) and 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. However, despite mental illness being prolific in rural communities, these health workers rarely receive mental health training.
To change this, we are training HAs and 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. As part of this training, we raise awareness and understanding of mental health issues to tackle the stigma and prejudice that surrounds mental illness.
Tapping into this local resource is a cost-effective way of creating services when there are none. Our aim is to establish sustainable, long-term local mental health support for the people who live in rural regions.
“I can’t express my happiness and gratitude towards you and your team.I keep remembering you all every day and night that you came to our place and cured the illness that was so difficult to manage.“
Durga, a service user from our Ilam clinic
LivelihoodProject
To complement the medical support offered through our regular walk-in clinics in Ilam, we are engaging with a group of service users as well as FCHVs in a project that builds a secure livelihood for people with mental health problems. We will promote the use of selected life activities with the purpose of enhancing or enabling participation in roles, habits and routines in home, school, workplace, community and other settings.
This project will encourage the social inclusion of people with mental health problems and help fight the stigma and prejudice surrounding mental illness. The end goal is to help some of South Asia’s most vulnerable people, particularly women and girls, to earn an income, be financially independent and have an active, visible role in community life.
Bringing mental health care to Upper Mustang
Since the success of the mental health walk-in clinics and training of local staff in Ilam, the local government has asked us to expand our work into other regions of Nepal. Working with them we have identified the high-altitude, extremely remote Himalayan district of Upper Mustang as the next region we will focus our efforts on.
The 15,000 people in this district rely solely on one hospital with only eight members of staff, none of whom have any mental health knowledge or experience. Reports of the abuse of people with mental illness are common and levels of suicide are high. The work is challenging but with your support we can change lives.
Starting in November 2022 this project will develop from a needs-based assessment of Upper Mustang and be tailored to create a sustainable solution to the lack of mental health services in the district. Much like Ilam, the programme will establish life-saving mental health walk-in clinics but also focus on training local staff and volunteers to create a long-term solution to the mental health crisis in this region.
Nursing Mentorship Project
We are creating and delivering a new evidence-based framework of mentorship programme for nurses (newly registered and experienced nurses) at Bhaktapur Hospital. This programme will help nurses develop professionally, providing them with specialist training to promote nursing leadership capacity in Nepal. This project will improve the work experiences of newly registered nurses as well as promote skill sharing between senior and junior staff and create a confident nursing workforce.
This framework will be replicable to other healthcare providers and nursing employers in Nepal and recognised by the Nursing Division, Ministry of Health, Nepal.
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.
”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
My Safe Space “Aafnai Thau” -A platform led by nurses, for nurses
According to the Nepalese Department of Health Services, Nepal desperately needs an additional 45,000 nurses. However, Nepalese nurses are poorly paid, work in rigid hierarchical healthcare services dominated by doctors, and burnout is common.
The COVID-19 pandemic has highlighted all of the above problems, with health services struggling to cope with the impact of the pandemic. Most concerningly, the crisis has emphasized the fragile and at times unsafe circumstances in which nurses practice, and how their role is regarded by Nepalese society.
Born out of the COVID-19 pandemic, the ‘My Safe Space’ project provides a platform for both qualified and student nurses to connect, get support, and to grow both personally and professionally. Nurses are able to access the first ever community-based information resource centre solely dedicated to the nursing profession in Nepal. They are also be able to access one-to-one or group counselling therapy as well as workshops and training sessions focussing on mental health, confidence building and leadership.
”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
Reaching out to Nepal’s only mental health care hospital
The Mental Health Hospital, Lagankhel is the only public hospital dedicated to mental health in the whole of Nepal. There are only 47 beds to service a population of 29 million people and a total of 16 nurses and 7 ward attendants running the whole hospital.
To develop the staff here we have been delivering training on violence prevention, stress management and rapport building.
Our aim over the coming months, is to roll out a comprehensive, holistic new programme of training and development to the whole of the staff at the hospital and make this a centre of mental health clinical excellence in Nepal.
Some of our achivements
Trauma centre for trafficked and abused children, Kathmandu, Nepal
– we trained the centre’s staff to offer effective treatment which is non-confrontational, culturally, and age-appropriate and avoids over reliance on medication.
Dementia charity, Colombo, Sri Lanka
– we trained and supported staff to improve the services they offer to people living with Alzheimer’s and other types of dementias including counselling, a befriending scheme, memory screening, a helpline, and a support group for carers.
Rescue centre for the homeless, Kathmandu, Nepal
– we trained staff on violence prevention and how to prepare people for life after they leave the centre, many of whom struggle with severe mental illness such as schizophrenia or severe depression.
Rawalpindi, Pakistan
– we have delivered mental health awareness training to a range of hospital-based professionals – this included 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 have their needs assessed and are provided with support that improves their quality of life.
”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.”
Sangita Laudari, Psychologist
Upskilling school nurses
In 2021, the Nepalese government allocated 900 qualified nurses to schools across the country. This new role is of great significance to school-age children because often they are 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 complex mental health and emotional problems.
Thankfully, the Nepalese government has also identified this issue and asked us to deliver a pilot project to train a small group of nurses and create a module of training that can be delivered to all allocated school nurses in the future. The training will provide them with basic counselling and mental health nursing skills and to date we have successfully trained 40 Nurses from Surkhet District, upskilling them to provide mental health support to some of the region’s most vulnerable children and adolescents.
