Autism Care Nepal Society helps those with autism

ASHADEEP NEPAL
Introduction
Ashadeep Nepal was established in 1991 as a non-profit and non-governmental,
voluntary social organization. It started it’s work in partnership with the sisters of Nazareth to
release men and women who were in jail solely due to their mental illness. No hospital facility
could accommodate their needs. In addition, families of such patients had wrong ideas about
mental illness due to wide spread misunderstanding and stigma in the community.
Therefore, those families viewed putting their loved ones in jail as the only alternative to
struggling to manage their behavior at home. Their living conditions in jail were appealing. They
were treated inhumanely and had no access to psychiatric treatment.
Agreement with the Directorate of Jail Administration in 1994 to stop the imprisonment
of mentally ill people without criminal offences in jails of Kathmandu valley.
34 out of the 46 mentally ill women from the prison were treated and rehabilitated in the first
year.
Ashadeep Nepal’s Vision
Ashadeep Nepal has remained dedicated to those mental illness and extend its service for 25
yeras in order to reach more people impacted by mental health and work towards the vision of
a healthy society where all can live with dignity, justice and respect.
Objectives
➢ To treat people with mental health problems and rehabilitate them.
➢ To provide psycho-social support to family of mentally affected and reduce the burden.
➢ To educate people on the importance of mental health.
➢ To motivate people to live with dignity and respect.
Areas of work
1. Residential Program
2. Day care program
3. Outreach program
4. Family / Guardian counselling
5. Family Welfare
6. Public awareness
7. Training
Residential Program
It has a residential treatment and rehabilitation centre in Nayapati, Sundarijal about 14 km
from Kathmandu city. It has the capacity of accommodating 40 residents. We provide service to
patients with psychotic disorders, mood and some neurotic disorders and occasionally alcohol
and drug addiction.
Key elements to the service are:
Short- and long-term admission according to the nature of the illness.

Regular visit from a psychiatrist.
Occupational and vocational therapy activities
Families are educated on their loved one’s condition and are provided with emotional, practical
and financial support to enable rehabilitation.
Follow up of discharged patients through home visits and telephone contact.
Day Centre Program
It runs a day care centre in Katunge, Bhaktapur. A facility open 5 days a week, where
people with mental health problems can take part in a range of activities and outings to
promote social and independent skills. Not only is this important to promote well-being and
give structure to their day, it also shares the caring responsibility with families and makes it
easier for the person with mental health problems to remain living at home.
In addition, there is a monthly psychiatry checkup, where patients are provided with required
free medications
This homely and friendly center can be accessed by anyone diagnosed with mental illness
Services Provided in day care center
3 months to one-year enrollment depending on the nature of their illness and rehabilitation
Monthly assessment of the parents by a visiting psychiatric
Occupational and vocational therapy activities
Follow up home visits
Case studies
Community awareness program
Activities
General daily activities: yoga, meditation, personal hygiene, counseling,
Occupational/vocational activities: art, craft, making paper bag, straw mat making, sewing etc
Medication: provide regular medication free of cost during their attendance and also at their
home depending on their economic situation.
Outdoor therapy
Bhaktapur day care
Kathmandu day care
Outreach program
Consists of clinics with checkups and free medicine, draws on the resources of a team of
psychiatrists, mental health nurses and social care staff. In many of the areas targeted mental
health facilities did not exist. A recent success story for Aasha Deep has been the organization
of a monthly mental health clinic in Sindhupalchowk.
Over a year there was a significant increase of attendees, suggesting an increase in dialogue on
mental health in the local community was helping to breaking down stigma and myths. There
will be five more clinics running imminently.
A
Ac
ct
ti
iv
vi
it
ti
ie
es
s o
of
f o
ou
ut
tr
re
ea
ac
ch
h p
pr
ro
og
gr
ra
am
m
Home visiting

Mental health outreach clinic free OPD service. This OPD service takes place on every second
Tuesday of the month both Kathmandu and Bhaktapur by psychiatric consultant
Outreach program and Public awareness about mental health organized on 18 districts of Nepal
F
Fa
am
mi
il
ly
y a
an
nd
d G
Gu
ua
ar
rd
di
ia
an
n c
co
ou
un
ns
se
el
ll
li
in
ng
g
We conduct regular meeting for families of the affected people. These meetings are of two
types; Meetings for families of residential patients and meeting for all the families using our
other service.
The main purpose of the meetings is to:
Provide moral support and share experiences
Provide counselling
Raise awareness
F
Fa
am
mi
il
ly
y w
we
el
lf
fa
ar
re
e
Ashadeep Nepal has a provision for supporting family members who are in financial needs.
The family welfare program supports fulfilling the basic and simple requirements of the family.
P
Pu
ub
bl
li
ic
c A
Aw
wa
ar
re
en
ne
es
ss
s
It has conducted school mental health orientation session and clinics checkups and from
medicines in 72 districts out of 75.
It has utilized variety of media and conducted street plays and rallies to reach an even
broader range of people within society.
T
Tr
ra
ai
in
ni
in
ng
g
It provides training to healthcare provides to up to date their knowledge.
A
Ai
im
m
Primary Aims:
• To free all the mentally ill woman from the jail for treatment and rehabilitation.
• To stop the practice of keeping mentally ill persons in jail.
Secondary Aims:
• To provide treatment to all mentally ill women in Kathmandu jail.
• To locate the families of mentally ill women whenever possible.
• To provide information to pt’s family about mental illness, its nature, symptoms and
treatment.
• To make family ready to accept the pt’s back once they are better.
• To increase awareness in the society about mental illness, its nature, symptoms and
need for treatment and rehabilitation.
• To rehabilitate the mentally ill within their own families
Other information
Rehabilitation center (sundarijal) - Capacity for 40 patients.
Day care center- established day care centers in Patan, Bhaktapur and Kathmandu

Case studies (Home visit) - through outreach progamme, visit to patient’s monthly basis to
eastern, mid and western part of Nepal.
• Awareness-Information dissemination, mobile clinic, school and streets.
• Training- Provide training opportunities to people received various institution.
55 District, Mobile clinic in 5 Districts
Access to services:
✓ Through referral from institution and individual. Patient should have guardian with
them.
✓ Rehab service-60% paid seat-clients have to pay at the rate of NRS.50-250/day as per
their economic status.40% are free seat.
In day care the client can attend the service for 3, 6, 9 months and 1year duration depend
upon their condition.
Referral system
✓ Referral system needed with proper suggestion
✓ Regular consultation among institute.
✓ For severe case there is residential center in sundarijal.
✓ Refer to NMC (Nepal medical college).
✓ Refer to same doctor per visit at NMC-Dr.Pradip Man Singh (Head of psychatric
department)
Committee
1. Maggie Shah
chairperson
2. Dr Dhruba Man Shrestha
Founding Chairperson
3. Dr Surendra Sherchan
Vice Chairman
4. Shanker Raj Pandey
Board Member
5. Gyanu Shrestha
Board Member
6. Dr Pradip Man Singh
Board Member
7. Sister Roselyn Karakattu
Advisor

AUTISM CARE NEPAL
Introduction
Autism care Nepal society (ACNS) was founded on 2nd April 2008 on the occasion of the
World Autism Awareness Day. It is the only active autism organisation in Nepal that is run by
passionate parents that care for person with autism. It is a non- governmental, non - profit
making, non-political NGO administration office and affiliate to social welfare council. It was
founded by Mrs. Kalpana Ghimire and doctor Hem Sagar, parents of child with autism name
Sylvia. Since its foundation on April 2nd, 2008, the charity has come a long way with the
involvement of several others parents and experts. The executive council of ACNS was formed
on march 8th, 2009. The council was revised several times and latest revision was performed on
September 9th 2017. Dr. Sunita Maleku Amatya was elected as chairperson in 2011,2013,2015
and again in 2017. Again, Dr. Sunita Maleku Amatya and team was re-elected for second
two-year term on 9th September 2017. “Each executive member brings valuable expertise and
a passion for ACNS's work towards ensuring all individuals with autism live meaningful lives,"
added Dr. Baral.
Vision
"A society where PWA enjoy independent and dignified life".
Mission
"Empowering people with Autism to protect and, promote their rights and utilise their skills to
have a meaningful and effective participation in the society".
The main aim of the society is to provide help and support person with autism, their parents
and caretakers to improve quality of living and inclusion in the society.
Goals
A condition where there is:
➢ Easy access of PWAs to health, appropriate education, employment/ livelihood,
Empowerment, Social participation, use of all facilities, assistance and support,
reasonable accommodation, including all services facilities and opportunities connected
to their special needs as their rights.
➢ Sustainability of ACNS
➢ Accessible, unbiased and accurate clinical diagnosis, assessment, and therapies; for
children with autism.
➢ Adequate constitutional provisions, policies, laws to address the all human rights and
needs of PWA.
➢ Availability of legal representation and assistance to PWA and their representatives for
full protection of all legal rights.
➢ Equal access to and use of all facilities, services and activities in the community.
Objectives
➢ Raising autism awareness throughout nepal.
➢ Advocacy and lobby for health, education and social security provision for the person
with autism.

➢ Provide intervention services to CWAS.
➢ Continuation and development of specialized school for CWAS.
➢ Assist and support inclusive and integrated schools.
➢ A nationwide survey on autism prevalence in Nepal.
➢ Capacity building of staffs and caretakers to provide appropriate services in schools and
for ACNS.
➢ A training center to develop specialized professionals on autism in Nepal.
➢ Include rights of PWAs in national policies of Nepal.
➢ Strengthening vocational, speech therapy and occupational therapy units at ACNS.
➢ Establishment of parents network groups in different parts of Nepal.
➢ Increase overall capacity of ACNS to serve the needs of PWAs.
Services
1.Family Counselling
2. Assessment and Diagnosis
➢ Diagnostic Assessments
➢ Functional Assessment
➢ Occupational And Sensory Assessment And Intervention
3. Parents & Child Training Program
4. Occupational therapy for children with autism
5. Physio Therapy For Children With Autism
6. Music therapy
7. Art therapy
8. Aarambha Pre Primary School
Activities
➢ Research, education and awareness.
➢ Training and capacity building for school teachers, parents, caregivers and other
professionals through regular workshop.
➢ Development of professional like special educators and therapists related to autism.
➢ Lobbying and advocacy to improve the rights of persons with autism and their
caregivers.
➢ Strengthening vocational and occupational therapy units at ACNS.
➢ Enrollment of CWAs in readiness class for inclusive school.
➢ Home visit program.
➢ Fundraising to sustain the activities of ACNS and to develop National Center for Autism
in Nepal with overall facilities.
➢ Awareness, advocacy and orientation to stake holders of different districts of Nepal.

