Integrating Mental Health Service Into Primary Health care System

Netra Bhatta, Health Team LeaderUnited Mission to Nepal

• “Mental health is as important as physical health to the overall well-being of individuals, societies and countries.

• However, only a small minority people suffering from a mental or behavioural disorders are receiving treatment”

• Source: The World Health Report 2001

No health with out mental health

• About 25-30% of the people in Nepal suffer from mental health problems

• Inadequate services and awareness leaves people in prison and streets

• A Mental Health Policy was passed by government long ago but it is not implemented properly

Mental Health Situation in Nepal

• 16% of deaths among women of reproductive age are due to suicide (MoHP 2009)

• Globally, 2% of total health budget is spent on mental health and 80% of that is in hospitals (Prince et al, 2007)

Mental Health Situation in Nepal(continued)

• Psychiatrist – 66 ( most of them are in private Medical Colleges and hospitals)

• Psychiatric Nurses – 62 • Clinical Psychologist – 14• Psychologist –100• Counselor – 100 • Occupational Therapist – 4 • Psychiatric Social Workers – None

Mental health HR situation

• Prevalence of common mental disorders:– Anxiety: 10%– Depression: 14%– PTSD: 2.2%– Hazardous alcohol user: 14%– Alcohol dependence: 2.4%

• Over 54% of the people seek help from Traditional healers and 39% from health workers as a first point of treatment

Preliminary findings of baseline study

• MH is not integrated into primary health service– Drugs, HMIS, Referral, Focal point, Training

curriculum and HR• Demand and supply gap is high• Sensitization of policy makers is low• No clear regulating body • No psychiatric social worker

There is still a big gap in MH

• 14% of global burden of disease are related to mental and neurological disorders

• PLWMD and their families are often stigmatized and discriminated

• PLWMD often can not access appropriate housing, work opportunities, schooling, financial security

• Families carry a heavy burden of caring for the ill person who often can not work and may have difficult behaviors.

Burden of mental disorders

• UMN has been a pioneer in mental health work in Nepal.

• Mental Health Program initiated in 1984 • Development of HR in Mental Health• Mental health services in jail and

hospitals• Mental Health policy in 1996

UMN’s history on mental health

• To ensure the availability and accessibility of minimum mental health services for all the population of Nepal.

• To prepare human resources in mental health.• To protect the fundamental human rights of

the mentally ill in Nepal.• To improve awareness about mental health,

mental disorders and healthy lifestyles.

National Mental Health Policy 1996

National Mental Health Network- Nepal (NMHN-Nepal)

March 2012

Member Organizations-NMHN

UMNSecretariat

KOSHISH

CWISH

TPO Nepal

CMC-Nepal NMHF

CVICT

HGCC

Maryknoll Nepal

Chhahari Nepal

MARC Nepal

RFN

Mukti Network

NSR

ANTARANG Kopila

FNC/Ankur

Merlin

ECTC

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• Mainstreaming of mental health services at PHC level is an effective approach in providing mental health care to the rural and disadvantaged people.

• Mental health needs multi sectorial initiatives from many community development programs.

• Awareness raising activities plays a crucial role for reducing public stigma and discrimination.

We learned some lessons

• The burden of mental disorders is great• Mental and physical health problems are interrelated.• The treatment gap for mental disorders is enormous• Primary care for mental health enhances access.• It promotes respect of human rights• It is affordable and cost effective.• It generates good health outcomes

Need for integrating mental health into PHC

• Anti-psychotic drugs in free list of medicines• BCC approach for reducing stigma and

discrimination• Multi-pronged and multi-sectoral approach • Standard implementation guide• Training of health workers• Strengthening referral System

Recommendations-Way forward

• Establishment of mental health focal unit at MoHP

• Increase the fund for mental health• Mental Health legislation in line with CRPD• Conducting more research on mental health• Evidence based programing

Recommendations-Way forward

Thanks