From the inception of KOSHISH, one of the important objective is to make Mental Health and Psychosocial Support Services available in the Community. KOSHISH has history of providing these services by making psychiatric services available in any one community health agencies per district and placing psychosocial counselors in the community.
Mental health in Nepal has been found less prioritized in government plans and programs. As the health professionals of all the field area of KOSHISH has less to no prior knowledge of MHPSW, there was challenges in the identification of the problem and proper referral. In health posts, the symptoms of mental health issues were over looked. Upon asking on mental health services, health professionals themselves thought that they are not liable for treating or managing mental health problems.
KOSHISH coordinated with District Public Health Office for organizing training of health professionals placed in community. KOSHISH conducted 5 days training for health workers based on mhGAP action program of WHO for prescriber. Similarly, for non-prescribers 3 days training was organized based on module one and three of training document on mental health and psychosocial support for health professionals working in health centers, district hospitals, PHCC and health post. It was published by National Health Training Center (Department of Health Service, Ministry of Health and Population, Nepal Government) to enhance their capacity to identify mental health problems and to provide first hand service as well as refer them to service providing centers.
“I have been working in the field of health from last 10 years. I have received many training on physical health but never have any training on mental health prior to KOSHISH’s intervention”. Health Post In-charge, Tanahu
The trainings of prescribers were facilitated by Psychiatrist, Psychologist, and Disability Experts. The trainings of non-prescribers were facilitated by Psychologist, Psychosocial Counselors and Disability Experts. The training evaluation was done using Pre-test and Training evaluation form (see annexes). The training follow ups are being done in involvement of Program Manager and Program Officer of MHPSS Program. The prescribers training were based on mhGAP and Standard Treatment Protocol which focus on identification, management and prescription for depression, anxiety, conversion disorder, schizophrenia, organic mental health problem etc. The major contents included in the non-prescribers training were:
In 3 events of Prescribers Training 46 prescribers participated. Among them 10 were from Bhaktapur, from 19 were from Kavre, 10 from Lalitpur, and 7 were from Sindhupalchowk. In 3 events of Non-prescribers Training 40 non prescribers participated. Among them 10 were from Bhaktapur, 15 from Kavre, 10 from Lalitpur, and 5 from Sindhupalchowk.
''Before the training I used to see complaint of clients from perspective of physical health only. I never thought that the symptoms might be because of mental health problems. Now I explore problems assuming there could be mental health problem also. I usually refer such cases to OPD of KOSHISH". Bishnu Dhakal, CMA, Panauti Health Post.
In early identification training 33 health professionals participated. Among them 28 were prescribers and 5 non prescribers. All prescribers from the training also participated in medical treatment training. In the trainings participants express training being effective in boarding their knowledge of MHPSW. The initial pre/post-test done with 12 questions questionnaire with non-prescribers done to see perception toward mental health and psychosocial problems shows average improvement from minimum 9 to 11, which shows the training was effective.
“My grandmother used to complaint for body aches and sleep disturbance over few years. We visited for physical checkup for multiple times with no progress. After training of KOSHISH we took her to psychiatric consultation where she was diagnosed with moderate depression and psychiatric medicine was prescribed. Now she no complain of physical pain and her sleep is also improved” Astha KC, Assistant Health Worker, Panchkhal PHC.
The trainings were evaluated in 8 dimension including venue and organization, relevance of the training, methodology and content, facilitation skills, duration of the training, encouragement for the participation, expectation met and applicability. Overall score was in average 37 out of 40 full score. Similarly, comparing prescribers’ pre-test and post-test scores shows the significant improvement as pre-test mean score of 23.47 was improved to 26.40.
“The open ended questioning technique discussed in training help to collect detailed information while history taking” Saru Shrestha, ANM, Panchkhaal.
“This training provided us knowledge which we can directly use in our work for helping persons with mental health problems in the way they should be helped” Dr. Poonam Rawat, Lele PHCC
KOSHISH was able to address the need orienting health professional on MHPSW through mhGAP and MHPSS training. The existing gap of MHPSS services was in process of addressing as health professional are able to prescribe basic medication, provide basic counselling support, follow up psychiatric patient and refer to higher facilities. At the same time training also supports to overcome hesitation of health professional to deal with mental health problems.