Branches of Autism Care Nepal:
Jhapa, Lalitpur, Chitwan, Kaski, Rupandehi, Gulmi, Surkhet
Future Plans
➢ Expansion of special school for children with autism.
➢ Consistent lobbying with government for development of inclusive and integrated
schools for CWAs in Nepal.
➢ A nation-wide autism awareness campaign.
➢ Create vocational trainings for persons with autism.
➢ Advocate for rights of person with autism in Nepal.
➢ A survey on autism prevalence in Nepal.
➢ Research on various aspects of autism.
➢ Training center to develop specialized professionals.
➢ Perform advocacy, preparation to create job opportunity for person with autism.
➢ A support living residence for person with autism.
➢ Decentralization of services in other parts of Nepal.
Finance
➢ ACNS had launched its major fund-raising initiative to meet the costs for building a
National Center for Autism called Autism Care Center Nepal since 2nd April, 2011.
➢ ACNS ask us to share their vision by sponsoring bricks at Rs.100 a piece. Buy one or buy
hundreds the choice is ours.
➢ Together, brick by brick, they can make it happen.
➢ All qualify income tax exemption (Income tax exempt organization under the Income
Tax Act 2058 Clause 2 (DHA) recognize by the Internal Revenue Department of Nepal).
Committee Members
•Chairperson- Dr. Sunita Maleku Amatya.
•Vice- Chairperson- Mr. Shyam Bhandari.
•Treasurer- Mrs. Kalpana Ghimire.
•Secretary- Mrs. Neelam Gautam.
•Executive members- Mrs. Anjana Mahara, Mr. Bidhan Shrestha, Ms. Kritika Lamsal.
Self Help Group for cerebral palsy Nepal
Cerebral palsy
Cerebral palsy is a neurological disorder that affect a child's movement, motor skills and
muscle tone. In most cases cp is caused by brain damage that develops while the baby is still in
utero or during or shortly after birth. There is currently no cure for CP, but there are numerous
treatment options that can help babies and children live quality lives.
Introduction
SGCP is a non-governmental and non-profit organization in Nepal dedicated for helping
and educating children and adults suffering from cerebral palsy and to providing emotional and
practical support to their parents. The organization was established in October 1987 with 6
children suffering from cerebral palsy in the Fiscal year 1986-87. The group is a team of medical
professionals, university teachers, parents of disable children a social worker with a common

desired to improve the quality of life of people with cerebral palsy. SGCP is an associate
organization member of International Cerebral Palsy Society, London. The organization has one
rehabilitation center established in 2005, situated in Dhapakhel, Lalitpur that consists of a team
of medical professionals, trained teachers and social workers.
Self Help Group for cerebral palsy Nepal:
Formation: 1987
Type: Non-Profit Organization
Location: Nepal
Affiliation: International cerebral palsy society, London
MISSION: To improve the quality of life of children and adults with cerebral palsy and
neurological conditions by providing comprehensive support and services.
GOALS AND OBJECTIVES
The objectives of the SGCP are to provide medical care, educational support, counseling to
children suffering from CP and their parents. It aims at helping the parents through different
interventions so that their children receive effective care on a long-term basis and
become independent within the limits of their abilities.
The objectives of the organization are:
➢ To help children, youth and adults in physical and mental disability conditions due to
cerebral palsy to lead a simple life and to be self-reliant through appropriate treatment.
➢ To provide emotional support to the parents of children with cerebral palsy and to
motive them to provide appropriate help and services to their dependent children on a
long-term basis.
➢ To rehabilitate all those CP affected cases through the proper use of available
community resources by maintaining close rapport with the parents.
➢ To conduct training to produce manpower necessary for providing appropriate
treatment and rehabilitation services.
➢ To build public awareness through Publicity of ways for prevention CP and reading
material on CP.
➢ To develop this institute as a resource centre for cerebral palsy
➢ To utilize knowledge and skills gain from this research finding of international research
agencies and associations.
EXECUTIVE COMMITTEE.
1.President: Dr Ranendra P.B Shrestha
2.Vice president: -Prof. Mukunda Prasad Maskey
3.Secretary: Mr. Mahim Rajbhandari
4.Treasurer: Mr. Kapil Dev Regmi
5. Chief executive officer: Mr. Bimal L Shrestha
6. Executive committee member:
- Mrs. Narwada Mathema
-Mr. Sushil Shrestha

-Mrs. Sarita Baryal
-Mr. Surendra Govinda Joshi
ACTIVITIES:
1) Cerebral Palsy Rehabilitation Center: This center mainly aims at educating the parents of
children suffering from CP and providing them with practical skills so that they are able to
support their children at home in order to avoid problems which might affect the development
of the child.
2) Special Education Program (SEP): SEP started in 1993 which aimed at providing primary
education and cognitive development processes for the children suffering from CP. The children
are assigned individual work, involved in group activities and given physiotherapy. Each child has
an individual plan according to their abilities and capacities.
3) Outreach programme: This is a home-based programme which extends its support to the CP
affected children in the outer district of Nepal which do not have access to the rehabilitation
center. This programme has active access to 21 districts of 77 in Nepal. It consists of a group of
trained home visitor to teach basic therapy skills and simulation techniques to parents of
children with CP.
4) Home visit programme: It consists of trained visitors who visit the homes of the children with
CP. The main function of this programme is to involve the parents in the rehabilitation process,
to teach the parents how to help their children through therapeutic exercise and to keep a
record of the home environment of the child with CP.
5) Day care centers (DCCs): Twenty-Five DCCs have been setup in fourteen districts, benefitting
over 275 children and their families. DCCs have continued necessary physical and cognitive
interventions to children with CP and neurological conditions within their community and with
parents’ involvement. SGCPs teachers, therapists and specialist doctor visit the DCCs on a
regular basis to provide therapeutic services and to train DCC staff and parents in rehabilitation
interventions. Home visitors have additional responsibilities like helping with technical aids,
clinic visits and referring cases to other. Also, they assist in obtaining disability cards which give
access to disability allowance, education fees, transportation customs and tax waivers and
more.
6)Phulbari Karyakram (PK): 62 children with cerebral palsy and their carers’ from 31 districts
are benefited from this programme. They have opportunity to stay in Centre for four, during the
time all the interventions available at the Centre for four weeks, during the time all the
interventions at the centre are provided as necessary. This programme also focuses on training
to carers in the care of the child as well as empowering them to stand in their community with
pride and comfort.
7) Care for Careers Programme(C4C): C4C started from November 2016 to empower careers by
using the Careers Worldwide (UK) model that comprises five core elements carers’ support
groups, health services including disaster preparedness, respite and short breaks, employment,
training and education and advocacy with the funding support from the funding support from
the Big Lottery Fund UK. Nearly 400 carers’ of children with cerebral palsy and other
neurological conditions have been connected conditions have been connected. Twenty-three
Carers’ support groups have been established at different locations in the Kathmandu under five
Carers Coordination Committees. All members are engaged in empowerment training. In this

year, over ninety-five carers benefited from health assessment camo, forty careers completed
Livelihood Training and eighteen carers got the Disaster Risk Reduction Training.
8) Technical Aids (TAs): This year over 100 sets of modified Tas were distributed to children with
CP. The use of TA directly empowers the children to improve their quality of life, enabling
participation in daily living, education, social, recreational and other activities. In this year, SGCP
received over 35 wheelchair seats and other equipment.
9)Volunteers / students: Total 92 national and international volunteers have participated in
different activities at SGCP Nepal. Some 62 students conducted placement internship at SGCP
and among them 6 were from international universities. outstandingly, over 350 national and
international.
According to Annual report income status in the FY2076/077:
S. N Programme In NPR
1. Donation 36,134,343.50
2. Government Contribution 2,708,754.00
3. Parent’s Contribution 1,748,475.00
4. Other income 444,607.20
Total 41,036,180.04
Strength
➢ It has been helping and educating children and adults suffering from cerebral palsy.
➢ It has been providing emotional and practical support to their parents from CP.
Limitations
➢ Though SGCP has provided support and medical assistance to the children affected by
CP, it still lacks in many areas.
➢
It has not been able to extend its capacity in order to incorporate a greater number of
children suffering from CP as chronically the organization lacks funds.
➢
This is a major problem as most of parents of the CP children refuse to invest in children
suffering from cerebral palsy because they think there is no return on the investment.
➢ There are very few medical professionals who are trained to diagnose people suffering
from CP, hence, the organization has few physiotherapists who also work as
occupational and speech therapists.
Recommendation
➢ Emphasis on parent’s awareness that their children also could live a productive life.
➢ Health professionals should be trained regarding Cerebral Palsy.
➢ Sufficient skilled health professionals should be recruited in such areas.

Chhahari Nepal
Chhahari-Nepal, established in 2007, is a non-governmental, not-for-profit organization
which was founded by a diverse group drawn from development workers, educationalists,
social activists and other professionals. Unlike many other development NGOs, Chhahari-Nepal
serves to directly put efforts for change in the hands of local people. It actively encourages
people to volunteer within their communities, aiming to unite all sectors of society in working
together to set up and run local projects. Chhahari-Nepal has a board of advisors and a board of
directors. Chhahari-Nepal also works in partnership with like-minded national and international
governmental and non-governmental organizations
Mission of the organization
Chhahari Nepal for Mental Health (CNMH) is a non-profit, non-religious, and apolitical
Non-Government Organisation (NGO), registered with the Government of Nepal. It was
initiated in 2003 and formally registered as an NGO in 2009. It is dedicated to the vision of a just
society, where the mental health needs and well-being of all women, men and children are
addressed. Chhahari Nepal's purpose is to facilitate appropriate support and treatment for the
homeless and mentally distressed individuals, so that they can be accepted back into society.
Board Members
CNMH Board Members 2021 - 2024
Ms. Mohini Lama - Chairperson
Dr. Chhatra Amatya - IPP
Ms. Ansu Tumbahangfe - Secretary
Ms. Rakchhya Maharjan - Treasurer
Dr. Dinesh Prasad Sharma - Executive Member
Ms. Anita Subba - Executive Member
Ms. Charu Arjyal - Executive Member
Staff
Bidya Maharjan :Programme manager
Ashmita Pariyar: Outreach worker
Dilu Buddha Magar: Admin/Finance officer
Work
The Street Project Report
The Welcome Centre
Awareness Activities
Advocacy
Fundraising
The Street Project Report
Since 2011, Chhahari has focused on working with mentally distressed men and women
on the streets of Lalitpur district through its Street Project’. The origins of the undertaking arose
chiefly due to the realization that we do not know enough of the conditions, needs and
perception of people living on the streets. The goal was therefore to gain an understanding;
and subsequently develop programmes and activities that are targeted to their needs. From the

