Sound mental health is fundamental to achieving a complete state of wellness and exercising one’s full potential. But it is a far cry in low and middle income countries (LMIC) like Nepal, where mental health is widely neglected. Consider that only 0.23 percent of the national health budget is spent on mental health in Nepal.
Mental illness is consistently associated with deprivation, low income, unemployment, migration, poor education, poor physical health, and increased health-risk behavior. Also, the economic crisis is expected to produce secondary mental health effects that may increase the rate of various mental disorders and suicide. Presently, Nepal is struggling with political instability and economic crises, which pose a high risk to the mental wellbeing of the general population. [break]
According to World Health Organization (WHO) Mental Health Gap Action Program, 14 percent of the global burden of diseases is attributable to mental disorders. Almost three quarters of this burden occurs in LMIC because of limited human and financial resources. Mental disorders not only have huge consequences on the quality of life, but also contribute to continued economic burden and reinforce poverty. They are also risk factors for both communicable and non-communicable diseases, as well as for disability. About 10 percent of Nepali people suffer from one or more mental illnesses, and an estimated 1-3 percent of the population suffers from chronic, severe mental illnesses (WHO, 2001).
Over 90 percent of the population that needs mental health services has no access to treatment. Besides, there are routine and rampant cases of human rights violations against people with mental health problems. This indicates that not only have mental disorders increased the burden to Nepali community, but mental health services are also out of reach for most people, especially in rural regions. This article emphasizes the urgent need to address mental health in Nepal, beginning with the integration of mental health into primary healthcare system.
There are likely to be many obstacles to the up-scaling of intervention strategies of the mental health system. These include limited availability of medications and health professionals; limited affordability of psychiatric treatment; policy limitations; lack of mental health legislation; different priorities in public health (eg, communicable disease, child health, reproductive health); and heterogeneous nature of primary healthcare providers.
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The big shortage of mental health professionals and relatively low level of awareness of mental disorders implies that primary healthcare is the single biggest sector for mental healthcare. Therefore mental healthcare has to be decentralized to all levels of healthcare system, and delivered by all health staff rather than just mental health specialists. A strong emphasis should be given on first line care at primary healthcare setting by non-specialist, trained healthcare providers like psychosocial counselors and social workers.
The World Health Report 2001, “Mental Health: New Understanding, New Hope”, outlined the need and rationale for building community based mental health systems and services. It has summarized 10 recommendations as key components for the development of mental health system. Those recommendations include: Providing treatment in primary care; making psychotropic drugs available; providing care in the community; educating the public; involving communities, families and consumers; establishing national policies, programs and legislations; developing human resources; linking with other sectors; monitoring community mental health; and supporting more research.
These recommendations make up the key components of National Mental Health Policy formulated by the government of Nepal in 1997. The policy aimed at providing mental health services to all Nepali people by 2000, and also promised to protect human rights of mental patients and generate awareness for a holistic health approach. More than 10 years have passed, and the policies have not been implemented. There is an urgent need to revise the Mental Health Policy and start implementing it for the development of community-based mental healthcare system. This would include mental health promotion and mental illness prevention programs to reduce the burden of mental illness with the potential for large-scale prevention of human suffering and associated significant economic benefits.
The authors are associated with Integrating Mental Health in Primary Health Care in a Post Conflict Setting Project in Dang
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