MHCP in Nepal | Conflict and Health | Volume 9, Issue 3, pp. 1-11
“The PRIME situation analysis tool yields data that has value for the planning of integrated mental health services, as well as evaluating the impact of implementing these plans […] The results of this study were very helpful for the development of the district level mental health care plan, especially regarding how national context and the district situation can influence the district care plan and what is realistic and feasible given the current lack of capacity [in Nepal].”
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.
Available Tools and Example Plans
PRIME has developed a Situation Analysis Tool to systematically analyze the gaps in mental health care in low-income countries, and inform the development of a district level mental health care plan (MHCP).
The PRIME Situation Analysis Tool is available for download.
PRIME has also made the following district level mental health care plans (MHCP) available:
- South Africa
Background on PRIME
PRogramme for Improving Mental health carE (PRIME) is a consortium comprised of research institutions and ministries of health from five countries, including India, Nepal, South Africa, Ethiopia, and Uganda. The consortium is led by the Centre for Public Mental Health at the University of Cape Town in South Africa, is funded by the Department for International Development (DFID).
PRIME’s mission is to “develop world-class research evidence on the implementation, and scaling up of treatment programs for priority mental disorders in primary and maternal health contexts in low resource settings.”
Partners and collaborators include:
- Federal Ministry of Health, Ethiopia
- Ministry of Health, Nepal
- Ministry of Health, Uganda
- Department of Health, South Africa
- Madhya Pradesh State Ministry of Health, India
- Addis Ababa University
- Makarere University
- University of Kwazulu-Natal
- London School of Hygiene & Tropical Medicine
- World Health Organization (WHO)
- Sangath (India)
- Public Health Foundation of India
- Health Net TPO (Nepal)
- Human Sciences Research Council (South Africa)
- BasicNeeds (UK)