onset, the Street Project has adopted an innovative and action learning approach, which
stresses reflective learning. Emphasis has been placed on building trusting relationships that
enable staff to connect with people living and coping with difficult circumstances, and to
respond to the unique condition of each person. This investment of time and effort remains a
corner stone of our organization’s philosophy and is considered essential in order to reach men
and women who have experienced profound and multiple exclusions. This created the
opportunity to be responsive to the uniqueness of each individual’s situation. It also allowed
CNMH to document the profound ways in which people experience multiple exclusions from
families, communities and the state.
To date, we have worked with 86 mentally distressed. Our one-year pilot (2011-2012)
showed that those who are wandering on the streets usually have families nearby who are
supporting them. This challenged our assumption that they were homeless. Rather they were
found to be disconnected from their families. Most were found to have given up, after long
struggles, as they did not know what to do or who to turn to for help. Rejection from private
mental health service providers were also not uncommon, especially considering that all the
families were poor with household incomes ranging between NPR 4000-5000 (GBP 25-31),
while monthly costs for treatments were NPR 1500- 2000 (GBP10 -12). Existing government
services were also found to be inadequate, discretionary and unresponsive to the diversity of
mental health needs.
Early on, our efforts were focused on providing food and clothing to the people we met
on the streets, and tracking down their families. But, this was just the beginning of our
involvement when we realized the need for a more holistic approach, which focuses on
providing medical treatment as well as psycho-social support to those with mental illness; and
their family members and carers, who were also found to be in need support systems. Presently
our core activities include:
➢ Securing and negotiating funds for affordable treatment options with existing
government, civil and private institutions
➢ Providing psycho-social counselling that is responsive to the physical, mental and
spiritual well being of clients, carers and family members.
➢ A day-care centre for clients and carers to allow them to express themselves (through
creative music, arts, cooking), build self-esteem (meditation, field excursions) and slowly
engage with others.
➢ Advocate for legal protection to safeguard vulnerable people from exploitation.
Capacitate social work trainees, volunteers and researchers to be more responsive to
the holistic nature of mental health issues.
The Welcome Centre
The Welcome Centre at Chhahari started in October 2013, as a direct reflection of the
needs of the men and women, with whom Chhahari was in contact through its Street Project.
The main objective of the centre is to offer multiple activities to allow clients and their carers to
engage in indoor and outdoor activities, take part in counselling sessions and creative classes.
During these sessions we aim to provide a safe and confidential relationship through which our
clients and carers will be able to say things that they might have not been able to share with

anyone else. We give guidance and suggestions on how to understand and resolve their mental
health conditions.
Activities are mostly centred around individual counselling sessions as well as group and
creative therapies with art, music, meditation, cooking and field trips. In between handicrafts,
music and food we also have discussions about mental health issues with the clients and their
family members. Discussions are chiefly centred around the clients' progress, problems faced
and assessments of the creative sessions. These are all free sessions, during which lunches are
also provided and they are also given money to cover travelling costs.
Till now, the response has been overwhelmingly positive with 15 clients and carers
coming regularly and showing encouraging signs of engagement. Our observations show that
their social skills have improved gradually as they are encouraged to engage with people, not
only within the centre, but also through guided outdoor activities and excursions. They are able
to communicate better and work together to have a good time for few hours a week. We have
gone shopping and motivated clients to buy things and talk to strangers. This has increased
their confidence and has helped us assess them whilst the session is ongoing (listening to their
speech, looking at their behaviour, etc.).One indicator of the success of the centre is that most
clients look forward to the sessions, with many arriving much earlier than the opening hours.
Equally significant has been the tremendous response from our staff and volunteers. After
observing and taking part in these sessions, many of our volunteers (in Nepal and abroad) have
gone on to donate their time and funds for other related activities. This has included, covering
the monthly medication bills of a few clients (who are most in financial need) to sponsoring
education and living allowances of carers. These generous donations, have not only allowed
Chhahari to expand its support but have also been invaluable to the clients that they reach.
Various suggestions have been given and duly noted such as more outings (to the zoo, a
picnic and outdoor games), dance classes (for exercising the mind and body) and a bigger room
to move around as well as to hold more clients and to conduct these sessions more than once a
week. We wish to take all suggestions on board and make our future welcome sessions more
vibrant and enjoyable.
Community construction
1. Community Learning Center: Not only to the school but we help to establish the learning
center in the community. Community learning center consists of library and computer lab.
2. Public school support programme: This program is carried out to those school and
community who need immediate construction in their area. We conduct the following works in
this program: School Building Students Learning Center School Toilet Reconstruction and
Maintenance of existing building
3. Orphanage support programme: Poverty and past conflicts have seriously affected the
people of Nepal. This situation has resulted in the deaths of thousands of people and turned
many children into orphans. The situation is even worst in the villages and because of this;
thousands of children arrive in urban centers like Kathmandu and other cities in search of jobs
and prosperous future. Unfortunately, the reality of city is very different from the charmed life
they’ve imagined. The children face torture and exploitation. Many of them work over 14-hours
a day in industries, hotels, and restaurants and many of the sleep in the street.
There is no government initiative to protect the children and their fundamental rights and

privileges. In this context, concerned citizens have opened orphanages and we have good tie up
with these orphanages within Kathmandu valley. If you have a strong enthusiasm and
willingness to make a positive impact in the lives of the innocent children, this is an ideal
project for you.
4.Health care volunteering: Nepal’s health sector is slowing moving towards standards seen
internationally. But the cost of using the facilities is very expensive and can’t be afforded by
poor people. The few government hospitals that exist are often poorly run and slow in
delivering their service. They are located in urban centers, away from rural areas where the
poor often originate.
Chhahari-Nepal has worked in conjunction with local health center of villages to offer health
projects for volunteers willing to help poor and serve humanity. During your work, you’ll treat
many poor and bring smiles to their faces. You’ll often work under the supervision of an
experience professional.
5.Environmental support programme: Nepal’s forest cover has been dwindling at an alarming
rate as demand for firewood continues unabated in Nepal. The growing human settlement in
forested land and industrialization has also intensified the problems. Many local
non-government and international organizations have been raising awareness against the issue.
The effect of this campaign can be seen with community forest and local initiative to halt the
march of deforestation. Realizing the need of nature conservation, Chhahari-Nepal has planning
to start a village nursery in a small rural village (Chitwan) where volunteers prepare seedlings of
different plant species and distribute free to local villagers and schools. There are frequent
nature preservation awareness and cleaning campaigns also. While working in the project,
volunteers can learn a great deal about nature, conservation efforts, work in nursery and
awareness drives.
6.Charity trekking
Day 1 : Arrival , Overnight in Hotel (Kathmandu)
Day 2 : Drive to Pokhara by tourist bus , Overnight in Hotel Lake Side
Day 3 : Drive to Nayapul (1,050m/1 & ½ hr) & Trek to Ghandruk (1,940m/5hrs)
Day 4 : Ghandruk – Chhomrong (2,170m/5hrs)
Day 5 : Chhomrong – Himalayan Hotel (2,920m/7hrs)
Day 6 : Himalaya – Machhapuchchhre Base Camp (3,720m/4hrs)
Day 7 : Machhapuchchhre Base Camp – Annapurna Base Camp (4,230m/3hrs) & descent
to Sinuwa (2,340m/4hrs)
Day 8 : Descend from Sinuwa to Tolka (1,700m/5hrs)
Day 9 : Descend from Tolka to Phedi (1,130m/5hrs) and drive back to Pokhara,
Overnight in Hotel Lake Side
Day10: Back to Kathmandu, overnight in Hotel Karma
Day11: International departure
Centre for Mental Health and Counseling-Nepal (CMC-Nepal)
Introduction
Centre for Mental Health and Counseling-Nepal (CMC-Nepal), is a national
Non-Governmental Organization (NGO) established in May, 2003 and is dedicated to enhance
and provide quality and affordable mental health and psychosocial counselling service. It works

on prevention, promotion, curative and community rehabilitation aspect of mental health
through various programs and activities in collaboration with the Government, I/NGOs and
CBOs. CMC-Nepal is registered in Kathmandu District Administration Office (838-059/060) and
affiliated to the Social Welfare Council (14822) of the Government of Nepal
Vision: Persons with mental health and psychosocial problems live a dignified life and equally
enjoy their rights as other people.
Mission: Promotion of mental health and psychosocial wellbeing by working in collaboration
with government, non- government and community-based organizations
Goal and Objectives
To develop CMC-Nepal as the centre of excellence in training, research and service provision of
mental health and psychosocial support & counseling in Nepal by;
➢ Working with community based organizations for community empowerment in
promotion, prevention, treatment, reintegration and rehabilitation of persons with
mental health and psychosocial problems
➢ Developing mental health and psychosocial support skills and knowledge among health
professionals, social workers and teachers
➢ Advocating and policy input for mainstreaming of mental health and psychosocial
services in primary health care and mandatory provision of school counseling.
➢ Support to establish effective response and prevention mechanism in GBV in health
service system and community.
➢ Raising awareness in mental health and psychosocial wellbeing and reduce social stigma
➢ Inclusion of disability in program designing and implementation
➢ Evidence based research in mental health & psychosocial area
Target Groups
➢ Persons living with mental disorders and psychosocial disabilities and their families, with
especial focus on children and women
➢ Persons affected by armed conflict and gender based violence, with special focus on
children and women,
➢ Migrant workers and their families left behind
➢ Persons affected by natural calamities & disaster including pandemic and living with
trauma
➢ Person with disability, children and women who at risk
➢ Health professionals, teachers, NGO/social workers, community members etc.
Thematic Areas of Work
➢ Adult and child mental health
➢ Psychosocial counselling
➢ Human Resource Development in Mental Health and Psychosocial Counselling
➢ Child protection

