Building Capacity of Mental Health Professionals in Nepal: Findings from the Missing Counselor Project

Background: Mental health problems have been a global public health concern, especially in the light of the COVID-19 pandemic. Despite the growing demand for mental health services in low- and middle-income countries (LMIC), the COVID-19 pandemic has exacerbated the mental health capacity in resource constrained settings, like Nepal. As such, providing education and training to mental health professionals and para-professionals could be a key in building capacity and mental health infrastructure. In collaboration with a US diasporic organization, we provided a short-term virtual intervention training as a pilot project, using US mental-health experts, to build the capacity of volunteer counselors (N=14) with the Missing Counselor Project, a youth-led voluntary initiative in Nepal, organized to mitigate the mental health service gaps in the wake of the COVID-19 pandemic.

Methods: Using a transformative mixed method intervention research design, we collected both quantitative and qualitative data throughout the project. The 8-session intervention content encompassed: trauma informed care; strength-based interventions, solution-focused therapy; crisis intervention; ethical considerations; compassion fatigue; self-care; mindfulness technique; and culture and mental health. The quantitative data were gathered using a 20-item questionnaire before the intervention, after the intervention, and a follow-up after three-months. Qualitative data were collected from eight 30-minute de-briefing sessions conducted after each session and 90-mute focus group discussions (FGD) after the culmination of the 8-week intervention to assess the efficacy of the intervention. We also conducted 60-minute in-depth interviews with five participants, exploring barriers and facilitators of providing mental health services in Nepal. We used Wilcoxon signed-rank test to measure the mean-differences in mental health knowledge, beliefs and levels of capacity, and competence before and after intervention. De-briefing sessions, FGD and interviews were video recorded, translated, and transcribed verbatim. The RADaR technique and five-step thematic analysis procedures were used for qualitative data analysis.

Results: Data analysis from Wilcoxon signed-rank test showed positive differences in mean scores in knowledge, attitude, beliefs and capacity from pretest to posttest. FGD discussion garnered three overarching themes on intervention efficacy: increase in knowledge and capacity at the individual level; increase in collective self-efficacy; and possibilities for cultural adaptability of westernized models. Deep-rooted cultural stigma, lack of mental health awareness, inadequate mental health trainings, limited job opportunities and absence of regulatory practices were identified as barriers to mental health service provision. Family stood as both a barrier and a facilitator to service provision and utilization. The multi-modal findings showed the pragmatic utility of short-term western interventions in increasing the capacity of mental health counselors with opportunities for cultural adaptations as well as increased knowledge on the state of mental health services in Nepal.

Conclusions: Our pilot intervention project demonstrates the utility and possibilities of mental health-capacity building projects in LMICs through virtual platforms, which can be replicated to larger cohort-sample and other similar regions. Cultural adaptability of Western mental health models could provide crucial and innovative pathways to building mental health capacity in under-resourced-settings in LMICs around the globe.