Mental health in Nepal: Time to invest more on the sector
In this blog, Pragya Lamsal and Rita Gautam from CBM discuss the consequences of the 2015 Nepal Earthquake on the mental health of the population and the launch of the International Mental Health Conference (2018) as a platform to promote more cost-effective and efficient approached to mental health care in Nepal. The blog highlights Nepal's commitment in breaking the silence on mental health issues and details recommendations for the journey ahead to address the need of comprehensive mental health care in the country.
In Nepal, mental health is one of the least prioritized areas of development. A large majority of the population is still deprived of basic health services, which often impedes their quality of life. In health facilities, mental health services are not integrated and local health professionals lack an understanding of mental health and psychosocial wellbeing. Superstition and social constrains surrounding mental health are still prevalent in many communities. Many people in Nepal tend to hide their mental health problems due to the fear of negative portrayal and isolation from society. People do not seek services and treatment because of reluctance and the stigma attached to mental illness, thus escalating the amount of suffering. At the same time, most people suffering from severe mental health and psychosocial conditions are subjected to human rights violations, abandoned or restrained. Both the government and some civil society organizations also run programmes and clinics providing mental health and psychosocial services. These are, however mainly concentrated within urban areas and are not enough to address the current needs of affected populations.
According to the World Health Organization, one in four people1 experience mental or neurological disorders at some point in their lives. A 2013 small-scale epistemological study showed that 37.5% of Nepal’s population suffers from mental disorders2. The exact rate of prevalence is still yet to be confirmed however, due to the lack of epidemiological studies at the national level. It is also worth mentioning that less than 1% of the total health budget is allocated to mental health, which is understandably insufficient to address the demand of mental health services in the country3.
The Nepal Earthquake
On 25 April 2015, a 7.8 magnitude earthquake rocked Nepal. The quake and a series of aftershocks delivered a severe blow, causing widespread damage in infrastructure and loss of lives. Thirty-five of the country’s districts were affected – 14 severely so. Approximately 9,000 people lost their lives and more than 22,000 people were injured.
Among others, one of the major intangible effects of the earthquake was on the mental health and well-being of the population. The disastrous earthquake came as a shock that made diverted public attention towards the importance of mental health and psychosocial wellbeing. According to mental health experts, the number of people experiencing mental health issues increased after the 2015 earthquake4. Many people were traumatized, suffered significant emotional distress and this trauma has existed since the disaster.
International Mental Health Conference: First of its kind in Nepal
In order to create a discourse on the status of mental health in Nepal, the first International Conference on Mental Health was organized on 16-17th of February 2018. This conference was organized by Primary Health Care Revitalization Division (PHCRD), Department of Health Services, Ministry of Health and Population, Nepal in collaboration with several national and international organizations working in the field of mental health. This also launched a discussion for identifying more cost-effective and efficient mental health programs in Nepal. It provided a common platform to discuss the development and promotion of mental health under the theme “Coming Together for Mental Health”. Participants discussed best practices, lessons learned and existing gaps related to mental health. CBM Nepal’s Country Office was a part of the organizing committee. There were more than 400 participants and 85 presentations under the theme of mental health promotion, prevention, treatment and rehabilitation. The conference concluded issuing a nine-point declaration as part of the next action plan.
Working Together to Promote Mental Health
The conference also provided a platform to reflect the work being done by CBM Nepal’s Country office and its partners on community mental health (CMH, one of the priority areas of focus for CBM in Nepal). CMH programmes target people living with psychosocial disabilities who are some of the most marginalized groups in society. The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) serves to promote, defend and reinforce the human rights of all persons with disabilities and therefore serves as the legal framework for CBM’s advocacy.
Following the earthquake, CBM in partnership with KOSHISH, a self-help organization and Central for Mental Health and Counselling Nepal (CMC Nepal) implemented a post-emergency response implementation plan (2016-2018) to strengthen the health system and existing capacity in 19 government health facilities to mainstream mental health services across six earthquake-affected districts. The project provides medical treatment, psychosocial counseling, sensitization and rehabilitation services to persons with psychosocial disabilities. To improve the basic skills of health professionals, mhGAP training and psychosocial counseling was implemented to more than 150 health professionals. CBM has reached more than 2000 people with mental health and psychosocial services providing psychiatric OPD, counseling and other services. Similarly, the project also focuses on the formation of self-help groups to empower persons with psychosocial disabilities to advocate for their rights. Learn more about the program by visiting its innovation page.
“I thought I could never come out from the grief. Now I want to help people who have gone through the similar pain. If someone from the village has mental health problems then they come to me for counselling. We talk in groups and try to solve the problem,”
- A women from Bhaktapur, Nepal who suffered from post-traumatic disorder after she lost her son during the earthquake
Way Ahead and Recommendations from the International Mental Health Conference
- Mental health should be established within the developmental agenda
- Mental health should be prioritized as an important area in national health policies
- Improve the technical capacity and skills of health professionals working at all levels of mental health care in addition to the improved understanding of CRPD and its implications
- Mental health services should be guided by the disability framework as it looks beyond the mental health condition or person to the wider context of interaction with society
- Both government and non-governmental bodies working on mental health should collaborate for community-based effective interventions
- Legal reforms and public awareness programs need to go hand-in-hand with systems strengthening
- Ensuring the availability of more efficient, recovery-based, accessible and affordable medical and psychosocial treatment involving the family and wider community
- As a signatory country to the Sustainable Development Goals (SDGs), Nepal should recognize mental health as an important aspect in health promotion
References:
- World Health Organization (2001). World Health Report. Press Release [accessed online at 10/07/2018)
- Luitel, Nagendra P., et al (2013). Conflict and mental health: a cross-sectional epidemiological study in Nepal. Social psychiatry and psychiatric epidemiology, 48(2): 183-193.
- World Health Organization (2006). WHO-AIMS Report on Mental Health System in Nepal, WHO and Ministry of Health, Kathmandu, Nepal. [Link]
- National Planning Commission, Nepal (2015). Post Disaster Needs Assessment. Volume B [accessed online at 11/07/18]