Improving access to mental health services by integrating them into general health services in Nepal

Mental illness is estimated to account for 18% of all noncommunicable diseases in Nepal 1. Despite this, in 2021 only one in four health facilities offered mental health services and most of these were concentrated in major cities, leaving rural populations underserved. Of those offering mental health services, only 16% had a health worker trained in mental health within the past two years 2. To address this lack, the Government of Nepal launched the National Mental Health Strategy and Action Plan 2020 and implemented the World Health Organization’s (WHO) Special Initiative for Mental Health. This included WHO Nepal providing evidence-based guidelines, technical intervention packages, rights-based frameworks, implementation guidance and training to the Ministry of Health and Population (MoHP). As a result, mental health services were extended to 35 of the 77 districts in Nepal.

How did Nepal, with the support of the WHO Secretariat, achieve this?

In 2020, the Government of Nepal activated its humanitarian cluster system to coordinate the emergency response to the COVID-19 pandemic, including a Mental Health and Psychosocial Support (MHPSS) coordination platform coled by the Government and WHO Nepal. WHO Nepal provided technical support for subcluster meetings, attended by representatives from NGOs, Government offices, experts, academia and members of the public with lived experience of mental health problems. By November 2022, partners had provided psychosocial support to over 40 000 people, including 20 000 children and 3000 health providers. This included the launch of the “1166” National Suicide Prevention Hotline which by November 2022 had received 1764 calls from people with suicidal ideations or mental health concerns; and the school Mental Health Initiative which provided training and supervision to school nurses and teachers. One hundred and sixteen school nurses and 269 schoolteachers across 120 schools in Bagmati Province were trained in social-emotional learning, mental health screening and initial management. It is anticipated that this will benefit 10 000 children and adolescents.

“ The magnitude of mental disorder in Nepal underlines an urgent need to strengthen and expand effective, affordable, and quality mental health care in Nepal. This will require adopting a holistic approach that emphasizes multi-sectoral coordination, community participation, strengthening health systems, and effective collaboration between federal, provincial, and local levels. WHO remains committed to supporting Nepal as it implements its national programme on mental health care strengthening.” - Dr Rajesh Sambhajirao Pandav, WHO Representative in Nepal

WHO Nepal provided technical support to the MoHP in drafting and funding Nepal’s National Mental Health Strategy and Action Plan 2020, launched in December 2020. In February 2021, Nepal joined WHO’s Special Initiative for Mental Health. WHO Nepal conducted a Rapid Assessment and held a multistakeholder meeting attended by representatives from MoHP, education and social sectors, people with psychosocial disabilities and civil society in order to tailor the initiative to Nepal’s needs, resources and gaps. After the MoHP approved the Mental Health Special Initiative’s workplan, WHO Nepal provided one technical expert at the federal level and five public health professionals at the provincial level. This augmented the governance capacity in all seven Provinces in Nepal, allowing for programme planning and further organization to integrate systems and services for mental health across all levels of health care delivery and administration.

In 2022, WHO Nepal supported the development of essential mental health competencies for preservice medical curricula and updated inservice training packages to increase mental health workforce capacity. More than 1700 health workers, including 215 programme managers, 584 primary care providers and 938 female community health volunteers, were trained in mental health. Primary health care (PHC) providers were taught to diagnose, identify and manage basic mental health issues. At least one medical doctor in each of Nepal’s 35 district hospitals was trained in mental health. Thirty-five of the country’s 77 districts now have PHC and district hospital mental health services.

Furthermore, intentional pesticide poisoning represents a significant clinical and public health concern in agricultural communities in Nepal. WHO Nepal is facilitating collaboration between health and pesticide management authorities to implement a ban on highly hazardous pesticides, and adapting a global publication to develop a national guidance on responsible reporting on suicides. As a pilot, 35 media persons have been trained on the new national guidance.

Accurate and up-to-date information on mental health interventions is essential for effective policies and practices. WHO Nepal and the Government collaborated to integrate eight mental health indicators into the Health Management Information System (HMIS). WHO Nepal identified data elements for a mental health register and developed a reporting tool to measure indicators. WHO Nepal also supported the monitoring of 13 general hospitals providing acute care inpatient mental health services. By December 2022, three of the 13 hospitals had established acute care mental health services following a baseline check and workshop with hospital teams, and visits by WHO Nepal and ministry officials.

Building the capacity of the mental “ health workforce and expanding mental health services beyond the cities have been our core priorities to ensure an effective response to the mental health situation in the country. Through the WHO-supported Special Initiative for Mental Health, several activities were undertaken in the past three years which helped the country achieve significant progress in the priority areas, and we will continue to further work on strengthening the mental health systems and services.” - Dr Chuman Lal Das, Director, Epidemiology and Disease Control Division (EDCD), Ministry of Health and Population

To further build and sustain mental health care capacity, on 10 October 2022, WHO Nepal supported the development of the National Mental Health Care Strengthening Programme, endorsed by the government and focusing on people-centred care, community participation and access to care. It provides a framework to deliver PHC-oriented mental health services, in line with the Public Health Service Act 2018, Regulation 2020 and National Mental Health Strategy and Action Plan 2020. Collaboration between health and non-health sectors, as well as multiple levels of the federal system, has so far enabled the successful building of implementation capacity. WHO Nepal plans to implement a support system whereby specialists from referral hospitals regularly provide mental health care and assistance to teams in district hospitals, persons with lived experience and their families are engaged in peer support and advocacy, and a toolkit will be developed for municipalities to plan and organize mental health care.

Knowledge

WHO country stories: delivering for all

“This impact story was published as part of the WHO country stories: delivering for all report, which presents a snapshot of how WHO has delivered on its mission in countries and contributed to health outcomes across a wide range of issues during 2022-2023.”