Qualitative evaluation of mental health training of auxiliary nurse midwives in rural Nepal

Abstract

The study supports the need for continued training for auxiliary nurse midwives who are based in the community. This gives them the opportunity to reach the whole community group and potentially have influence over reduction of stigma; offer support and diagnosis of mental ill-health. There is still stigma around giving birth to a female child which can lead to mental health problems. It is imperative to increase awareness and educate the general public regarding mental health illnesses especially involving family members of those who are affected.

Stigma against mental health disorders in Nepal conceptualised with a ‘what matters most’ framework: a scoping review

“…Several publications reported public and health workers’ perceptions of PWLE as violent and aggressive people who can damage property and harm themselves or others. Thus, fear of harm or danger was a prominent driver of mental disorders stigma among health workers in Nepal (Kohrt and Harper, 2008; Neupane et al ., 2016; Mahato et al ., 2018; Upadhaya et al ., 2020).…”

“…(1) Articles published in English or Nepali only (2) Articles published between 01/01/2000-06/24/2020 (3) Articles focused on Nepal as a geographical location (excludes studies carried out among Nepali population outside geographical area of Nepal such as Bhutanese refugees) (4) Articles published in both Nepali and international peer-reviewed journals (5) Relates to articles focused on stigma and its definitions such as discrimination, prejudice or stereotype (6) Articles focused on stigma related to health conditions (excludes studies in other forms of stigma and discrimination such as gender and ethnicity and its effects on health outcomes) (7) Includes data regardless of its 'quality' and study design (8) Articles that include or mention at least one stigma-related outcome or domain mental disorders stigma among health workers in Nepal (Kohrt and Harper, 2008;Neupane et al, 2016;Mahato et al, 2018;Upadhaya et al, 2020).…”

“…Community members, sometimes even health workers, labelled PWLEs with stigmatizing terms such as paagal/baulaahaa (mad/crazy), taar khuskeko (loose wire), dimaag nabhayeko (no brain-mind), bokshi laageko (afflicted by witchcraft), paapi/ paap ko bhogi (sinful), khusket (someone whose mind has become lose), dimaag crack bhayeko (one whose brain-mind has cracked) (Kohrt and Harper, 2008;Kisa et al, 2016;Angdembe et al, 2017;Lempp et al, 2018;Upadhaya et al, 2020). Such stigmatizing terms were mostly used towards people with low socioeconomic conditions such as Dalits (low caste groups, historically referred to as untouchables), women, widows and other minorities (Mahato et al, 2018); this highlights the intersectionality of the perception of mental disorders with female gender, marginalised ethnicities and persons of low socio-economic status. The public perceived that PWLE, especially women, showed symptoms such as talking incessantly, and should be isolated from society (Mahato et al, 2018).…”

Mental Health in low-and middle income countries (LMICs): Going beyond the need for funding

“…At the same time, we need to train existing community health workers, primary care providers on the range of issues around mental health and mental illness. For example, a recent project used UK healthcare workers that volunteered to train ANMs (auxiliary nurse midwives) in Nawalparasi (southern Nepal) on a range of mental health issues [48,49]. Theory of change was used to integrate mental health into primary health care services by training healthcare workers, finding volunteers for community champion on mental health within the community in Nigeria [50].…”

Importance of families in care of individuals with mental disorders: nurses' attitudes

“…2 The paradigm change in the mental health care intended for community states that a greater emphasis should be placed on the family's involvement, 5 and this family should be considered as an indispensable social actor for care effectiveness. 2,[8][9][10] The last reform of primary healthcare in Portugal (equivalent to Primary Health Care in Brazil) had formal beginning in 2005, integrating different types of units, namely: the PHU (Public Health Unit) which works as observatory on health of the geographical area in which it is integrated; the SARU (Shared Assistance Resource Units) that integrate social workers, psychologists, physical therapists, occupational therapists, among others, and which provides assistance services to all other functional units; the CCU (Community Care Units) that provides health care and psychological and social support, in the scope of the domicile and the community; the HPCT (Home Palliative Care Teams) provides care to patients, who need them, in their home, such as, support their relatives and caregivers. 11 Finally, the units more suited for personalized medical and nursing care, namely: the FHU (Family Healthcare Units) and the PHCU (Personalized Health Care Units).…”