Mental health and human rights in Nepal.pptx

Mental Health and Human Rights in Nepal

1. Mental Health and Human Rights in Nepal Prof Dr. Nirmal Lamichhane Department of Psychiatry and Mental Health Gandaki Medical College and Teaching Hospital, Pokhara, Nepal

2. — Virginia Satir   “ We must not allow other people's limited perceptions to define us . ”

3. Overview Introduction History of Mental Health Services in Nepal Mental Health Protection and Act Challenges Future Perspectives Conclusion

4. World Health Organization ( WHO: “ Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity ” Worthwhile to note that WHO definition of health also includes mental well-being I ntroduction

5. Constitution of Nepal 2015 has recognized right to health as fundamental right of citizens Without distinction of race, religion, political belief, economic or social condition National Human Rights Commission (NHRC) of Nepal has put in high consideration for the promotion and protection of human rights of mentally disabled people, NHRC has included rights of people with mental disabilities as a priority issue in Strategic Plan 2015-20 I ntroduction

6. History of Mental Health services in Nepal Psychiatric OPD was established in Bir Hospital   P sychiatric inpatient unit with 5 beds   in Bir Hospital Pysciatric inpatient unit increased to dozen beds in Bir hospital P sychiatric unit with ten beds was created for military personnel at Tri-Chandra Military Hospital   1961 1965 1971 1976 History

7. History of Mental Health services in Nepal Drug Abuse and Demand Reduction Project   1995 1997 2006 2014s History Mental Health Policy adopted; MD Psychiatry initiated in Institute of Medicine ( IOM) Mental Health (Treatment and Protection) Act was introduced Nepal Health Sector Strategy ensured providing OPD & emergency services on mental health.

8. History of Mental Health services in Nepal Child Psychiatry Department was established in Kanti Children’s Hospital   2015 2017 2018 History Depression, psychosis, AUDs, epilepsy included in Basic Health Service Package 2020 Community Mental Health Care Package; WHO Mental Health Gap Action Programme ( mhGAP ) Ministry of Health and Population endorsed new National Mental Health Strategy and Action Plan

9. Mental Health (Treatment and Protection) Act, 2006 Protection All mentally ill person must be provided with proper protection by his/her family or guardian delegated by local District Administration Office In case of patient without family members or relatives, the local body shall provide protection A guardian nominated as per this act shall extend his/her guardianship towards mentally ill person’s rights. Introduction

10. Mental Health (Treatment and Protection) Act, 2006 Act against discrimination and maltreatment No person is authorized to make any kind of discrimination towards mentally ill person No adverse effect on physical or mental health of a mentally ill person shall be exercised by means of use of force, coercion and beating or others. Exception: this clause shall nor prove hindrance to taking control of mentally ill person, using humane methods, who poses a threat to him/herself , or others Introduction

11. Mental Health (Treatment and Protection) Act, 2006 Penal codes Following are considered a crime liable for penalties: For not providing care and protection by the guardian to the mentally ill person For damaging or destroying property of the mentally ill person Forced labour without salary Introduction

12. Mental Health (Treatment and Protection) Act, 2006 Right of a law suite Convicted under this act, a legal suite shall begin , proceed and resolved in the district court with the government as the plaintiff. Introduction

13. 2020 Mental Health Strategy and Action Plan E nsure easy and equal access to high-quality mental health services; I ntegrate mental health services into primary healthcare; M aintain participation, cooperation and partnership between government, non-government and private sectors; P rovide an evidence-based and comprehensive mental health service that is rights-based, participatory and inclusive . Introduction

14. 2020 Mental Health Strategy and Action Plan C onducting awareness campaigns to remove superstitions and myths related to mental illness and promote mental health ; P rotecting human rights of people with mental illness and psychosocial disability M onitoring and evaluation of program implementation at all three government tiers – central, provincial and local. Introduction

15. The scarcity and unequal distribution of specialist in mental health Total number in-patient psychiatric facilities is 25; number of beds is 500 Number of psychiatrists are around 200 currently; about 45 residents in psychiatry training; Only 0.36 psychiatrists per 100,000 people in Nepal Challenges

16. N o significant rise in the mental healthcare budget for many years I t accounts for less than 1% of total national health expenditure Lack of awareness on mental health P revailing stigma against mental Health Challenges

17. No national treatment center/ institution for recovery and rehabilitation of alcohol and substance use disorders Law enforcement agency perspective : recovery and rehabilitation comes with incarceration of offenders Challenges

18. Future Perspective PERSPECTIVE Range of Services Consultation, Collaboration Partnerships OBJECTIVES Residential , non-residential and day-care services Easily available, acceptable and affordable National standardized treatment package; multisectoral consultation Joint monitoring missions to monitor the human rights situation of mentally disabled person

19. Future Perspective PERSPECTIVE Prioritizing vulnerable populations Community mobilization OBJECTIVES Youth (especially youth out of home and school) Women Lower socio economic Homeless populations Complex comorbid presentations (e.g. substance use & serious mental health disorders ) Self-help groups & people with lived experience Social interactions & income generating activities Community based support can be provided by mental health patients, partners & their families  

20. Future Perspective PERSPECTIVE Media and Information Building Workforce OBJECTIVES Evidence based information to policy makers, community leaders, public, families of patients Communication specialists Translate research into brief and understandable packages Multi-discipline approach Mental health professionals; social workers, clinical and counselling psychologists, self-help groups, peer workers with lived experience

21. Future Perspective PERSPECTIVE Champions Monitoring and Supervision OBJECTIVES People with lived experience Families of those with lived experience Media or entertainment personalities Politicians Effective in influencing the public & create public awareness Continued awareness and sensitization activities at province and local level including locally elected bodies Ensure Safeguarding of human rights

22. Conclusion

23. References Singh, R., & Khadka , S. (2022). Mental health law in Nepal.  BJPsych international ,  19 (1), 24–26. https:// doi.org/10.1192/bji.2021.52 Rai , Y., Gurung , D., & Gautam , K. (2021). Insight and challenges: mental health services in Nepal.  BJPsych international ,  18 (2), E5. https:// doi.org/10.1192/bji.2020.58 Gupta, A. K., Joshi, S., Kafle , B., Thapa, R., Chapagai , M., Nepal, S., Niraula , A., Paudyal , S., Sapkota , P., Poudel , R., Gurung , B. S., Pokhrel , P., Jha , R., Pandit , S., Thapaliya , S., Shrestha, S., Volpe, U., & Sartorius, N. (2021). Pathways to mental health care in Nepal: a 14-center nationwide study.  International journal of mental health systems ,  15 (1), 85. https://doi.org/10.1186/s13033-021-00509-4 References

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