➢ Protection of human rights, with special focus on persons living with mental health
problems
➢ Advocacy and Awareness
➢ Peace reconciliation, by providing psychosocial counselling and support to persons
affected by GBV and conflict
➢ Research and Publication in mental health and psychosocial wellbeing
➢ Current Executive Committee (Formed on: 3rd October 2021, Sunday)
Current Executive Committee (Formed on: 3rd October 2021, Sunday)
Name Designation
Dr. Shankar Prasad Kalaunee Chairperson
Ms. Jyotshna Shrestha Vice Chairperson
Ms. Khagi Maya Pun Member Secretary
Mr. Bishnu Bhakta Kawan Treasurer
Dr. Mohan Raj Shrestha Member
Dr. Subhash Chandra Sharma Member
Ms. Bina Katuwal Member
Mr. Mahanta Babu Maharjan Member
Dr. Ananta Psd. Adhikari Member
Advisors
Dr. Kapil Dev Upadhyaya (Sr. Psychiatrist/ Former Chairperson)
Ms. Rebecca Sinha
(Former Chairperson)
Dr. Martina Bungert (Psychiatrist, Psychotherapist from Gernmany)
Ms. Raija Kiljunen (Clinical Psychologist from Finland)
Current Programme
1.Community Mental Health and Psychosocial Support Programme (January 2022 – December
2025)
The aim of this programme is to enhance access to mental health and psychosocial
services by integrating them into existing district hospitals, primary health centres and health

posts. This seventh phase of this programme is being implemented in 16 (rural) municipalities
of 4 districts (Okhaldunga, Udayapur, Surkhet and Jajarkot) of Nepal. CMC-Nepal, in
collaboration with the Non Communicable Disease and Mental Health Section of the
Epidemiology and Disease Control Division and the National Health Training Centre of the
Department of Health Service (DoHS), at central level, Ministry of Social Development at
provincial level & with local government at community level, has been conducting training on
mental health and psychosocial counselling support to government health professionals. Post
training supportive clinical supervision and backstopping is inbuilt within the training. It is also
creating awareness at community level through radio programs, awareness campaigns and
workshops with female community health volunteers (FCHV), traditional healers, mother
groups, teachers, health facility operation management committee (HFOMC) and other
community people. CMC-Nepal is also working with persons with mental disorders and
psychosocial disabilities and their family members to disseminate or educate them in mental
health, mental illness and its effects at individual, family and community level by encouraging
them to raise their voices for the protection of rights to services and other social benefits with
the formation of self-help group, for self-advocacy. Financial support for this project is provided
by Tearfund Australia.
2. School Mental Health Program (January 2022 – December 2025)
CMC-Nepal is implementing School Mental Health Program in close collaboration with
the Ministry of Education, Science and Technology (MoEST) at central level and with (rural)
municipality at local level. This programme promotes the psychosocial wellbeing of children
and adolescents in school, and develops access to psychosocial support for those who have
emotional and behavioral problems, learning difficulties and developmental delays which can
impede learning. It mainly focuses on improving classroom behavioral management,
empowering parents and other stakeholders involved in school activities, employing a positive
disciplinary approach and managing a student listening unit (school counseling). This
programme also encourages referral service mechanism in government hospital for advanced
cases from the schools. The sixth phase of this project is implemented in 80 schools of Kalikot
and Jajarkot districts from July 2022 for three and half years with financial support from Felm,
Finland. The follow-up support will be provided in 100 schools of Salyan and Kailali until June
2022.
On the other hand, it is also collaborating and closely working with Centre for Education
and Human Resource Development (CEHRD), Ministry of Education and Ministry of Social
Development of the concerned provinces for policy advocacy in mainstreaming school mental
health components in school education system through development of in teachers’ training
packages and its delivery at school level.
3.Psychosocial support in SaMi (Safer Migration) Project Phase III (July 2022- July 2024)
The Safer Migration project (SaMi) is a bilateral initiative of the Governments of Nepal
(GoN) and Switzerland. The project is implemented through a partnership between the Ministry
of Labour, Employment and Social Security (MoLESS), HELVETAS Swiss lnterco-operation Nepal
as a technical assistance provider, the Foreign Employment Board (FEB) and selected local
governments. CMC-Nepal is implementing psychosocial components to address social cost of

migration in its’ phase I (2013-2014) in two districts, phase II (2015-2018) in nine districts and
phase III (2019-2022) in 38 districts (152 local levels). SaMi phase III has been extended for two
years from 16th July 2022 to 15th July 2024 with an objective to support local and provincial
governments to gradually institutionalize migration services for long-term sustainability,
including through increased cost sharing. In addition of regular psychosocial component of this
project, CMC-Nepal extends coordination and provide support for the institutionalization of
psychosocial component at local, province and federal level in this extended phase.
4. Inclusive Community Mental Health Programme (January 2020-December 2022)
This program is implemented in partnership with Ministry of Social Development of
Karnali Province and local government of Surkhet and Dailekh districts since January, 2020 for 3
years, and is financially supported by cbm. This project contributes to increase access of quality
mental health and psychosocial services at community settings by supporting the local and
provincial government to make their health and education policy and programs inclusive of
mental health. This programme will be implemented in 5 (rural) municipalities of Surkhet and
Dailekh districts in partnership with the local and provincial governments and funding support
of CBM Australia through CBM Nepal.
5. Promotion of Child Mental Health & Psychosocial Wellbeing in Community (February 2021
to December 2024)
The main objective of the project is to improve mental health & psychosocial wellbeing of girls,
boys including children with disability in collaboration with local governments of working areas
in Siraha & Dhanusa In financial support of CBM Switzerland through CBM Nepal.
6.GBV Response Project in COVID-19 in Nepal (1st September 2021 to November 2022)
This is EU funded project, implemented by UNFPA on the technical assistance of
CMC-Nepal and WOREC-Nepal. This is implemented in 7 local governments of Province No 2
and Karnali Province, in partnership with the local government. The specific objective of this
project is to ensure the availability of essential prevention and response services for GBV
survivors during and after the COVID-19 lockdown, in line with the priorities identified in the
Nepal Country Preparedness and Response Plan (CPRP). Further, this project address both the
demand side challenges of GBV response, i.e., demand from women as well as the supply, i.e.,
provision of good quality, multi-sectoral services. CMC-Nepal’s role in this project is to
capacitate to GBV response team (health workers, case managers, and psychosocial
counsellors, CPSW, FCHV) in order to provide health and psychosocial response to the GBV
survivors.
7.Psychosocial Support in GBV Prevention and Response Project – II (July 2021 to June 2024)
The aim of this project is to strengthen multi-sectoral response to the survivors of
Gender Based Violence (GBV) through enhancing the capacity of Community Psychosocial
Workers and Case Managers in order to provide psychosocial support and counseling to the
GBV survivors. This project was started from September 2016 and implemented till June 2021.
The 2nd phase of GBVPRP has been implemented in 19 (rural) municipalities of Morang,
Udayapur, Okhaldhunga, Kailali, Achham, Baitadi, Bajura and Bhajhang districts. This project

enhances service capacity of 8 hospital based OCMCs and also establish response mechanisms
at community level through placing Community Psychosocial workers, CPSWs coordinators at
local level and case managers and psychosocial counselors in the OCMC. The Gender-based
Violence Prevention and Response Project (GBVPR) Phase II is supported by the Swiss Agency
for Development and Cooperation SDC and the Norwegian Embassy in Kathmandu through
UNFPA. The lead of this project is IPAS & CMC-Nepal’s responsibility is in psychosocial
component.
8.Psychosocial Counselling to Community Integration of Conflict Victims (September 2021 –
July 2024)
This program is implemented in partnership with local government in Bardiya, Kavre,
Surkhet, West Rukum and Jajarkot districts and funding support of Embassy of Switzerland. The
pilot phase of this project was implemented from March 2020 until August 2021. The present
phase is extended from September 2021 till August 2024 with objective to address the
psychosocial distress & trauma of the conflict as experienced by the Conflict Victims who are
key actors in the Transitional Justice process of Nepal. Psychosocial Counselling services have
been offered in 13 local government
9.Enhancing Mental Health Wellbeing of the Migrant Workers and their families_Prabardhan
Pariyojana (Mar 2022 to Dec 2025)
The main objective of this programme is to bring happiness in the work and life of
migrant workers and their family members, including persons with disabilities through
promotion of mental health and psychosocial wellbeing. The project intends to initiate actions
in collaboration and partnership with local government and migrant workers and their families
to increase awareness on mental health and psychosocial issues and building access of mental
health and psychosocial service for the families, returning migrant workers, persons with
disability and other community people at goverment health system. Further, this project
empowers to the migrant workers and their families, through building social enterprize
business skills and supporting them in livelihood support activities. This program is
implemented in 7 municipalities of Kailali & Salyan districts in financial support of Felm
10.Strengthening Provincial Health System and Services to provide essential Mental Health &
Psychosocial Support (MHPSS) during emergencies in Lumbini Province (1st July 2022 to 31st
Dec 2022)
The overall objective of this project is to improve the access to MHPSS services to the
population affected by COVID 19 in Lumbini Province through supporting provincial authorities
to build health systems capacity to provide mental health care by strengthening primary care
providers with knowledge and skill to identify people in distress, provide initial basic mental
health support and initiate referral. This project is implemented in 6 districts of Lumbini
province ie. Palpa, Gulmi, Arghakhachi, Bardiya, Rupandehi & Kapilvastu in financial support of
World Health Organisation and close coordination and collaboration with the central,
provincial, district and local health system

Completed projects
➢ Bharosa intervention (connecting people intervention) Project
➢ Collective Action for Inclusive COVID-19 Initiatives in Nepal
➢ Inclusion and Rights of the Persons with Psychosocial Disabilities
➢ Psychosocial Support to Survivors of Earthquake
➢ Psychosocial Support to Verified Minors and Late Recruits (VMLRs)
➢ MALA -III Project
➢ Harmonised Social Mobilization (SM)
➢ CABA Project
➢ SRP for Brick Kiln Industries
➢ Support for SEE to SDC Project
Partners
➢ National Organisations
➢ Mental Hospital, Lalitpur
➢ Tribhuvan University Teaching Hospital, Department of Psychiatry and Mental Health
➢ Ministry of Health and Population / Department of Health Services
➢ Ministry of Women, Children & Senior Citizen
➢ Ministry of Education, Science & Technology /Center for Education & Human Resource
Development (CEHRD)
➢ Helvetas Swiss Intercooperation Nepal
➢ Rythm Neuropsychiatry Hospital & Research Centre Pvt. Ltd.
➢ Provincial Organisations
➢ Okhaldhunga Community Hospital
➢ B.P. Koirala Institute of Health Science,Dharan
➢ Ministry of Social Development
➢ Provincial Health Directorates
District/Local Level Partner Organisations
S.No. District Name of Municipalities
1 Kailali 1.Dhangadi Sub metropolitan
2.Ghodaghodi Municipality
2 Bajura 1.Badhimalika Municipality
2.Budhiganga Municipality
3 Baitadi 1. Dasrathchand Municipality
2. Patan Municipality
4 Bajhang 1. Jay Prithivi Municipality
2. Bithadchir Municipality
5 Jajarkot 1. Bheri Municipality

