The community empowerment approach of KOSHISH promotes self-empowerment, inclusive families, responsive governance, and a sensitive community for the wellbeing of persons with psychosocial issues and the elimination of barriers that restrict participation and inclusion on an equal basis with others. KOSHISH promotes full compliance with UNCRPD to ensure the rights of persons with mental health conditions and psychosocial disability and focuses on a person-centered right-based approach to model community mental health services that is replicable by the government and other stakeholders. The approach also emphasizes social considerations in basic services and security, strengthening support systems, and providing non-specialized and specialized services to persons with mental health conditions in line with Inter-Agency Standing Committee (IASC) Guideline.
Community Mental Health (CMH) Program
Community Mental Health (CMH) is one of the key programs to extend services in order to improve the quality of life of persons with or at risk of mental health conditions. The program is promoting mental health and psychosocial wellbeing in the communities through awareness and de-stigmatization campaigns. The program has been applying evidence-based practices and has envisioned a replicable model of mental health service in community settings. The CMH program contributes to mental health initiatives of the Government of Nepal, SDG Goal, and work towards ensuring ‘No one is Left Behind’.
This program focuses on:
- Empowerment and engagement
- Community mobilization
- Stigma and barrier reduction
- Wellbeing promotion
- Conducive environment
Projects under CMH Program
Overall objective : Improved quality of life of women, men, girls and boys living with and who are at risk of mental health and psychosocial disability in collaboration with Local Governments
Project Duration : 2019-2023 (five years)
Project location : Marsyangdi RM, Besishahar Municipality, Lamjung, Siranchowk RM, Palungtar Municipality, Gorkha
Target group : Direct: 5,400 persons living with or at risk of mental health and psychosocial condition, government representatives, health workers and volunteers, teachers, students, parents. Indirect: Family members, community people, political and community leaders.
Overall objective : Improved access to quality mental health and
psychosocial support services and quality of life of
persons living with mental health condition and psychosocial disability
Project Duration : 2020-2023 (four years)
Project location : All 10 rural/municipalities of Tanahun district
Target group : Direct: 2,500 people living with and at risk of mental health and psychosocial issues, persons with disabilities, women in pre and post- natal stages, school children, teachers, health workers, FCHVs, traditional healers, CBOs. Indirect: Family members, community people, political and community leaders
Overall objective : Minimizing suicide risk factors through multi-sectorial collaboration at Local, Provincial and Federal Levels of government contributing to the national commitment of reducing suicide mortality
Project Duration : 2021-2023 (three years)
Project location : Pokhara Metropolitan City and Sundarbazar Municipality
Target group : Suicide survivers and family members, vulnerable groups, health workers, police, FCHvs, teacher etc.
Overall objective : The resilience of the entire population of the Rural Municipality Panchakanya is strengthened through income-generating measures, improved WASH conditions, appropriate response strategies in the event of disasters and the care of those affected by mental disorders.
Project Duration : 2020 July – 2023 April
Project location : Panchakanya Rural Municipality, Nuwakot
Target group : 3,052 people directly reached through MHPSS, capacity building, and sensitization of health workers, community mechanisms, teachers, students and local government representatives. 30% of total population of the project municipality
will be indirectly reached through mass suicide
prevention campaign and media engagement. (Consortium with RSDC Nepal)
Key Achievements
Mental health and psychosocial support service
| Mental health and phsycosocial support service | Gorkha & Lamjung | Tanahun | Total |
|---|---|---|---|
| Emergency Psychosocial Care & Rehabilitation | 13 persons | 9 persons | 22 persons |
| Psychosocial Counseling and Therapy | 96 persons | 32 persons | 128 persons |
| Mental Health OPD | 387 persons | 387 persons | |
| Psychoeducation and Follow up | 844 persons | 111 persons | 955 persons |
| Coordination and advocacy meeting | 52 events | – | 52 events |
| Relief material Support | 196 persons | – | 196 persons |
| Support to receive Disability ID Card | 49 Persons | – | 49 Persons |
Capacity building of health professionals and volunteers
| Mental health and phsycosocial support service | Gorkha & Lamjung | Tanahun | Total |
|---|---|---|---|
| Capacity building of FCHVs on MHPSS and Suicide Prevention | 56 persons | 58 persons | 114 persons |
| Capacity building of Health Professionals on mhGAP, MHPSS and Self Care | 117 persons | – | 117 persons |
| Clinical Supervision to Health Professionals | 14 persons | – | 14 persons |
SHG members empowered on their rights
Four Self-Help Groups (SHG) of person with psychosocial disability has formed each two in Gorkha and Lamjung districts with a total of 29 members. The capacity building of existing SHG members in Tanahun and newly formed groups were conducted. A total of 89 members of SHG oriented on the basic rights of persons with psychosocial disability inline with the Constitution of Nepal, Disability Rights Act and UNCRPD.
