It is not an overstatement that mental health care delivery is one of the sector within Nepal health system that gets little or not attention at all. However, the burden of this same illness, which is one of the most prevalent illnesses inflicting our human kind, is increasing every year with the rise of modernity, rapid urbanisation, poverty, social upheavals, breakdown of social fabrics. This applies the same in Nepal, where taboos related with mental illnesses is intense such that we may consider, there such practices, such condition as “unworldly possession” beyond modern medicine and care. Therefore, there is a growing consensus among leaders, health professionals and thought leaders that this global as well as national phenomenon need to be addressed before we drown ourselves, families and community with the rising burden of mental health problems.
In order to bring mental health issues at the policy table within the ministerial function and space, we need to start discussing mental health (its burden, causes, socio-economic, political and its overall management) as new policy dialogue. For this, we need to acknowledge that “without mental health, there can’t be healthy and wellbeing of citizen, family and our community”. We need credible “data” that state the ground reality and people’s suffering with various mental illnesses like anxiety disorder, affective disorders, schizophrenia and those many others classified in Diagnostic and Statistical Manual of Mental Disorders (DSM - 5). For now, we need to seriously analyze all the data gathered through HMIS platform. Our guess, although there is concern related timeliness and completeness as well as the quality of data, there is an acceptable level of basic mental health data from all levels, including health post, district hospitals, regional and tertiary hospitals. Also, we can safely say that there are numerous academic papers as well as program reports, which we can review and get fair pictures of the mental health situation in Nepal. Based on such analysis, as well as landscape analysis to assess the mental health care services, we may be able to get the panoramic view of Nepal’s mental health scenario.
To repeat again, “there is no health without mental health”. According to New Constitution of Nepal (2072 BC), every citizen has inalienable right to live a dignified life and state has every responsibility to provide basic services that include mental health at the doorstep or near villages. Our country is also committed to Sustainable Development Goals (SDG), and in particular, since we are talking about people’s health and welling, the goal no 3 is about “good health and well being”. To achieve this goal by 2030, one the target is to “reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being”. Also, it is appropriate to stress here that this goal number 3 is related to all other goals like poverty reduction, reducing inequalities, ending hunger, economic growth, and social justice.
To achieve SDG targets by 2030, one of the essential pathway is to achieve Universal Health Coverage (UHC), which means according to WHO that “all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship.” To achieve this grand goals, we need to work hard and secure health care financing and most importantly, we need to have dedicated human resource management, unlike current political interference.
Next Steps in Strengthening the Mental Health System, I have liberally sourced a conclusion form WHO - AIMS report on Mental Health System in Nepal. It is high time we read through it.
Excerpt from “WHO-AIMS REPORT ON MENTAL HEALTH SYSTEM IN Nepal”
“To ensure the availability and accessibility of mental health services for all of the population of Nepal, and in particular for the most vulnerable and underprivileged groups of the population, mental health services have to be integrated into the general health services system of the country. Mental health care facilities should be developed and have an active and dynamic interaction with the communities they serve. Mental health services have to be made available at the regional, district and peripheral levels. They have to be integrated into general health services at all levels including primary health care. Mental health resources have to be distributed in accordance with the mental health policy, and an adequate supply of essential psychotropic drugs should be maintained. Research exploring the development of a more efficient and effective mental health care structure has to be undertaken, and an evaluation of the impact of such structures and services has to be made. Given that there are inadequate human resources in the area of mental health to address the need of mental health patients, mental health training for all health workers, preparation of personnel with a specialty in mental health, and training for groups are needed. There has to be adequate and appropriate mental health and behavior science components in all health workers’ curricula in the country. Mental health components have to be developed within the in-service training structures, especially at the National Training Centre and the Regional Training Centres. The manpower of specialists in mental health, i.e., psychiatrists, psychiatric nurses, clinical psychologists, psychiatric social workers, etc., has to be further developed. Mental health legislation to ensure the rights of people with mental disorders has to be developed and implemented. Finally, awareness raising activities on the formulated rights have to be done as well.”
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