2. Barekot Rural Municipality
3. Chhedgad Municipality
4. Nalgad Municipality
6 Salyan 1. Sharada Municipality
2. Baghchaur Municipality
3. Bangadh Kubinde Municipality
4. Chatreshwori Rural Municipality
7 Kalikot 1. Raskot Municipaity
2. Khadachakra Municipality
8 Surkhet 1. Gurbhakot Municipality
2. Chaukune Rural Municipality
3. Lekbesi Municipality
4. Panchapuri Municipality
5. Chingad Rural Municipality
6. Barahataal Rural Municipality
7. Bheriganga Municipality
8. Birendra Nagar Municipality
9. Simta Rural Municipality
9 Rukum Paschim 1. Aasthbiskot Municipality
2. Chaurjahari Municipality
10 Jumla 1.Chandannath Municipality
11 Bardiya 1. Barbardiya Rural Municipality
2. Bansgadhi Rural Municipality
3. Thakurbaba Rural Municipality
4. Rajapur Municipality
12 Achham 1. Kamalbazar Municipality
2. Mangalsen Municipality
3. Safebagar Municipality
13 Siraha 1.Lahan Municipality
2.Dhangadimai Municipality
14 Sarlahi 1. Malangawa Municipality
15 Kavrepalanchowk 1. Dhulikhel Municipality

2. Panchkhal Municipallity
3. Chaurdeurali Rural Municipality
16 Udaypur 1. Katari Municipality
2. Triyuga Municipality
3. Chaudhandigadhi Municipality
4. Belaka Municipality
5. Rautamai Rural Municipality
17 Okhaldhunga 1. Siddhicharan Municipality
2. Manebhanjyang Rural Municipality
3. Molung Rural Municipality
4. Chisankhugadhi Rural Municipality
18 Morang 1. Biratnagar Metropolitan city
International Partner
➢ Finnish Evangelical Lutheran Mission (FELM), Finland)
➢ Tear Australia, Australia
➢ Swiss Agency for Development and Cooperation (SDC)
➢ Safer Migration Project (SaMi)/HELVETAS Swiss Intercooperation Nepal
➢ Asian Health Institution, Japan
➢ Freedom Fund
➢ Himal Partner
➢ cbm Nepal
➢ UNFPA Nepal
➢ Finnish Church Aid (FCA)
➢ ACTION CONTRE LA FAIM (ACF-France)
➢ Ipas Nepal
➢ World Health Organisation
➢ World Bank Nepal
FREEDOM CENTRE
Introduction
Freedom Center is a support and activism community run by and for people labeled with
severe 'mental disorders.' The Freedom Center, an extension of Interim HealthCare, was
founded in March of 2011. It was first founded by will hall and Oryx Cohen. It is based on
support, activism, and human right for the people diagnosed with severe mental illness such as
schizophrenia, bipolar disorder, borderline personality disorder and obsessive-compulsive
disorder. The Freedom Centre is a part of the international psychiatric survivors’ movement and

was founded to provide mutual aid and support to people facing emotional distress who have
not been helped by mainstream hospital and professional care.
Aims
It works to challenge stereotype of helplessness, break silence around psychiatric abuse, expose
the corruption of pharmaceutical companies and work for change in mental health care.
Mission:
Freedom Center is dedicated to providing a comprehensive continum of care to alcohol and/or
drug abusing adults, adolescents and their families
The Freedom Center's goals are:
➢ to ensure access to resources such as housing without strings and not conditional on
treatment "compliance;"
➢ to defend human rights and ensure protective laws and regulations are enforced;
➢ to ensure all treatment decisions are based on true informed consent and accurate
information about risks;
➢ to change drugging as the medical standard of care for psychosis;
➢ to end institutionalized psych drugging of children and offer alternatives instead;
➢ to support effective alternatives such as nutrition, exercise, holistic health care, nature
and animals;
➢ to provide voluntary, non-paternalistic social supports such as peer-run programs,
housing, income, and individual and family therapy;
➢ to expose psychiatric and pharmaceutical industry myths, propaganda, and corruption;
➢ to end wasteful bureaucracies and funding wasted on expensive professional elites;
➢ to break the silence around trauma and abuse;
➢ to end fear and misunderstanding of "madness" and extreme states of consciousness;
➢ and to make common cause with progressive movements for social justice and
ecological balance.
Team of Freedom:
➢ Substance Abuse Treatment
➢ Domestic Violence classes
➢ Anger Management classes
➢ Gambling Assessments
➢ Drug and Alcohol Prevention Education
➢ Ending all force and coercion, including involuntary treatment such as forced drugging
and involuntary commitment.
➢ Defending human rights and ensuring protective laws and regulation
➢ Ensuring all treatment decision based on true informed consent and accurate
information about the risk
Programs
Freedom Centre seeks to provide people space to find their own pathway to recovery
and let them explore, with support, a variety of wellness resources, which may or may not

include psychiatric medications. The centre undertakes educational work and public events,
and hosts a radio show that is also broadcast globally over the internet. Projects include a
weekly support group, writing group, free community acupuncture clinic, and yoga class as well
as responding to information and resources request from around the local area and beyond.
Vocation
➢ Self advocacy
➢ Health and Fitness
➢ Transportation
➢ Socialization
➢ Computer Skills
➢ Art
➢ Volunteering
➢ Education
➢ Cultural Diversity
Support Groups of Freedom Centre
1.Empowerment Based Groups
2. Healing groups
1. Empowerment groups
Meditation and Mood: This group explores mood regulation through learning meditation skills.
Empowerment groups
2.Healing groups
Tell true story through art: In this group, story is told through art for survivors of all genders
who have experienced sexual or relationship violence. Safer space is provided to share story
with other survivors. Each group member will explore their experience and create art in
response to prompts that will help the stories flow. Stories and art will be shared each week
with positive feedback. In this group, art is the medium by which the group will share their
experiences.
Survivor's Writing Group: In this group, survivors are supported to explore their personal stories
through writing by facilitators.
Drop-In Survivor's Group: This is a judgement free, safe space for survivors to drop in and share
what's on their mind. Facilitators will discuss coping skills and issues common to all survivors
such as trust, boundaries and triggers.
KOSHISH NEPAL
KOSHISH, National Mental Health Self-Help Organization / Organization of Persons with
Disability (OPD), established in 2008, is breaking the silence and amplifying voices of persons
with mental health condition and psychosocial disability for inclusion of mental health and
psychosocial support (MHPSS) within and beyond the health system (There are many factors
which contribute towards poor mental health which includes poverty, employment
opportunities, education, violence, nutrition, awareness, stigma and discrimination to name a

few. It requires multisectoral collaboration to address these factors if we are to envision good
mental health and wellbeing. But mental health has not even been prioritized within the
Ministry of Health. Therefore, there is a need to not just mainstream mental health in Ministry
of Health and Population but also in other ministries which deals with issues relating to
children, women, employment, violence, disability etc. if we are to promote good mental
health) and elimination of barriers that restrict participation and inclusion on an equal basis
with others.
KOSHISH promotes full compliance with UNCRPD (UNCRPD Article-3: Basic Principles:
The principles of the present Convention shall be: Everyone is free to make their own choices.
No one should be discriminated against. Disabled people should be effectively included in the
society like everyone else.) to ensure rights of persons with mental health condition and
psychosocial disability and focuses on a person centered right based approach to model
community mental health services that is replicable by the government and other stakeholders.
Vision: It strives to achieve: Mental Health and Psychosocial Wellbeing for All
The Mission of KOSHISH is:
1.To empower mental health service users and their families to advocate for better treatment
as is their right.
2.To formulate plans, establish programs and execute rights-based awareness and advocacy
targeted at the grassroots community, top level government, and bi-lateral and multi-lateral
agencies
3.To monitor and evaluate treatment services for quality and accessibility for users and
families.
Authenticity
➢ KOSHISH is registered at District Administration Office, Kathmandu with Reg. No.
086/065 and affiliated with Social Welfare Council, Nepal, Reg.No. 25676.
➢ Being an OPD of Psychosocial Disability, KOSHISH is a member organization of the
National Federation of Disabled-Nepal (NFDN) from 2066/07/19 B.S.
Summary of relevant work:
KOSHISH is a national, non-governmental, non-profit, self-help organization which works
in mental health issue in Nepal. The organization started to work informally in the mental
health sector from 2004. It was formally registered in the year 2008 in Kathmandu District
Administrative Office (registration number 086/065) with the approval of the Nepal Social
Welfare Council (registration number 25676).
KOSHISH takes a twin track approach, carrying out advocacy and awareness programs as
well as service delivery simultaneously. These programs take a public-private partnership
approach to mental health services and advocacy for mental health prevention, promotion and
protection.

Community Based Mental Health Program:
Mental Health Action Program (mhGAP)
KOSHISH follows the Mental Health Action Program (mhGAP) model developed by the World
Health Organization to ensure mental health services are available in the primary health care
sector and to increase the service seeking behavior of people with mental health problems.
KOSHISH has a pilot project providing mental health out-patient services, medication service
and psychosocial counseling in its working areas in collaboration with local government and
community hospitals.
Self-Help and Peer Support Group
Persons with mental health problems are encouraged to form Self-Help Groups (SHGs) to
discuss their issues. The groups are run by them and for them. With this objective, SHGs are in
operation in our working areas for their empowerment through livelihood support,
self-advocacy and medication services. Peer support is also a key model activity of this program
in which persons with mental health problems gather to share knowledge & experience and
provide emotional, social and practical support to each other.
Emergency Support
KOSHISH has been offering emergency relief support for abandoned women with mental health
problems which aims to rescue, provide treatment and finally facilitate reintegration in their
family and community.
Advocacy and Awareness Program
KOSHISH has been advocating for the policy update, amendment of discriminatory laws,
formulation of laws in line in Convention on the Rights of Persons with Disabilities (CRPD) and
another human rights standard and for its effective implementation. KOSHISH is the voice of
the persons with psycho-social disability/mental health problems, and it advocates with the
concerned stakeholders and government bodies to ensure their rights and to integrate mental
health in the primary health system in Nepal. KOSHISH runs a Community Radio Program which
is broadcasted in different radio stations to help increase awareness about mental health and
well-being. Awareness programs have been carried out in the different colleges to internalize
the issue of mental health and to build a network for collective campaigning in the mental
health sector. Similarly, awareness programs have also been carried out to sensitize and to
apply political pressure to concerned stakeholders.
Patan Community Based Rehabilitation Program
Overview
Patan Community Based Rehabilitation Program was initiated in 1995 AD with the
initiation of Patan Lady Jaycees. It is registered in District Administration Office, Lalitpur and
Social Welfare Council in 1999 AD as separate organization and has been working for Children
with Disability. It is community-based rehabilitation service provider with non-profit motive and
is not politically aligned organization.
It works for differently-able children of community-based rehabilitation service all over
22 wards and 19 VDC of Lalitpur sub-metropolis, 9 vdcs of Kathmandu district, 2 of Nuwakot
District and Bidur municipality
Patan CBR has served 1800 children in day care and home visit till date through school,
home visit, field program and day care service. Since 2010 AD, this organization has been

providing physiotherapy service to control disability and public health improvement. Also,
special training and production program is undergoing through skill development unit. For
obtaining the organizational goal, there has been tremendous support of donor agencies SC
Nepal, On-Q Australia and Rotary International District 1840, Rotary Club of Newberg, Germany
and Rotary International District 3292, Rotary Club of Patan West. Its prime donor SC Nepal has
cut-off the financial support and has been providing only technical counseling service since
2010 AD.
HISTORY
Patan Community Based Rehabilitation Organisation (Patan CBR) is a non-profit
non-politically allined social organization established in 1999 AD. Initially providing
rehabilitation services to just 60 children within the historic town of Patan, it has succeeded in
expanding three districts of Nepal – Lalitpur (including Patan), Kathmandu and Nuwakot.
Patan CBR provides services for Children with Intellectual/Multiple Disabilities including:
➢ Day-care centre
➢ School Education program
➢ Skill training
➢ Physiotherapy to the CWDs and to the out patients
➢ Class for Children with Autism
See the activities page for more information about activities.
It has been estimated that, before the establishment of Patan CBR, 90% of children with
disabilities were completely ignored by their family members and communities – the treatment
of disability was such that even parents would not expose their sons and daughters to society.
Due to intensive efforts by Patan CBR, awareness within communities has been improved and
parents are now willing to refer their children to centres and organizations providing CBR
facilities. Altogether, 14 full time staff and 2 part time staff are working in the organization.
AREA COVERAGE
The region covered by Patan CBR – Lalitpur, Kathmandu and Nuwakot districts, has a total area
of around 1900 square kilometres. The area includes the cities of Patan and Kathmandu, but
two-thirds of the district lies in hilly and remote areas, communities that can only be reached
on foot.
It is estimated that around 5% of the population of the area – over 124,000 people – suffer
from some form of disability. This number includes around 50,000 children.
The most common type of disability is physical, but other disabilities are frequently
encountered – visual, hearing, intellectual etc.
FUNDING
Government of Nepal
SCN Norway (SCNN)
VISION: to create a suitable environment for Children with Disabilities within the area so they
may become involved in household and social activities equally with able people. This vision

includes the development of Patan CBR into a CBR Resource Centre in collaboration with
various government and non-government organizations.
MISSION
To ensure the rights, inclusive development and respectful life of CwDs by mobilizing parents,
community, GOs, NGOs for the protection and promotion of the rights of Children with
Disabilities (CwDs)
OBJECTIVES
➢ To increase the maximum development of working abilities of C/YwDs through
community based complete rehabilitation
➢ To develop disable friendly environment in the society and to create public awareness,
mobilize community and society
➢ To develop the working abilities through Physiotherapy
➢ To Access to and to utilize complete inclusive education to all the disabled children.
➢ To provide access to services and skill-oriented training to the youths with Disabilities
➢ To carryout theoretical and practical studies and researches related to disability
➢ To develop, establish and expand resource centre for disability for at least Lalitpur
district
➢ To advocate and make implement of rules related to disability and continuous release of
government budget for promotion of equal participation of P/CwDs
➢ To enhance the living capacity of community of disable people through microcredit and
hence reduce poverty
Patan CBR’s strategic aim and activities:
Strategy 1. To increase the maximum development of working abilities of C/YwDs through
community based complete rehabilitation
Activities:
Home visit (physiotherapy, consultation, discussion with family)
Medical rehabilitation (Artificial body parts, medicinal care, operation, referral)
Discussion with society.
Strategy 2. To develop disable friendly environment in the society and to create public
awareness, mobilize community and society
Activities: Gathering the society’s leader, local institution for training related to disability.
Street drama, rally, posters.
Training to the teachers and students, workshops, distribution of educational material,
interactions.
Radio, TV programs spreading the success stories of the PwDs.
Competition of special sports, showing their abilities in society
Strategy 3. To develop the working abilities through Physiotherapy
Activities:
Physiotherapy services to the community people, interaction to the community

Clinical physiotherapy services to the community people and counseling
Coordination with the hospital for referral
Radio, TV programs related to the physiotherapy
Strategy 4. To Access to and to utilize complete Inclusive Education (IE) to all the disabled
children.
Activities:
Formal, pre-primary, primary education
Informal classes
Early Childhood Development
Radio, TV program related to the Inclusive Education
Interaction to the teachers, head teachers, School Management Committee, students
Training to the teachers for the IE
Physical facilities to the Schools like making ramps, toilets etc
Equally participate and provide scholarship to CwDs
Awareness program to the family, neighbors, parents
Strategy 5. To provide access to all services and skill-oriented training to the disabled
children/youths
Activities:
Medicine distribution
Different camps related to health (eye, teeth, ENT)
Health education for the parents
Orientation and sensitization to the youth with HIV AIDS
Orientation of health and hygiene to the community and parents.
Skill development training to the Children/Youth with Disabilities.
Search for market and training to the product management
Strategy 6. To carryout theoretical and practical studies and researches related to disability
Activities:
Case studies of the problem of P/CwDs
Collection of the stories and publish
Cary out studies for other organizations
Disseminate study findings
Strategy 7. To develop, establish and expand resource centre for disability for at least for
Lalitpur district
Activities:
Data collection related to disability and recording
Capacity development training to the community, BOD, staff etc.
Open library under Resource centre.
Collection and distribution of national, international books/ publications related to the
disability

Strategy 8. To advocate and make implement of rules related to disability and continuous
release of government budget for promotion of equal participation of P/CwDs
Activities:
Advocate for the implementation of the disability related laws in participation with PwDs.
Networking with different government and non-government organizations.
Advocate for the District Development Committee for the continuous release of the
government budget
Take help from the parliamentarian to make continuous release of government budget
Manage combined monitoring of the disability related programs in cooperation of government
agency
Strategy 9. To enhance the living capacity of community of disable people through microcredit
Activities:
Form community, parents, staff, BOD groups and teach saving
Provide load from the groups
EXECUTIVE COMMITTEE
President= Nigma Tamrakar
Immediate Past President= Manjushree Pradhan
Vice President = Meena Shakya
Secretary= Loonibhah Chitrakar
Treasurer= Laxmi Shova Shakya
Executive Member Rajya Laxmi Nakarmi, Surendra Man Shakya, Vidhaya Shakya, Amrit
Ratna Shakya, Dr. Sabina Shrestha, Chhaya Zuwa
ACTIVITIES
Day Care
Since 2000, Patan CBR has been operating a day-care centre for children with multiple
disabilities, in Shankhamul, Lalitpur. In 2002, this centre was extended to provide a unit for
specialist education for children with educational disabilities.
Disability awareness
In a country where disability was, until recently, hidden away, one of Patan CBR’s main
objectives is to increase awareness at all levels, from families to central government. Patan CBR
produces a range of material – brochures, leaflets, training material – and works actively to
increase awareness through workshops, seminars and individual contact.
As a result of improved awareness at family and community level, there is less stigma attached
to disability and more children are reported to the organisation and receiving support.
Families and children increasingly see school attendance as a realistic option and feel motivated
to work harder to increase functional capacities. Once in school, the incentives multiply.
Parents make extraordinary commitments such as carrying their children to school each day,
helping with daily life skills and maintaining a rigorous schedule of therapy, often on top of
work and other demands.
Increasingly, government and non-government organizations are incorporating disability issues
in their agendas.

Disability prevention
It is estimated that around 40% of disability in the region is due to disease and accidents, both
of which are largely preventable. Improvements such as a clean environment, a balanced diet
and safer roads could have a large impact.
Patan CBR provides education on disability prevention at all levels from school upwards.
A large part of this effort is aimed at improving girls’ understanding of the needs of both
mothers and their children during pregnancy and after birth.
Community Physiotherapy Clinic
This program has been started in 2010 January after the phase out of the SCNN. Rotary
International, Rotary club of Newberg, Germany, district 1840 provided the equipments of the
clinic in assistance with Rotary Club of Patan west district 3292. During day time we provide the
physiotherapy services to the children of the centre. In order to sustain it we are accepting the
community patients also. Since we are not for profit making organization, we charge very
nominal amount to the community out patients. We have two professional and highly qualified
Physiotherapists.
Skill Development Program
Vocational service is one of the praiseworthy services of the organization. We are providing
training to those C/YWDs, who are capable of doing work. These training includes envelop
making, candle making, incense, pop corn, cumin powder making, coriander powder making
etc. We hope these types of skill development training help them in raising quality of their life
to some extent.
School Education Program
Patan CBR provides the school education to those who are capable to learn something. Under
this program 30 CWDs are getting education. We use visual communication rather than lecture
method to make understand them.
Other Programs
Besides these we are providing disability and physiotherapy orientation programs to the
community people. Similarly, home visits, advocacy, mass awareness, identity cards for the
PWDs, medicine distribution are our regular programs.
Building Construction Appeal
Patan CBR Disability friendly building construction
Appeal for help
ACHIEVEMENTS
Patan CBR has achieved much since its establishment in 1995:
➢ CBR facilities have been provided to over 2000 children. As a result, around 1100 have
developed their functional capacity sufficiently for them to lead a more independent
life.