Capacity building of health staff to provide quality mental health and psychosocial support services
KOSHISH provided six-days prescribers’ training to 30 health professionals (medical officers and health assistants) representing from local health facilities of Gorkha and Lamjung districts. The training was based on WHO’s mhGAP. 87 other health workers trained on basic mental health support, psychological first aid and self-care. The trainied health professionals were provided periodic clinical supervision that has enhanced the capacity of health professionals to provide quality mental health service.
A total of 93 Female Community Health Volunteers (FCHVs), 35 Gorkha and Lamjung districts and 58 from Tanahun district received 3-days basic mental health and psychosocial support training.
387 persons with mental health condition have received mental health service, follow up and referral from the trained health professionals. 17 cases of suicidal attempts and ideation were also successfully managed by those trainied health professionals in consultation with psychiatrist and psychologists. The access of community people to mental health and psychosocial support services in the project area is increasing.
Local governments are sensitized to prioritize mental health in their plans and programs
A total of NPR. 17,00,000 has been allocated by the project municipalities in Gorkha and Lamjung district for the promotion of mental health and livelihood of persons with psychosocial disabilities. Marsyangdi Rural Municipality has allocated budget for procurement of psychotropic medicines. Siranchok Rural Municipality has allocated for enrollment of persons with severe mental health condition in government health insurance scheme.
Case Story: Tele Mental Health– when technology meets psychosocial wellbeing need
During this COVID-19 pandemic, the tele-mental health service has offered many opportunities, including improvement of the individuals’ experience, increased mental health care access, and reduction of health care costs. Online clinical supervision from psychologists and psychiatrist to local health professionals has helped to manage most of the mental health issues at the community level. ‘I heard that a man was running towards Daraudi River to dive and end his life. I immediately ran towards the river, pulled him from the riverbank, and took him directly to my health post. He agreed to discuss the matter with a professional in a video call. I arranged a video call with an expert and managed the case from here. I had never believed that mental health conditions are treated and I could do that all myself!’, says Lalita Gurung, In-charge of Gankhu Health Post, Gorkha. She has already dealt with 7 cases of suicidal ideation and attempts during this lockdown. During this period, she has provided mental health service and counseling to more than 100 individuals under clinical supervision from KOSHISH.
Lalita has been working in the health sector for two decades. Last year, she participated in six days of training on mental health and psychosocial wellbeing provided by KOSHISH. After the training, she is regularly receiving online clinical supervision and mentoring from senior consultant. As many individuals are currently experiencing increased levels of stress, anxiety, and depression, mental health services must continue to prevent further decompensation and avoid potential consequences, suicidal thoughts, and attempts in the face of a pandemic that strains health care resources.
Relief materials distributed to people affected by pandemic
People living under extreme poverty and those who were affected by the pandemic in Panchakanya Rural Municipality, Nuwakot provided with relief materials by KOSHISH under the project supported by Malteser International. A total of 246 persons from all wards of Rural Municipality received basic food and hygiene items. The program was conducted from 21st to 25th December 2020.
Addressing the immediate needs of the beneficiaries, relief packages were distributed in line with government’s relief distribution guideline. Each package contained food items (rice, cooking oil, lentils) and non-food items (masks, sanitary pad, and soap bar).
