Nepal: Mental health care neglected
|Publisher||Integrated Regional Information Networks (IRIN)|
|Publication Date||30 December 2010|
|Cite as||Integrated Regional Information Networks (IRIN), Nepal: Mental health care neglected, 30 December 2010, available at: http://www.refworld.org/docid/4d22e2b81e.html [accessed 12 December 2013]|
|Disclaimer||This is not a UNHCR publication. UNHCR is not responsible for, nor does it necessarily endorse, its content. Any views expressed are solely those of the author or publisher and do not necessarily reflect those of UNHCR, the United Nations or its Member States.|
KATHMANDU, 30 December 2010 (IRIN) - More than six million Nepalis - 20 percent of the population - had symptoms of mental health disease in 2010, according to the government, but the issue remains neglected and underfunded, according to experts.
"This is a major public health concern and we still do not have a proper mental health care system in place," said Ram Lal Shrestha, director of local NGO Centre for Mental Health and Counselling-Nepal (CMC), which provides community mental health (MH) services
"MH issues have to be addressed urgently or a lot of lives will be at stake," he added.
More than 15 years have passed since the government formulated its first MH policy in 1996, but little of the policy has been implemented, said NGOs.
The key components of the policy included ensuring access to all minimum MH services, training MH human resources, protecting human rights of the mentally ill, and improving awareness about this public health issue.
"There is absolutely no mechanism [of policy enforcement] in place at the community level in the districts. Even the health professionals, like government medical officers, remain unaware due to lack of training on MH," said Jamuna Poudel, programme director of the Centre for Victims of Torture (CVICT), a national NGO specializing in psycho-social treatment.
There are more than 4,000 health posts and 75 district hospitals run by the government nationwide, but none have a dedicated MH unit, according to CVICT, which has been lobbying the government to start implementing the 1996 MH policy.
Only one government run health centre, Patan Hospital in Kathmandu, offers outpatient MH care. There are no inpatient or outpatient MH services in any other government-run health facilities in the country.
A 2006 World Health Organization (WHO) report said countrywide there were 32 psychiatrists, six clinical psychologists and 16 non-specialized medical doctors working in MH facilities at NGOs or Patan Hospital, and no occupational therapists.
Although reported almost four years ago, the situation is unchanged, according to local MH specialists.
Government officials said the main constraint is money.
"The government has a shortage of funds and manpower for MH services," said a Health Ministry official who asked not to be named.
Less than 1 percent of the nation's US$330 million health budget in 2010 was allocated for MH spending, but there is also little clear tracking of how much of that money was actually spent on MH services, according to NGOs.
"Most of the budget goes to pay salaries of the staff, administrative costs and logistics of the hospitals but not to the real beneficiaries like care and treatment of the patients," said Jaganath Lamichhane, founder of Nepal Mental Health Foundation (NMHF), a local NGO focusing on the care and treatment of MH patients.
Only a negligible number of patients have free government-subsidized access to psychotropic drugs, one form of medical treatment, he explained. The cost of anti-psychotic medication is high in Nepal and unaffordable for most affected families.
"Many families outside the capital have no option but to travel to India for treatment and they get impoverished due to the medical costs," said Bhusan Guragain, a medical doctor with CVICT.
Januka Sharma, a 28-year-old MH patient from Nepalgunj in midwest Nepal, nearly 500km west of the capital, was taken to India for treatment six months ago, requiring her family to sell livestock and land to pay her medical expenses.
"They lost everything and she was not even cured," said Guragain, who eventually treated her in Nepal and helped to recover her health.
NGOs remain the last hope for MH patients. But even then only a handful of the 275 rights-based NGOs nationwide target the mentally disabled population, according to NMHF. "And most of them don't receive enough [outside] funding support and have to rely on their own limited funds," said Lamichanne.
Patients are treated for free by NGOs which, however, mostly focused on psycho-social counseling; there is little clinical treatment of patients with severe depression.
"It [deteriorating MH] is a serious concern and the consequences are quite shocking," said CMC's Shrestha.
In less than 10 months in 2010, the Nepal police recorded a total of 7,300 cases of suicide nationwide. More than half were women.
[This report does not necessarily reflect the views of the United Nations]