➢ 90% of children receiving help from CBR now participate in social activities due to
improvements in their ability.
➢ Awareness within the families and communities of disabled children is much improved.
Parents who were reluctant to expose their children now bring them for registration at
Patan CBR without hesitation.
➢ Disability issues are now included in the annual plans of a variety of organizations:
Lalitpur Sub-Metropolitan City, DDC-Lalitpur, Bidur Municipality, Rotary and Lions clubs,
etc.
➢ Improved public awareness has resulted in greater numbers of disabled children being
referred by government and non-government organizations, their communities,
families, etc.
➢ Over 400 community people have been benefited by our community physiotherapy
clinic within three years of operation.
➢ Awarded by certificate of appreciation by Women Development Office, a government
body under ministry of Women Children and Social welfare for the outstanding service
provided to CWDs.
➢ 5 CWDs have been referred to the main stream education after reducing their disability.
RICHMOND FELLOWSHIP NEPAL
INTRODUCTION
Richmond fellowship Nepal is a non-governmental organization working in the field of
drug and alcohol since 1997.In the process of rehabilitation program, it started a pure recovery
guidance modality based on the ‘therapeutic community’(TC) approach since October 2001 that
stress on detoxification through psychosocial method without medication, restructuring of the
thinking pattern, emotional management stability , behavior reshaping, capacity building,
spiritual healing and reintegration into society. Among the vulnerable group in Nepal, rate of
HIV infection among the drug user is significantly very high and without discrimination, It has
been providing treatment, care and support with the target people including women.
Current programs
Rehabilitation and reintegration of substance users.
I/DUs Male – Kathmandu, Lalitpur, Biratnagar, Pokhara, chitwan and Dhangadi.
I/DUs Female – Kathmandu
Alcohol- Kathmandu
GOALS
To strengthening the national framework strategies for drug abuse control, risk reduction,
rehabilitation and counselling service for people using drugs generally, those considered to be
‘at risk’ of controlling HIV/AIDS, children and adolescents and part of a coordinated national
system of drug demand reduction.
OBJECTIVES
➢ To provide drug treatment and rehabilitation program for substance set in Nepal.
➢ To provide a drop-in, counselling and rehabilitation centre for substance/ drug user.

➢ To provide outreach services and create public awareness through various media, school
programs and street outreach services, against substance/ drug user.
➢ To offer training in similar field of work to the staff of various other organization and
work together to tackle the problem.
➢ To work with the children of the substance users and PLWHA.
➢ To collaborate with activities of similar organizations.
➢ To include harm reduction measures as one of the components in counselling and
rehabilitation program.
➢ To establish a support group for PLWHA and recovering substance/ drug users, their
spouse and children.
ORGANOGRAM
General assembles
Executive board
Program officer
Different unit and service
Staffs:Program Coordinator, Counselors, Project Officer, Finance Officer, Health assistant,
Consultant.
ACTIVITIES
Rehabilitation program is focused on whole person recovery with the individuals rehabilitation
and reintegration into the family, community and society. The treatment module in practice is
Therapeutic Community(TC) concept that includes the following components.
Rehabilitation and reintegration of substance users;
Outreach
Assessment
Detoxification
Health recovery
Orientation classes for nurses
Home visit
After care service
Continuum care
Awareness and education program
Counselling, family, individual, group and social counselling.
Primary health care services
Residential care and treatment
Day care services

Richmond Fellowship Nepal Rehabilitation Centers
Rehabilitation center Kathmandu
Treatment and rehabilitation programme
Day care services
Aftercare services
Micro-credit project
Outreach (peer led intervention)
Trainings
Research
Rehabilitation center Biratnagar
Day care services
After care services
Outreach
Health care services
Rehabilitation center Chitwan
Day care services
Outreach
Health care services
Capacity development programme
Rehabilitation center Pokhara
Day care services
Referral service
Outreach
Drop-In-Center syangja
Care and support programme
Education and awareness programme
Rehabilitation center Kailali
Day care services
After care services
Peer led HIV prevention/intervention in prison
Referral service
YOUTH VISION
Introduction
Youth Vision (YV) was established in 1985 as a non-profitable, non-government, and
non-political organization to serve people who use drugs and people affected by HIV and AIDS.
In Nepal, Youth Vision (YV) is viewed as a pioneering organization dedicated to minimize the
drug use and drug induced HIV. YV is devoted to protect and promote the rights of people who
use drug(PUDs) and ensure essential drug demand reduction and accessibility and availability of

harm reduction services to its marginalized beneficiaries. YV has been offering comprehensive
services such as OST based on buprenorphine pharmacotherapy, prevention services, needle
exchange, with primary health care, inpatient drug treatment and rehabilitation services, HIV
care and support and income generating programs and referral to existing relevant services. YV
has been providing these services in seven districts Kathmandu, Lalitpur, Bhaktapur, Parsa,
Makwanpur, Rupandehi and Jhapa.
Vision
To achieve a stigma and discrimination free society/Community towards Drug Users &people
living with HIV and AIDS (PLHA) by protecting their rights, creating supportive environment,
proper health care and empowerment for people using drugs and infected and affected by HIV
& AIDS, congeal the rapid drugs use, HIV transmission and create awareness among the Youth,
society and community for preventing HIV/AIDS transmission.
Mission
➢ Youth Vision aims to increase the quality of life of drug users and PLHA by empowering
them with positive attitude and providing a caring and supportive environment where
they can live with dignity and pride.
➢ YV is also dedicated to prevent the risk of drug abuse and HIV to the most of the
risk-prone population.
Goal
Empowering affected and infected of people who use drugs and people living with HIV and AIDS
to take control of their lives for an improved health and socio-economic wellbeing.
Objectives
➢ To facilitate for the protection and promotion of human rights of people who use drug
(PUDs) and people living with HIV and AIDS (PLHAs)
➢ To ensure access to effective and qualitative comprehensive services to people who use
drug and PLHAs
➢ To improve the quality of life of people who use drugs through harm reduction activities
➢ To facilitate and support people who use drugs and PLHAs for treatment, rehabilitation
and social integration
➢ To integrate drug use, HIV & AIDS, hepatitis, tuberculosis and sexual reproductive health
issues for services linkage
➢ To facilitate and support civil society and media action to change societal attitudes
towards drug use, HIV &AIDS, Sexual Reproductive Health, Hepatitis and Tuberculosis
➢ To Integrate HIV with Tuberculosis, Hepatitis and other blood borne diseases to
minimize the risk of opportunistic infections among people who use drugs and PLHAs
➢ To facilitate to improve the living standard of people who use drugs and PLHAs through
drug treatment, comprehensive care including income generating activities.

Existing program
Oral Substitution Therapy (OST): Youth Vision (YV) is providing OST (Opioid Substitution
Therapy) using Buprenorphine to nearly 200 drug users in Nepal. YV run OST program has been
a significant tool to minimize injecting drug use and HIV induced by injecting drug use, hepatitis
B & C and other blood borne diseases. The OST is also reported to contribute to minimize the
drug induced crime and stabilize and prosper the socioeconomic lives of the OST's beneficiaries.
Low-Cost Community Based Treatment Program: Youth Vision has run Low-Cost Community
Based Treatment Program in different districts. It is a 15 days detoxification and treatment
program run in demand and collaboration of communities and stakeholders.
Post Rehabilitation Center: Youth Vision has been running Post Rehabilitation Center (PRC) in
Birgunj, Parsa. In PRC, people currently recovered from drug use learns life skills along with
relation building, behavior change communication (BCC) and decision making.
Treatment
Youth Vision has been providing short term and long-term treatment services to target group.
The short term is a 15 to 30 days and long term is a 30 to 90 days detoxification and treatment
program.
Publication and Advocacy: Youth Vision has been publishing several reading materials. The
purposes of these publications are to share the issues, intervention and progress on drugs and
HIV. Similarly, the publications also aim to do advocacy to protect and promote the rights of
people who use drugs and people living with HIV. YV has been conducting advocacy campaign
to entrench the rights of target communities by conducting meetings, workshops, interactions
and producing magazine, documentary, T-Shirts, stickers, posters and other IEC materials.
Training and Capacity Building: Youth Vision has been running training and capacity building
programs for its human resources and partner organizations to ensure the effective facilitation
of services. YV has been providing HTC(HIV Testing and Counselling), Prevention,
M&E(Monitoring and Evaluation), Client Management, OIs(Oppurtunistic Infections)
Management and Prophylaxis, Treatment Preparedness etc in coherent to standard curriculum.
These trainings have also enabled several governments and non-government implementing
partners and stakeholders. YV has been capacitating staffs, partners and stakeholders
considering the innovation and the challenges of the issues.
Income Generating Activities: Youth Vision has been running income generating activities. It
comprises printing press, semi organic farming and women business programs. These activities
have introduced multi facets benefits. In one hand, it has empowered target groups with skills
and offered employment opportunities whereas in other hand it has generated resource for the
sustainability of the project. These income generating activities have also been meaningful to
make target groups self-reliance and to deter them from relapse.

HIV Care and Support Services: Youth Vision has been providing residential and home-based
facility for supportive care for those who are under ART and managing opportunistic infections.
It has also interlined these programs with state’s programs in terms of VCT(Voluntary
Counselling and Testing), STI, PMTCT, CD4, Viral load, ART, family planning etc.
Prevention
The prevention program focuses on the positive behavior change of target community. It
enhances their access to achieve a positive health impact. Youth Vision has been catering these
services: reduction of harm and HIV transmission to I/DUs, PLHIV and most risk population
through referral and raising awareness on the availability of the existing services.
Outreach Services
Outreach service is an integral part of Youth Vision’s project. YV has been providing outreach
services in its all project areas: Kathmandu, Lalitpur, Bhaktapur, Nawalparasi, Parsa, and
Rupandehi districts. Competent Peer Educator, Outreach Educator, and Supervisor provide
Information Education and Counseling (IEC) materials, condoms syringe and alcohol swab and
medication services to its target population at targeted hotspots. Youth Vision also mobilizes
outreach mobile van to cater services to increasing target communities within the Kathmandu
valley. It also applies one to one counseling and group contact approaches to provide accurate
and complete information to the targeted groups.
Production and Dissemination of IEC
Youth Vision has produced IEC materials on drugs, HIV and blood borne diseases. Those
materials have primarily highlighted on the coping measures on drugs and HIV. YV also
produces innovative IEC materials foreseeing the need of target population. As a result, it has
produced pocket-sized reading materials on safe injecting behavior and abscesses management
which is highly liked by target groups. Considering the need of target population YV has widely
disseminated those materials from fieldbased outreach and existing drop-in centers. IECs
produced by YV have also been an asset to likeminded organizations.
Syringe Exchange Program
Injecting drug use has been a major gateway for the HIV, Hepatitis B/C and other blood borne
diseases due to the prevalence of sharing of contaminated syringe among drug users.
Therefore, Youth Vision has been implementing Syringe Exchange Program to deter the spread
of contamination from one drug user to another. YV collects used syringe and provides new
syringe through its static and mobile clinic and outreach programs within the Syringe Exchange
Program. The Syringe Exchange Program has contributed significantly to minimize the threats of
growing blood borne diseases among its target groups.
Awareness/sensitization programs for preventing drug use and HIV infection
Youth Vision has been conducting awareness programs on drugs, HIV and blood borne diseases
like Hepatitis B/C. YV primarily run awareness program for people who use drugs, PLHIV and
most at-risk population on drug use and HIV. It ensures the meaningful participation of the

