Establishing mental health walk-in clinics in Ilam, Nepal
The mountainous district of Ilam, Eastern Nepal is a region that has one of the highest rates of suicide in Nepal. Ilam is the location of our first mental health walk-in clinic, held monthly and providing the local community with free talking therapies, social support, and if they need it, medication. Jaya’s free mental health walk-in service 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 health volunteers (known as Female Community Health Volunteers, or FCHVs) or hear about it on the local radio; some walk over four hours to access this clinic.
So far, we have supported over 263 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
of service users felt able to enjoy normal day-to-day activities
70%
Since the clinics started the numbers of suicides in the region has reduced
77%
To find out more Jaya Mental Health’s work in Ilam, please read our latest report.
Training local staff
and 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, childbirth, and HIV prevention. But they report to our team a need to receive mental health training to be able to support the huge numbers of individuals with mental illness in their communities.
To change this, we are training HAs and FCHVs in basic mental healthcare and diagnosis, which helps them raise their status in their own communities and encourages them to shape the 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.
Increasing the skills and knowledge of local health workers is a key approach to creating a cost-effective long-term solution to the lack of mental health professionals in these regions. Our aim is to establish sustainable, long-term local mental health support for the people who live in rural regions and replicate our model of community mental health to many more areas of South Asia.
“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
Livelihood
Project
To complement the mental health 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. This project will engage this group in livelihood activities that not only bring additional income in the long-term but create a safe space to encourage healthy habits and routines to improve lives.
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.
Like in Ilam, the focus of this project is not only on establishing life-saving mental health walk-in clinics but also on training local staff and volunteers to create a long-term solution to the mental health crisis in this region.
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. We are also tackling the stigma and prejudice that often exists even in these healthcare settings, by improving knowledge and understanding about mental health support and therapies.
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, Nepal. This programme is helping nurses develop professionally, providing them with specialist training to promote nursing leadership capacity in Nepal. This project improves the work experiences of newly registered nurses as well as promotes skill sharing between senior and junior staff and creates 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.
”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.
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 can access the first ever community-based information resource centre solely dedicated to the nursing profession in Nepal. They are also 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.
Gokarneshwar training hospital
Successfully trained a group of general and psychiatric nurses in Gokarneshwar training hospital , Nepal, helping them meet the mental health needs of their patients.
”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
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.
Upskilling school nurses
We have successfully trained a group of 40 school nurses from one of the regions in Nepal. This pilot project helped upskill these nurses so that they can provide mental health and emotional support to some of the regions most vulnerable children and adolescents. Our team continues to support these school nurses, giving them access to mental health professionals to build their confidence and work through the more challenging cases.
We continue to explore ways we can connect with schools and young people in their communities, to raise awareness of mental health and fight the stigma that stops so many from seeking help.
For further information on our findings from the School Nursing Project, see our report here:
