Emergency Psychosocial Support and Rehabilitation Program

Program Background

People with severe mental distress in Nepal are chained, tied, and locked up at homes or are abandoned in the streets. Such persons can also be commonly seen wandering in the streets. Mental health has been and continues to be a neglected issue in Nepal. The worst-case scenarios are seen in rural Nepal due to a lack of awareness of the seriousness of mental health issues. People with mental health problems are treated in the most inhumane ways possible. In most of the cases, the mental health problem begin with minor symptoms, but due to the lack of mental health knowledge and its attached stigma and discrimination, those minor symptoms create a huge impact on the lives of people living with mental health conditions. Nevertheless, it remains a silent epidemic and a neglected health issue in Nepal.

KOSHISH has been working in the field of mental health since 2008. From its very beginning, KOSHISH has focused on providing a dignified life through rescue and reintegration of people living with mental health problems. In 2015, when a devastating earthquake struck the country it caused unimaginable trauma resulting in an increase in cases of mental health problems. Before the earthquake, the short-term residential center was limited to female clients, but after the massive earthquake, the need arose for a male transit home and one was subsequently established. While the female center was opened in 2011 with a capacity of 40 beds, KOSHISH was able to open the male center only from the beginning of 2016 with a capacity of 30 beds. Under the Mental Health emergency support program, KOSHISH operates these two transit centers, separately for male and female, by rescuing abandoned people with mental health problems and providing them with emergency holistic psychosocial support, before reintegrating them into their families and communities. The transit center provides holistic care, combining medical expertise with human affection, to aid the timely recovery of the beneficiaries before they are reintegrated into their own families and communities.

KOSHISH facilitates the process of rehabilitation by identifying the client’s family, and providing psychosocial education to the family members as well as the community. Rehabilitation of the clients has always been a challenge for KOSHISH since there is an existing deep-rooted stigma, and discrimination in society regarding mental health issues in Nepal. These are especially prominent in rural areas. One of the greatest barriers that the recovered beneficiaries face is that of the community acceptance. Centuries old notions about the cause of mental disorder involve concepts of sin, taboo violation and witchcraft. To deal with this, KOSHISH works within the community framework, providing services that are culturally appropriate, and helping the beneficiary to restore their dignity by regenerating their agricultural skills and helping to them to have the ability to take part in the family and community life.

This program has become immensely successful in setting the example that mental health and psychosocial problems are treatable and can be managed through proper care and support, thereby challenging deeply rooted social stigmas and misconceptions. KOSHISH has played a pioneering role by working for the people, not in an artificial setting but in the community itself, to eradicate their bondage and allow them to lead a dignified life in their place of origin, a life in which they can exercise full freedom.

Vision:

To improve the quality of life of persons with mental illness through treatment and their reintegration into the family and community, providing them with the opportunity to live a dignified life.

Objective:

Provide multidisciplinary treatment (clinical, psychological and social support) in residential care to abandoned persons, especially women of reproductive age (WRA) with mental health problems and reintegrate back into their community living.

Program intervention:

Recue and Receive

Persons with mental health problems are rescued or received from streets or from locked up conditions at home. Awareness is created through psychoeducation given in the field, through social workers, mass media, or through the distribution of IEC materials. Similarly many were received based on referrals received from government organizations, non-governmental organizations, families and individuals.

Residential Care

Specialized care, including psychiatric treatment, psychosocial counseling, nursing care, and medication, as well as food and accommodation are provided to the beneficiaries of residential care. The beneficiaries are also involved in various recreational and therapeutic activities as a way of therapy, as well as relaxation.

Reintegration

Following recovery, upon the authorization of the psychiatrist, the beneficiaries are reintegrated back into their families and communities. In cases where the families were not identified, they are rehabilitated into other organizations that provide long-term care to destitute men and women.

Psycho-educationa and Follow ups

Following reintegration in the community, psycho-education programs are conducted for the family and community members, to provide sensitization on the issue, and to minimize the commonly held misconceptions about mental health. In addition, follow-ups on reintegrated beneficiaries are also made to understand how they are coping in familial setting, their current situation in their home, and their family's response towards them.