nearest stakeholders: parents, guardians, teachers, security personnel, media persons,
government agencies and students in those programs.
Comprehensive Harm Reduction programs
Youth Vision has been providing comprehensive harm reduction program through OST using
Buprenorphine, Outreach with NSP, PHC, dissemination of information and education related
materials, drop-in center, linkage with other essential services and condom distribution. The
harm reduction services are targeted to prevent the injection related infections and injuries
which include HIV, hepatitis B/C along with other blood born infections. At present, the harm
reduction services are being delivered from Kathmandu, Lalitpur, Bhaktapur, Nawalparasi,
Rupandehi and Parsa districts
Treatment and Rehabilitation Program
Youth Vision has been implementing an innovative drug treatment and rehabilitation program
from more than two decades in Kathmandu and extended to Parsa and Rupandehi districts. YV
has been providing free rehabilitation service to the marginalized female drugs users from
Putalisadak, Kathmandu for last two years.
BOARD MEMBERS
Methadone maintenance treatment or therapy
INTRODUCTION
Methadone is an opioid, like heroin or opium. Methadone maintenance treatment has been
used to treat opioid dependence since the 1950s. The opioid dependent patient takes a daily
dose of methadone as a liquid or pill. This reduces their withdrawal symptoms and cravings for
opioids.
Methadone is addictive, like other opioids. However, being on methadone is not the same as
being dependent on illegal opioids such as heroin:
• It is safer for the patient to take methadone under medical supervision than it is to take
heroin of unknown purity.
• Methadone is taken orally. Heroin is often injected, which can lead to HIV transmission
if needles and syringes are shared.
• People are heroin dependent often spend most of their time trying to obtain and use
heroin. This can involve criminal activity such as stealing. Patients in methadone do not
need to do this. Instead, they can undertake productive activities such as education,
employment and parenting.
President Navin Kumar Verma
Vice President Ishan Ghimire
Secretary Sharad Kumar Aryal
Treasure Durgesh Kumar Ranjitkar,
Member Karuna Kunwar
Member Dipak Baruwa Chhettri
Member Suman Raj Bharati
Member Pawan Kumar Pyakurel
Member Pooja Kunwar

Methadone has been included on the World Health Organization's List of Essential Medicines.
This highlights its importance as a treatment for heroin dependence.
There has been a great deal of research on MMT. This research has found that
• MMT significantly reduces drug injecting;
• because it reduces drug injecting, MMT reduces HIV transmission;
• MMT significantly reduces the death rate associated with opioid dependence;
• MMT reduces criminal activity by opioid users; and
• Methadone doses of greater than 60mg are most effective.
In closed settings, MMT should be available to patients who have been receiving MMT in the
community and wish to continue this treatment in the closed setting, and patients with a
history of opioid dependence who wish to commence MMT. Patients should receive MMT for
the entire duration of their detention in the closed setting. This ensures the maximum benefits
of the treatment are obtained.
Methadone maintenance therapy in Nepal
The first MMT clinic was introduced in a psychiatric hospital in Kathmandu in 1994 with
the objective of “preventing relapse, facilitating recovery and reducing overdose, risk of HIV,
hepatitis and other infections among drug users”. The clinic had a medical doctor and a trained
nurse working under the supervision of a psychiatrist. Methadone was dispensed as a tablet of
40 mg (unlike the current practice of dispensing liquid form), and most clients received a
maintenance dose of 40 mg daily. Each client paid a subsidised amount, roughly 25 US cents for
a full dose of 40 mg methadone. By 2001, about 270 clients had received methadone.
MMT was reintroduced in 2007 and while there is little information about what
happened to the clients in these five years, reports have suggested some medical casualties
among drug users. Elsewhere, the negative consequences of the closure of MMT clinics on drug
use, criminal behaviour and HIV risk of PWIDs have been well documented. Pressure from drug
user groups such as ‘Recovering Nepal’ forced government and other bilateral/multilateral
agencies to restart MMT as an ‘emergency response’. With ‘emergency’ funding from United
Nations Office on Drugs and Crime (UNODC), MMT services were reinstated in 2007 in a tertiary
care medical teaching hospital in Kathmandu. By 2011, MMT services were available in three
clinics, catering for a total of 946 clients; 409 clients were actually receiving MMT.
Initially MMT services were not restricted to PWIDs; criteria for access included a long
history of opioid dependence with failure in other treatment programmes (irrespective of
whether a client was injecting or not). Thus the aim of MMT was not primarily the prevention of
blood borne diseases, but rather it was considered to be a long term pharmacological
treatment for those who were opioid dependent. The reinstatement of MMT in Nepal occurred
at a time when the country was undergoing major political upheaval. The royal family of Nepal
had been massacred in 2002 and the country was moving from a monarchy to a democratic
form of governance in 2007. This period also witnessed Maoist insurgency (or a ‘people’s war’)
and their eventual entry into mainstream electoral politics. Since then, there has been major
unrest in the country over the drafting of the constitution. In the midst of this political
turbulence, MMT has been expanded in other sites, which should be seen as a major
achievement. This sequence of events is interesting in light of the observations of some
researchers on priorities accorded to HIV by democratic versus autocratic and authoritarian

regimes. The Ministry of Home Affairs is in charge of matters related to the control of illicit
drugs in Nepal, including the formulation of policies and programmes and it has administrative
oversight of the implementation of activities approved in policy. Apart from control of the
supply of illicit drugs through a ‘drug enforcement’ section, the ministry has a separate project
office to implement plans for treatment, rehabilitation and other demand reduction activities.
In Nepal so far, such an ideological clash has been avoided for MMT, even though here
too different arms of the government are involved. The hospitals where MMT is provided are
part of the health sector; the Ministry of education is in charge of medical college hospitals
where MMT is located. Coordination between these various arms of government is ensured by
MOHA, which also works with NGOs and other service providers on drug demand reduction.
The National drug control strategy (2010) outlines specific programmes for OST and other harm
reduction measures for minimising infections by blood borne viruses, as well as sexually
transmitted diseases among drug users and their families.
Rationale for MMT in closed settings
In countries where MMT is available in the community, it should also be available in prisons.
This is in line with the public health approach to HIV prevention and the principle of
equivalence of care.
MMT is provided to inmates in prisons in at least thirty countries, including Australia, Canada,
Indonesia, Iran, and Spain. There are several compelling reasons for providing MMT to opioid
dependent patients in closed settings:
1. Reducing risks associated with injecting drug use: MMT in closed settings reduces drug
injecting by prisoners. In Australia, a trial of MMT in prison found that despite being in
prison, over 80% of inmates starting methadone treatment had used heroin in the
previous month; however, after four months of treatment, only 25% of prisoners were
still using heroin.16 By reducing drug injecting, MMT reduces opportunities for HIV to be
transmitted between prisoners.
2. Reducing risk of re-incarceration: Many drug users experience multiple episodes of
detention in closed settings. However, patients who remain in MMT after leaving closed
settings are less likely to return to closed settings than non-treated heroin users.17
3. Reducing the risk of relapse following release: People who leave closed settings often
relapse to regular drug use within a few days or weeks of being released. Being in MMT
in the closed setting and then continuing treatment in the community reduces the risk
of relapse.
Required resources
Essential staff
Physicians: Only a medical doctor may prescribe methadone. A medical doctor should conduct
the assessment on which the decision to prescribe methadone is based. Doctors also take part
in treatment planning and treatment reviews.
Nurses: Nurses are required to conduct methadone dispensing and supervision of its
consumption. Other roles for nurses in methadone maintenance treatment include:
• Taking part in treatment reviews and providing reports to clinic doctors
• Providing vaccinations (e.g. hepatitis A and B) and referring patients for infectious
disease testing (e.g. HIV, hepatitis, sexually transmitted infections, tuberculosis)

• Attending to general health needs of patients, for example, dressing wounds and ulcers;
assisting with general hygiene and infection control
Counsellors: Counsellors support medical staff of the treatment program by:
• Providing general counselling on issues of concern to patients
• Undertaking motivational interviewing with patients to increase motivation to reduce
illicit drug use
• Providing pre- and post-test counselling for patients seeking testing for HIV or other
infectious diseases
Other professionals
Although not essential, the following staff can also assist patients in methadone maintenance
treatment:
Psychologists: Psychologists can assist patients suffering from co-morbid mental illnesses and
psychiatric problems such as depression, anxiety or post-traumatic stress disorder.
Social or welfare workers: Social workers and welfare workers can provide general counselling
and assist patients with practical concerns such as contacting their family or finding housing for
when they leave the closed setting.
Community liaison officers: A community liaison officer is employed specifically to assist
patients to transfer to community-based MMT programs on their release from the closed
setting. This person may have skills or training in social or welfare work.
Facilities
Medical clinic: Methadone should be dispensed via a medical clinic within the closed setting.
The clinic must be staffed and open to patients seven days per week. The clinic should be
equipped with a dispensing pump or measuring cylinder for ensuring accurate methadone
dosing, and should also maintain adequate supplies of basic first aid and resuscitation
equipment.
Secure storage area: Methadone must be stored in a secure area within the medical clinic, for
example, locked in a room or safe. It should not be obvious to patients that this is where
methadone is stored.
Post-dosing supervision room: Following dosing, patients must move into a supervision room
located next to or close to the medical clinic. This is to help prevent diversion of methadone to
others. Patients in the supervision room must be monitored for around 15-20 minutes after
dosing.
Effects of methadone
Methadone is a synthetic opioid agonist. This means it produces effects in the body in the same
way as heroin, morphine and other opioids. It is taken orally as a tablet or syrup.
When an opioid dependent person takes methadone, it relieves withdrawal symptoms and
opioid cravings; at a maintenance dose, it does not induce euphoria.
Onset of effects occurs 30 minutes after swallowing and peak effects are felt approximately
three hours after swallowing. At first, the half-life (the length of time for which effects are felt)
of methadone is approximately 15 hours; however, with repeated dosing, the half-life extends
to approximately 24 hours. It can take between 3 and 10 days for the amount of methadone in
the patient's system to stabilise.

Autism Care Nepal Society helps those with autism

Autism Care Nepal Society helps those with autism

Recommended

Recommended

More Related Content

Similar to Autism Care Nepal Society helps those with autism

Similar to Autism Care Nepal Society helps those with autism (20)

More from SushmitaBajagain

More from SushmitaBajagain (20)

Recently uploaded

Recently uploaded (20)

Autism Care Nepal Society helps those with autism