LEADS' pioneering Mental Health Camps and mobile-enabled Follow-Up Clinics in Rural Nepal
Aug 12, 2024
LEADS Nepal, in partnership with BasicNeeds UK, has been running a mental health and development program in Baglung and Myagdi districts since April 2010. The program helps people with mental illnesses and epilepsy recover and supports their families with livelihood opportunities.
LEADS works closely with government health institutions to train health workers, improve mental health services, and influence policies. It also advocates for better access to mental health medicines and aims to integrate mental health care into rural health facilities. Through trained health workers and volunteers, the program raises awareness and ensures communities receive the support they need.
Mental Health Challenges in Rural Nepal: The Impact of Poverty, Violence, and Gender Discrimination
People in the program area face a high risk of mental illness due to poverty, violence, past conflict, and substance abuse. Hill districts have high suicide rates and many mental health problems, but the nearest mental health service is in Pokhara. Those with mental illnesses often face stigma and exclusion from family and community life. In severe cases, they may be locked up, violating their rights. Mental illness also creates challenges for employment—both for the affected person and their carers.
Women, especially poor and marginalized ones, are more vulnerable due to gender discrimination. They have fewer rights, lower literacy, and face high levels of gender-based violence, which is worse for those with mental illnesses.
Challenges in Mental Health Services in Nepal: Limited Access, Resources, and Expertise
In Nepal, access to mental health care is severely limited, particularly in rural areas. Local health posts lack mental health drugs, and district hospitals have only a limited supply. There's no emergency mental health plan in place, unlike the emergency protocols for general health, and many healthcare workers cannot prescribe psychotropic medicines due to strict regulations.
Nepal also suffers from a significant shortage of mental health professionals. The country has only 0.59 mental health professionals per 100,000 people, including 32 psychiatrists, 16 general doctors, 68 nurses, and 6 psychologists. There are no social workers or occupational therapists. The sole mental hospital in Kathmandu has just 50 beds and primarily serves low- and middle-income patients, with 750-800 inpatients and 23,000 outpatients annually.
A critical issue is the lack of government mental health services in rural areas, where most health institutions do not have trained staff. Private mental health clinics are unaffordable for the poor, placing a heavy financial burden on families seeking care for loved ones.
LEADS' Mental Health Camps: Providing Essential Care and Promoting Awareness in Rural Nepal
In the past nine months, LEADS has organized six mental health camps in two districts. These camps are conducted by a medical team from the Western Regional Hospital under an agreement with the head of the psychiatry department.
What are the goals of the Mental Health Camps?
- Provide free, specialized treatment and support for individuals with mental illness.
- Help district hospitals become recognized for mental health services.
- Reduce stigma and increase public understanding of mental health.
- Encourage people with mental illnesses and their carers to participate in service development.
- Ensure rural health facilities have enough services to support patients.
- Promote mental health prevention efforts by the government.
Identifying and Supporting People with Mental Illness in Rural Communities
LEADS sends social mobilizers to visit homes and inform families about mental health, raising awareness and the District Public Health Officer sends a letter to health post staff, asking them to invite local leaders, volunteers, and community groups.
After this, LEADS organizes meetings at village health posts, where 35-50 people attend, and the meetings last 3-4 hours to identify people with mental illnesses. Following the meetings, individuals with mental health issues and their carers are invited to attend the Mental Health Camp at the district hospital, where many learn about it from volunteers and health staff.
Challenges in Expanding Mental Health Camp Access and Integrating Services into the Government System
As awareness of mental health spread through health posts, volunteers, and media, more people attended the mental health camps, showing high demand for services. However, organizing monthly camps became difficult due to limited psychiatrists and high costs.
The western region has only two government psychiatrists, both working in private practice. While hospitals like Manipal Teaching Hospital are willing to help at a lower cost, they require registration in their system. LEADS focuses on integrating mental health into the government system, and government participation is crucial. Positive changes in the Health Management Information System are helping prioritize mental health in the region.
Overview of the Mental Health Camp Process
The bi-monthly camp is led by a senior psychiatrist with hospital support. New patients are registered into the government system, and those with other health issues are referred accordingly. The camp is divided into three sections:
- Registration Unit: Staff register new and returning patients, collect baseline information, and guide them to the next unit.
- Examination Unit: A psychiatrist and a senior health assistant conduct check-ups, with the assistant performing basic health checks before referral to the psychiatrist for diagnosis and prescription.
- Pharmacy Unit: Staff distribute pre-packaged medicines with dosage instructions, prepared in advance in Pokhara.
Patients receive a one-month supply and are advised to visit their nearest health facility for follow-up and additional medications the next month.
The Importance and Benefits of FOLLOW-UP CLINICS in mental health care
Follow-up clinics are essential in preventing complications and side effects, adjusting treatment as needed, tracking recovery, and assessing the financial and social situations of patients.
These clinics offer several benefits, including immediate guidance from psychiatrists, cost-effective and accessible services, and opportunities for skill development for health workers.
They also help increase mental health awareness, promote the integration of mental health services into the government system, and influence policy.
Additionally, follow-up clinics provide evidence-based advocacy for better mental health policies, ensuring a more effective and inclusive approach to mental health care.
Using MOBILE PHONES for mental health follow-up clinics
The growing demand for mental health services in Baglung and Myagdi districts has highlighted the need for sustainable follow-up care. By the third quarter, 245 individuals were receiving treatment at Mental Health camps, with 52% from rural areas. This surge in demand strained resources, affecting service quality and timeliness.
To address this, LEADS organized follow-up clinics at rural health institutions, staffed by trained personnel. However, the involvement of a psychiatrist was crucial for accurate diagnoses. Given the shortage of psychiatrists and challenges with remote visits, LEADS introduced mobile phone consultations as a cost-effective, practical solution. This approach enables rural health workers to consult psychiatrists remotely, ensuring continuous, high-quality care.
The initiative represents a significant step forward in overcoming geographical and professional barriers, offering a scalable, cost-effective model for expanding mental health services across Nepal.