This document discusses several topics related to measuring and promoting mental health at the population level, including: 1. Administrative records and population surveys can provide data but have limitations for international comparisons due to differences in methods and definitions. 2. Prevention of mental illness can occur at primary, secondary, and tertiary levels through community programs, screening, and treatment. 3. Nepal has developed community mental health programs and rehabilitation services alongside policies to improve access to mental health services.

1. Measuring MH at population level
• Administrative records:
• requires good records;
• not viable for many low and middle income countries;
• does not capture population not accessing services
Differences in national legislation, regulations, and
administrative practices may cause significant bias in
international comparisons.
• Population surveys
• High level of stigma about MH disorders generates under-
reporting
• Complex construct to measure
Differences in purpose, instruments, method of data collection….
may cause significant bias in international comparisons.

2. Applications of principles of prevention and control of mental illness
o Different level of prevention
o Rehabilitation
o Community Mental Health program
o Policy and strategy of prevention and management strategy of Nepal
Government

3. Prevention- 3 Levels of prevention
Primary prevention
It operates on a community basis .
This consist of “improving the social environment” and promotion of
social, emotional, & physical well being of all people.

4. Secondary prevention
It consists of early diagnosis of mental illness & of social & emotional
disturbance through screening programmes in schools, universities, etc.
& provision of treatment facilities and effective community resources.
In secondary prevention ‘family based’ help services have much role to
play. Family counselling is one method of treatment intervention for
helping the mentally ill.

5. Tertiary prevention
• It seeks to reduce the duration of mental illness & thus reduce the
stress they create for family & the community. In short, the goal at this
level is to prevent further break down & disruption.

6. Mental health services
Mental health services in a community comprise-
1- early diagnosis and treatment
2- rehabilitation
3- group and individual psychotherapy
4- mental health education
5- use of modern psychoactive drugs
6- after care services.

7. 10 COMMANDMENTS OF MENTAL HEALTH
1. Think positively; it’s easier
2. Cherish the ones you love
3. Continue learning as long as you live
4. Learn from your mistakes
5. Exercise daily; it enhances your well-being
6. Do not complicate your life unnecessarily
7. Try to understand and encourage those around you
8. Do not give up; success in life is a marathon
9. Discover and nurture your talents
10. Set goals for yourself and pursue your dreams

8. Rehabilitation
Rehabilitation, also known as psychsocial rehabilitation, and
sometimes simplified to psych rehab by providers, is the process of
restoration of community functioning and well-being of an individual
diagnosed in mental health or mental or emotional disorder and who
may be considered to have a psychiatric disability.

9. The rehabilitation is to enable with best practices of illness
management, psychosocial functioning, and personal satisfaction.
Treatments and practices towards this is guided by principles. There are
seven strategic principles:
1. Enabling a normal life.
2. Advocating structural changes for improved accessibility to
pharmacological services and availability of psycho-social services.
3. Person-centered treatment.
4. Actively involving support systems.
5. Coordination of efficient services.
6. Strength-based approach.
7. Rehabilitation isn't time specific but goal specific in succeeding.

10. Community Mental Health program
Psychiatric rehabilitation services may include:
• community residential services,
• workplace accommodations,
• supported employment or education,
• social firms, assertive community treatment (or outreach) teams
assisting with social service agencies,
• medication management (e.g., self-medication training and support),
housing, programs, employment, family issues, coping skills and
activities of daily living and socializing.

11. • Social (relationships, recreational and hobby, family and friends,
housemates and boundaries, communications & community integration)
• Vocational and/or Educational (vocational planning, transportation
assistance to employment, preparation programs (e.g., calculators), GED
classes, televised education, coping skills, motivation)
• Financial (personal budget), planning for own apartment (startup funds,
security deposit), household grocery; social security disability; banking
accounts (savings or travel)
• Community and Legal (resources; health insurance, community recreation,
memberships, legal aid society, homeownership agencies, community
colleges, houses of worship, ethnic activities and clubs; employment
presentations; hobby clubs; special interest stores; summer city schedules)

12. Policy and strategy of prevention and
management strategy of Nepal Government
In 1961 A. D. Psychiatric out patient service in Bir hospital was started
by Dr. B. P Sharma & in 1965, 5 -bedded inpatient psychiatric unit was
started in this hospital, bed strength was increased to 12, in 1971.
Psychiatric services was started in Tri-Chandra Military hospital
(Est.1925 AD) Kathmandu in 1976 by Dr. Desh Raj Bahadur Kunwar
for the army personnel and their families. It had inpatient facility of 10
beds initially.

13. Psychiatric inpatient and outpatient department of Bir Hospital was shifted to
Lagankhel and became a first and central level Mental Hospital in 1984, with
25 inpatient facility.
It is noteworthy that there were no large custodial mental hospitals in Nepal
and Nepalese mental patients used to go to Ranchi Mental hospital, or
Gorakhpur or Lucknow for treatment of mental disorders. Faith healing,
Homeopathy, Ayurbedic medicine, naturopathy were other means of
treatment, which are popular now also.
NGO sector started rehabilitation centre for Nepali drug abuser in 1976.
Community mental health programme as a pilot project was started in
Lalitpur district through community health development project (CDHP) in
1984
Mental health project (MHP) was established with the financial support of
INGO’s in Kathmandu in the year 1989. Its office was in the TUTH
compound.

14. Some Organizations working on Mental Health in Nepal

15. It has adopted five policies in area of mental health to ensure easy
availability and accessibility of basic quality mental health services for
all citizens, prepare necessary human resources in order to deliver
1. mental health and psycho-social service
2. protect the fundamental human rights of the people with psycho-
social disability and mental illness
3. enhance public awareness to promote mental health
4. combat stigma resulting from mental illness, and
5. promote and manage health information system and research.
Mental Health Policy 1996
Mental Health Policy 2017