MENTAL HEALTH IN NEPAL

Mental Health in Nepal

Introduction

We are currently living in a world where one out of four people is affected by some kind of mental illness or mental disorder. Among them, 3 out of 4 people don't receive proper treatment or proper counselling. Neuropsychiatric conditions account for 13% of total disability-adjusted life year (DALYs) lost due to all-disease and injuries and is likely to increase to 15% with depression, anxiety, schizophrenia, panic disorder, phobias have neutralized people to perform in any task, engage in creative works, coping with normal stress in life, and to be economically and socially productive.

The possibility of mental disorder in people is very high in the developing or underdeveloped countries like Nepal due to lack of efficient mental health services, diagnostics, treatment and availability of human resources to address the mental health issues. Suicide is the second most common cause of death among young people globally. Nepal has the seventh-highest suicide rate in the world-mostly among girls and woman of reproductive age. Additionally, the aftermath of an earthquake on April 25, 2015, have raised the burden of post-traumatic stress disorders among the survivors exponentially [3-5].

Health system provision for Mental Health in Nepal

Mental Hospital in Nepal

The increasing rate of mental health problems, lack of mental health services, availability and accessibility are the major challenges for Nepal. The allegations associated with mental health and labelling of mental health service seekers as “mad” has created difficulty to face the health issues and get proper counselling and treatment [6]. There are very few specialist mental health services in Nepal-1 mental hospital and 18 outpatient mental health facilities and 17 generals and teaching hospitals with inpatient mental unit limited to central, zonal or district-level hospitals. None of these facilities is specialized for child or adolescent mental health. There is only 0.59 human resource working in mental health per 100,000 populations of which only 0.13 are psychiatrists [7]. At community level counselling and psychotherapeutic are not available and trained mental health force is almost negligible, and those who are trained in mental health are not provided with regular refresher course and are poorly documented. The broad classification of mental health data under “mental disorder” has further limited the evidence of prevalence and management of diverged mental health issues. Moreover, the mental health policy developed in 1997 still lacks a framework for implementation hence fails to integrate mental health within the health system in the country [8].

Addressing Mental Health through primary prevention in Nepal

School-level kids with pamphlets about mental health

Mental health is a many-sided problem. So to face the multi-sectoral problem inclusion of non-health sector is important. The inclusion of mental health in education, nutrition program, maternal and child health is vital. The lack of information and data regarding mental health issues in Nepal is a drawback for identifying and tackling mental health in Nepal. Educational institutions and workplace can be a very important area to address mental health issues. Formation of child-friendly school, inclusion of programs that supports children to speak about stresses, failures and pressures at school level, anti-bullying programs, awareness on drugs and anti-drug programs, provision of counselling sessions for students and training teachers on identifying symptoms and necessary skills to handle such issue at primary level are some of the possible interventions that will create a supportive environment against mental health. Moreover, stress prevention program at work settings, provision of physical exercise at work and home settings will help to reduce mental stressors. Studies have shown that physical activity also helps to improve mental health hence there should be provision to include adequate space for school and housing [9-10].

Psychotropic drugs and their availability

*not the original drug but a representation only

Unfortunately, there are not many studies on the availability of psychotropic drugs in Nepal. The market dynamics and markups in such drugs, according to studies in neighbouring countries, shows a high share of branded drugs and high out of pocket expenditure. The annual cost per average case of disorder in Nepal was highest for anti-psychotic drug and was 176.47 US$ [10] and largely such medicines are paid out of pocket. Not having an insurance system complicates the problem furthermore, and there are other hidden costs to the person suffering the illness and their family members due to loss of workdays in accessing the services. There are only 12 drugs listed in the national essential medicine list of Nepal related to treatment of mental health problems [11] compared to 17 in 19th revision of WHO essential medicine list (EML) including all the complementary forms of the medicines as of 2015 [11] and of them only 3 are present in the free drug list of Nepal [12]. So, our recommendation is that the government without a delay should allocate essential psychotropic drugs and its formulations to the free drug list.

Conclusion

Mental health is an emerging health priority though we don’t know the exact burden of it as of now. The provision of mental health services at the primary care and tertiary care remains weak with only 0.13 psychiatrists per 100,000 populations and 0.59 mental health workers per 100,000 populations. The availability of psychoactive drugs remains faint with high out-of-pocket expenditure on medicines. The government should immediately roll out mental health services through primary health care, for that number of both specialist and mid-level health workers need to be trained and their numbers increased. The prevention of mental illnesses should be looked through a primary prevention approach so that the risk factors and their precipitators for poor mental health outcomes at the different levels of community and social structures can be mitigated.

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