Mental health care in Nepal: current situation and challenges for development of a district mental health care plan
- PMID: 25694792
- PMCID: PMC4331482
- DOI: 10.1186/s13031-014-0030-5
Mental health care in Nepal: current situation and challenges for development of a district mental health care plan
Abstract
Background: Globally mental health problems are a serious public health concern. Currently four out of five people with severe mental illness in Low and Middle Income Countries (LMIC) receive no effective treatment. There is an urgent need to address this enormous treatment gap. Changing the focus of specialist mental health workers (psychiatrists and psychologists) from only service delivery to also designing and managing mental health services; building clinical capacity of the primary health care (PHC) workers, and providing supervision and quality assurance of mental health services may help in scaling up mental health services in LMICs. Little is known however, about the mental health policy and services context for these strategies in fragile-state settings, such as Nepal.
Method: A standard situation analysis tool was developed by the PRogramme for Improving Mental health carE (PRIME) consortium to systematically analyze and describe the current gaps in mental health care in Nepal, in order to inform the development of a district level mental health care plan (MHCP). It comprised six sections; general information (e.g. population, socio-economic conditions); mental health policies and plans; mental health treatment coverage; district health services; and community services. Data was obtained from secondary sources, including scientific publications, reports, project documents and hospital records.
Results: Mental health policy exists in Nepal, having been adopted in 1997, but implementation of the policy framework has yet to begin. In common with other LMICs, the budget allocated for mental health is minimal. Mental health services are concentrated in the big cities, with 0.22 psychiatrists and 0.06 psychologists per 100,000 population. The key challenges experienced in developing a district level MHCP included, overburdened health workers, lack of psychotropic medicines in the PHC, lack of mental health supervision in the existing system, and lack of a coordinating body in the Ministry of Health and Population (MoHP). Strategies to overcome these challenges included involvement of MoHP in the process, especially by providing psychotropic medicines and appointing a senior level officer to facilitate project activities, and collaboration with National Health Training Centers (NHTC) in training programs.
Conclusions: This study describes many challenges facing mental health care in Nepal. Most of these challenges are not new, yet this study contributes to our understanding of these difficulties by outlining the national and district level factors that have a direct influence on the development of a district level mental health care plan.
Keywords: Integration of mental health into PHC; Mental health; Mental health care plan; Nepal; Situation analysis.
Similar articles
-
The joint JMA-JICA project in Nepal.Acta Paediatr Jpn. 1993 Dec;35(6):571-5. doi: 10.1111/j.1442-200x.1993.tb03113.x. Acta Paediatr Jpn. 1993. PMID: 8109243
-
Acceptability and feasibility of using non-specialist health workers to deliver mental health care: stakeholder perceptions from the PRIME district sites in Ethiopia, India, Nepal, South Africa, and Uganda.Soc Sci Med. 2014 Oct;118:33-42. doi: 10.1016/j.socscimed.2014.07.057. Epub 2014 Jul 29. Soc Sci Med. 2014. PMID: 25089962 Free PMC article.
-
Challenges and opportunities for implementing integrated mental health care: a district level situation analysis from five low- and middle-income countries.PLoS One. 2014 Feb 18;9(2):e88437. doi: 10.1371/journal.pone.0088437. eCollection 2014. PLoS One. 2014. PMID: 24558389 Free PMC article.
-
Dementia care landscape in Nepal: Understanding the context, barriers, and opportunities for the development of a national dementia care plan.Int J Geriatr Psychiatry. 2024 Jun;39(6):e6111. doi: 10.1002/gps.6111. Int J Geriatr Psychiatry. 2024. PMID: 38862409 Review.
-
Health systems context(s) for integrating mental health into primary health care in six Emerald countries: a situation analysis.Int J Ment Health Syst. 2017 Jan 5;11:7. doi: 10.1186/s13033-016-0114-2. eCollection 2017. Int J Ment Health Syst. 2017. PMID: 28070217 Free PMC article. Review.
Cited by
-
Feasibility and Acceptability of a School-Based Emotion Regulation Prevention Intervention (READY-Nepal) for Secondary School Students in Post-Earthquake Nepal.Int J Environ Res Public Health. 2022 Nov 4;19(21):14497. doi: 10.3390/ijerph192114497. Int J Environ Res Public Health. 2022. PMID: 36361372 Free PMC article. Clinical Trial.
-
The Long-Term Mental Health Consequences of Torture, Loss, and Insecurity: A Qualitative Study Among Survivors of Armed Conflict in the Dang District of Nepal.Front Psychiatry. 2020 Jan 15;10:941. doi: 10.3389/fpsyt.2019.00941. eCollection 2019. Front Psychiatry. 2020. PMID: 32009989 Free PMC article.
-
Prevalence of depression and associated symptoms among patients attending primary healthcare facilities: a cross-sectional study in Nepal.BMC Psychiatry. 2024 May 14;24(1):356. doi: 10.1186/s12888-024-05794-0. BMC Psychiatry. 2024. PMID: 38745133 Free PMC article.
-
Predicting the risk of depression among adolescents in Nepal using a model developed in Brazil: the IDEA Project.Eur Child Adolesc Psychiatry. 2021 Feb;30(2):213-223. doi: 10.1007/s00787-020-01505-8. Epub 2020 Mar 12. Eur Child Adolesc Psychiatry. 2021. PMID: 32162056 Free PMC article.
-
Adaptation of the World Health Organization Electronic Mental Health Gap Action Programme Intervention Guide App for Mobile Devices in Nepal and Nigeria: Protocol for a Feasibility Cluster Randomized Controlled Trial.JMIR Res Protoc. 2021 Jun 15;10(6):e24115. doi: 10.2196/24115. JMIR Res Protoc. 2021. PMID: 34128819 Free PMC article.
References
-
- WHO . Mental Health Gap Action Programme (mhGAP): Scaling up care for mental, neurological and substance use disorders. Geneva: World Health Organization; 2008. - PubMed
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical
Miscellaneous