Background In the aftermath of the devastating 2015 earthquakes in Nepal, three non-governmental organizations collaborated to develop a program responding to the immediate mental health and psychosocial support (MHPSS) needs in three severely affected districts: Dhading, Gorkha, and Sindhuli. The program was implemented between April 2015 and February 2017 and aimed to (i) strengthen health worker capacity to provide integrated MHPSS services; and (ii) increase access to mental health services. This paper describes the program's implementation and the results of a pragmatic evaluation of the program's overall reach, effectiveness, and lessons learned. Methods The mixed-methods evaluation used routine program data, quantitative data from pre- and post-tests conducted with trainees and service users, and qualitative data from stakeholder interviews and focus group discussions. Results A total of 1041 health workers received MHPSS training and supervision. Participants demonstrated significant improvements in skills, knowledge, and self-rated perceived competency. Trainees went on to provide MHPSS services to 3422 people. The most commonly identified presenting problems were epilepsy (29%) and depression (26%). A total of 67% of service users reported being ‘completely satisfied’ with the services received and 83% of those experiencing severe functional impairments on enrollment demonstrated improvement after receiving services. Conclusions Despite operational challenges, the program successfully engaged both laypeople and health workers to provide MHPSS in the aftermath of the crisis. Lessons learned can inform the planning and implementation of future training and integration programs to provide large-scale MHPSS efforts in humanitarian settings.

中文翻译：

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尼泊尔地震后将心理健康纳入初级卫生服务：混合方法项目评估

背景 在 2015 年尼泊尔发生毁灭性地震后，三个非政府组织合作制定了一项计划，以应对三个受灾严重的地区（达丁、廓尔喀和信都里）的即时心理健康和社会心理支持 (MHPSS) 需求。该计划于 2015 年 4 月至 2017 年 2 月期间实施，旨在 (i) 加强卫生工作者提供综合 MHPSS 服务的能力；(ii) 增加获得精神卫生服务的机会。本文介绍了该计划的实施情况以及对该计划的总体影响、有效性和经验教训进行务实评估的结果。方法 混合方法评估使用常规计划数据、对受训者和服务用户进行的前后测试的定量数据，利益相关者访谈和焦点小组讨论的定性数据。结果共有1041名卫生工作者接受了MHPSS培训和监督。参与者在技能、知识和自评感知能力方面表现出显着提高。学员继续为 3422 人提供 MHPSS 服务。最常见的问题是癫痫（29%）和抑郁症（26%）。共有 67% 的服务用户表示对所获得的服务“完全满意”，83% 的注册时出现严重功能障碍的用户在接受服务后表现出改善。结论 尽管存在运营挑战，但该计划成功地让非专业人士和卫生工作者在危机过后提供 MHPSS。