Table 1.
Mapping of results from situation analysis
| Category | Situation of Nepal | Challenges for transformation |
|---|---|---|
| Policy framework and infrastructure | • National mental health policy developed in 1997. | • Lack of implementation of the policy framework into practice |
| • Policy proposes establishing a separate mental health division in the MoHP | ||
| • Lack of endorsement of mental health legislation | ||
| • Policy aims to provide mental health services to all the population by 2000 | • No mental health division in the MoHP or Department of Health Services (DoHS) | |
| • Mental health legislation has been drafted | ||
| • Absence of a long-term mental health strategy and program | ||
| • Mental health is also included under Disability Act and ensures disability benefits to people with severe mental illness | ||
| • No sufficient budget allocation on mental health | ||
| • Minimal health budget is allocated for mental health | ||
| Mental health services | • Mental health services available in the country are mostly institution based | • Lack of holistic treatment approach (community care to specialized care) for the treatment of mental health problems |
| • Out of 75 districts, only 7 district hospitals provide mental health services | ||
| • Lack of integration of mental health services to other non-health sectors such as education, social welfare, and sports | ||
| • Mental health services are limited to psychotropic medication | ||
| • Lack of separate hospital for providing mental health services to children and elderly people | ||
| • About 450 mental health beds i.e. 1.5 per 100,000 population (both government and private hospitals) in the country | ||
| • Lack of training and involvement of community volunteers (e.g. FCHVs and traditional healers) in identification and referral of people with mental illness | ||
| • Traditional healers or/and religious leaders are a primary source of mental health treatment in the community | ||
| • NGOs provide community based mental health services to the specific population; mostly these services are in isolation with government services | ||
| Mental health services in the PHC | • No systematic information available about the services of mental health in the PHCs | • Lack of standardized mental health training manual for PHC workers |
| • Mental health services are available in few districts where community mental health services are introduced by both government and NGOs | ||
| • Lack of basic psychotropic medicines in the free drug list | ||
| • Lack of formal referral mechanism from primary to secondary/tertiary care or vice versa | ||
| • Lack of mental health supervision mechanism in the existing supervision system | ||
| • Lack of referral system from primary to tertiary care or vice versa | ||
| • Number of PHC staff trained on mental health by NGOs and government in the country: General Doctors 156 (including doctors from district hospital); Health Assistants/Auxiliary Health Workers (AHWs)/Staff nurse 672; Nurse/auxiliary nurse mid wife 39 | ||
| • Only few (i.e. phenobarbitone and amitryptyline) psychotropic medicines available in the PHCC and HP. No psychotropic medicine available in the SHP | ||
| Human resource | • Mental health services are coordinated by different institutions in the center e.g. mental hospital, management division. | • Lack of designated person in the MoHP to coordinate mental health activities |
| • Lack of specific strategy for developing human resources in mental health | ||
| • Limited human resource on mental health: 60 psychiatrists 60 (an estimated 25% are reported to be out of the country); 25 psychiatrist nurses; 16 clinical psychologists; 400–500 para-professional counselors (trained by NGOs); 867 general doctors/PHC workers who have received short mental health training | ||
| • Lack of mental health component in the existing curriculum of all cadres of PHC workers | ||
| • No fulfillment of vacant position in the PHC for long time. | ||
| • Most of the psychiatrists, psychiatrists nurse and psychologists are working in private sector and in big cities | ||
| • High staff turnover and frequent transfer in another places | ||
| • Community health volunteers are not trained on mental health issue | ||
| Public education and links with other sectors | • No mental health education carried out; hence, low/no public awareness on mental health among the general population | • Lack of mass sensitization program on mental health and psychosocial issues in the community |
| • Lack of coordination and linkage with other non health sectors such as education and social welfare | ||
| • Mental health highly stigmatized in the community | ||
| • Psychosocial and mental health services integrated in the hospital based one-stop crisis management center focusing for victims of gender based violence | ||
| • Lack of involvement of key community actors such as teachers, and youth clubs for identification and referral | ||
| • Psychosocial and mental health incorporated in the care plan of children affected by HIV/AIDS | ||
| • Mental illnesses is included under disability | ||
| • Establishment of National Mental Health Network (NMHN) to advocate for mental issues with concerned stakeholders | ||
| • Establishment of two organizations led by people with mental health and psychosocial disability | ||
| Monitoring and supervision | • A morbidity form is available for outpatient clinics, from PHC level | • Lack of involvement of mental health specialists (psychiatrist and psychologist) in the supervision of the PHC workers |
| • Current HMIS system includes seven mental health indicators (such as Depression, Psychosis, Anxiety (coded as Neurosis), Mental Retardation, Conversion Disorder (Hysteria), Alcoholism and Epilepsy) in the PHC/district level and 47 mental health problems and 13 self-harm related indicators in hospitals | ||
| • Lack of nationally representative epidemiological data on mental health | ||
| • Lack of data use culture at the Health Facility level | ||
| • The only national level mental hospital reports comprehensive data on mental health. Besides the above data, it also provides data on bed occupancy rate, mental health budget release and expenditure and leading causes of morbidity. | ||
| • No separate monitoring and supervision system exists for mental health care | ||
| • Small scale studies have been conducted with specific population to identify prevalence of mental health problems |