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Integrating Mental Health Service Into Primary Health care System Netra Bhatta ,

Integrating Mental Health Service Into Primary Health care System Netra Bhatta , Health Team Leader United Mission to Nepal. No health with out mental health. “ Mental health is as important as physical health to the overall well-being of individuals, societies and countries.

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Integrating Mental Health Service Into Primary Health care System Netra Bhatta ,

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  1. Integrating Mental Health Service Into Primary Health care System NetraBhatta, Health Team Leader United Mission to Nepal

  2. No health with out mental health • “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

  3. Mental Health Situation in Nepal • 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

  4. Mental Health Situation in Nepal(continued) • 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)

  5. Mental health HR situation • 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

  6. Preliminary findings of baseline study • Prevalence of common mental disorders: • Anxiety: 10% • Depression: 14% • PTSD: 2.2% • Hazardous alcohol user: 14% • Alcohol dependence: 2.4% • Over54% of the people seek help from Traditional healers and 39% from health workers as a first point of treatment

  7. There is still a big gap in MH • 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

  8. Burden of mental disorders • 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.

  9. UMN’s history on mental health • 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

  10. National Mental Health Policy 1996 • 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.

  11. National Mental Health Network- Nepal (NMHN-Nepal) March 2012

  12. Member Organizations-NMHN

  13. We learned some lessons • 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.

  14. Need for integrating mental health into PHC • 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

  15. Recommendations-Way forward • 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

  16. 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

  17. Thanks

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