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In the aftermath of the devastating 2015 earthquakes in Nepal, three non-governmental organizations collaborated to develop a program responding to the immediate mental health and psychosocial support (MHPSS) needs in three severely affected districts: Dhading, Gorkha, and Sindhuli. The program was implemented between April 2015 and February 2017 and aimed to (i) strengthen health worker capacity to provide integrated MHPSS services; and (ii) increase access to mental health services. This paper describes the program's implementation and the results of a pragmatic evaluation of the program's overall reach, effectiveness, and lessons learned.
The mixed-methods evaluation used routine program data, quantitative data from pre- and post-tests conducted with trainees and service users, and qualitative data from stakeholder interviews and focus group discussions.
A total of 1041 health workers received MHPSS training and supervision. Participants demonstrated significant improvements in skills, knowledge, and self-rated perceived competency. Trainees went on to provide MHPSS services to 3422 people. The most commonly identified presenting problems were epilepsy (29%) and depression (26%). A total of 67% of service users reported being ‘completely satisfied’ with the services received and 83% of those experiencing severe functional impairments on enrollment demonstrated improvement after receiving services.
Despite operational challenges, the program successfully engaged both laypeople and health workers to provide MHPSS in the aftermath of the crisis. Lessons learned can inform the planning and implementation of future training and integration programs to provide large-scale MHPSS efforts in humanitarian settings.
Humanitarian crises such as armed conflicts and natural disasters frequently unfold in countries that are already struggling with underlying economic difficulties, political instability, social marginalization, and poor overall health indicators. Persons with mental health conditions are at increased risk for human rights violations during humanitarian crises. Exposure to human rights violations is rampant during humanitarian emergencies, which, in turn, negatively impacts mental health. This chapter describes key human rights instruments and guidelines on mental health and psychosocial support in humanitarian settings. Specific challenges and approaches for promoting and protecting the human rights of persons with mental health conditions living in communities and institutions in countries affected by conflict and crises are discussed. These include barriers to accessing basic needs, insufficient availability of appropriate mental health services and supports, and limited access to social and economic opportunities. Recommendations include promoting a human rights framework as part of programs and services, increasing access to mental health services at the community level (including for severe mental disorders), protecting persons with severe mental disorders in communities and institutions, and providing comprehensive social and community interventions that promote full inclusion and participation.
This chapter highlights various issues related to mental health in intellectual disability (ID), and the kind of solutions that may be provided to meet the challenges in global mental health. The predominant view is that ID is associated with considerable burden because it presents special challenges not only to the individual but also to the family. Quality of life (QoL) provides an alternative to the traditional medical approach in that it emphasizes understanding, respecting, and providing what is important to and valued by each individual, and what aspects of life or the environment contribute positively to life quality. There is abundant literature on both individual and family QoL in ID, but there is no empirical evidence to suggest that the relationship between them is robust. Rather, the relationship is influenced by the level of disability and behavioral problems in the individual.
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