Community Based Rehabilitation (CBR) program was formally incorporated in regular program of KOSHISH in the year 2010. Before the initiation of CBR program some services for severe cases of mental health problems were present but services for people with mild and moderate mental health and psychosocial problems were limited. Traditional healing practitioners were highly regarded option for any mental health problems. Most of the services which were available used to view mental health and psychosocial problems from disease model. People with psychosocial problem used to hesitate to seek proper treatment due to existing stigma and discrimination.
In 2010, CBR program was introduced as a brain child of Mr. Matrika Devkota after frequent interaction with people and learning from Out Patient Department (OPD) and medicine services. The program intended to address the existing gap of proper community based mental health and psychosocial programs in Nepal. The efforts of KOSHISH were supported by Women and Children Offices, Social Welfare Ministry and CBM. CBR program was the first initiation of KOSHISH to make community involved in promoting Metal Health Psycho Social Wellbeing (MHPSW). As KOSHISH envisioned, "Psychosocial wellbeing for all", the involvement of community in very essential to achieve the vision. KOSHISH CBR also supports the Twin Track Approach of the organization with the overall objective of improved mental and psychosocial well-being of individuals and people with disabilities. CBR approaches to reduce stigma, discrimination and obstacles making services available in community, spread awareness about the issues, making community involved and advocating for friendly policies and laws. The KOSHISH CBR program ensures community involvement in both the program and the recovery process of the beneficiaries. This process supports the development of a sense of ownership by the community, people, and the agencies that make the program more sustainable. The main roles of the CBR program are the promotion of mental health and psychosocial wellbeing and prevention, and the care and rehabilitation of those experiencing mental health problems.
- Increased access of individuals and person with disability to mental health and psychosocial support services in community level
- Increased capacity of community to address mental health and psychosocial problems in community level
- Mainstreaming mental health and psychosocial issues
KOSHISH CBR program is currently being implemented in Bhaktapur, Lalitpur, Tanahu, Sindhupalchowk and Kavrepalnchowk districts.
STRENGTH and ACHIEVMENTS
CBR program adopt the community right based approach of work with psychosocial holistic methods. Every year 400 to 500 people receive psychiatric services from OPD supported by KOSHISH (more than 50 % are women)
- Similarly 400 to 500 people receive psychosocial counselling services (more than 50 % are women)
- 390 people with severe psychosocial problems are successfully reintegrated in family after psychosocial rehabilitation service (290 women)
- Treatment seeking behavior for psychosocial problem is improved in our working areas
- 100 people receive psychiatric medicine support from KOSHISH
Through our effort we were able to achieve following: -
- Most of Mental health and psychosocial cases have been managed in community level
- People with mental health and psychosocial problems have adopted better service seeking behavior
- Community program established organization in community level in short time span
- Counselling service are made available in community
- Enhance community capacity through orientation and training of stakeholders
- Develop evidence for mainstreaming and promotion of the issues
- Integration of mental health into health system
- KOSHISH has supported drafting government laws and policy through its continuous efforts and advocacy
- KOSHISH has inspired many organization for mainstreaming psychosocial support in their programs
- KOSHISH had worked for capacity building of community agencies for promotion of community mental health and psychosocial wellbeing (e.g. health)
- Radio program from national media house has helped mainstreaming mental health and psychosocial wellbeing
- Self-help group are taking initiation.
- Standard treatment protocol by government.
- Capacity building of Health professional
- Community involvement in referral, follow up, promotion and care
- Emergency Short Term Residential Center (2011): addressing abandoned and neglected people living severe MHPS issues and set an exemplary model where mental health problem are treatable and can be managed through proper care and support
- Change in working modality: from advocacy and specialized service incorporated in holistic model of community based MHPS support program with realization of importance of community involvement throughout the service delivery process
- Extension of CBMHPSS program (2014): as multi-year plan in 5 districts
- Integration of Mental Health Services: Primary Health Care System of government
- Capacity building of FCHVs: supported in identification, case referral, follow up and integration people with MHPS in their own community
- School Mental Health Initiatives (2015): assisted with tools and techniques to manage the psychosocial issues including Mass Conversion Disorder
- Extension of specialized care for male (2016): Establishment of Emergency Short Term Residential Center for males suffering from mental health and psychosocial issues after the earthquake
- Formation and mobilization of exclusive self help group: People with MHPS issue united as SHGs linked with livelihood support. This helps to break the social and stigma barrier among them
- Peer Support Group: Members have been prepared as self-advocates and have formed delegation to Ministry of Health, Primary Health Care Revitalization Division (PHCRD) and Leprosy Control Division i.e. focal point for disability