The state of mental health in Nepal is appalling. According to World Health Organization, as many as 266,000 people in the country have severe mental health disorders. At least twice that number is believed to be suffering from neuroses, the relatively milder mental illnesses. But there is just a single hospital exclusively dealing with mental health. Of the around 50 psychiatric clinics and 12 psychological counseling centers, an overwhelming number is located in Kathmandu and other urban centers; and half of the 50 psychiatrists registered in the country are plying their trade abroad. Whichever way we look at it, the state of mental health in the country presents a bleak picture. Considering the scale of the problem, one would have thought the state would take the issue seriously. But that is far from the case. Under one percent (yes, under a percent) of the national budget for health is set aside for mental health. Not a surprise considering that until recently the topic only made footnotes of the government’s periodic plans.
Thankfully, mental health does get a mention in the Three Year Interim Plan. To its credit, the plan is right to focus on the assessment of the impact of the 10-year-long civil war on the psyche of those directly affected by it. The other areas of focus like public awareness, training of health workers on basic mental health management and rehabilitation of severe mental health patients into the community also make all the right noises. But there seems to be a big gulf between commitments and actions, both from the levels of government and NGOs working in the field. Again, this is not to overlook the good work that has been done in recent times, particularly when it comes to pushing for policy level interventions for greater prioritization of mental health in government programs. There has also been some improvement in treatment and rehabilitation of severe mental health patients from the NGO level.
Yet the fact that all these efforts have barely scratched the surface of the problem was poignantly brought home at a national level seminar on psychosocial disability rights in Kathmandu on Friday. There was a hush in the floor when a young lady, a mental health patient, spoke for all those who have had to shoulder the twin burdens of mental health problems and the accompanying social stigma and exclusion. Her indignation at the society’s neglect clearly reverberated in her shaky voice: for all the talk, she told the rapt audience, neither she nor any of her peers with mental health issues had received any help. None.
This suggests piecemeal approaches are unlikely to work considering the sheer magnitude of the problem. In this situation, the recent push for prioritization of mental health issues at the policy level has been long time coming. So have been efforts to link mental health with the broader disability rights movement, another important step that could increase the visibility of the mental health crisis. These are hopeful signs. But let no one be in any doubt: there is a long-long way to ensure adequate treatment for hundreds of thousands of sufferers, much less to guarantee sound mental health for each and every Nepali.
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