BackgroundService user and caregiver involvement has become an increasingly common strategy to enhance mental health outcomes, and has been incorporated in the mental healthpolicies of many developed nations. However, this practice is non-existent or fragmented in low and middle income countries (LMICs). Instances of service user and caregiver involvement have been rising slowly in a few LMICs, but are rarely described in the literature. Very little is known about the context of user and caregiver participation in mental health system strengthening processes in a low-income, disaster- and conflict-affected state such as Nepal.MethodsThis study explores (a) the extent and experiences of service user and caregiver involvement in policy making, service planning, monitoring, and research in Nepal; (b) perceived barriers to such involvement; and (c) possible strategies to overcome barriers. Key Informant Interviews (n = 24) were conducted with service users and caregivers who were either affiliated to a mental health organization or receiving menta health care integrated within primary care. Purposive sampling was employed. Data collection was carried out in 2014 in Chitwan and Kathmandu districts of Nepal. Data analysis was carried out in NVivo10 using a framework approach.ResultsThe involvement of service users affiliated to mental health organizations in policy development was reported to be ‘tokenistic’. Involvement of caregivers was non-existent. Perceived barriers to greater involvement included lack of awareness, stigma and discrimination, poor economic conditions, the centralized health system, and lack of strong leadership and unity among user organizations. Increased focus on reducing public as well as self-stigma, improved policy frameworks and initiatives, and decentralization of care are some strategies that may facilitate service user and caregiver involvement.ConclusionThe study highlighted need for user and caregiver networks free from competing interests and priorities. Improved policy frameworks and decentralization of care may support meaningful service user and caregiver involvement.Electronic supplementary materialThe online version of this article (doi:10.1186/s13033-017-0139-1) contains supplementary material, which is available to authorized users.

 A study was carried out to prepare cereal bars incorporated with flaxseed rich in nutritional and sensory characteristics which are convenient to carry and consume as a snack. Full fat roasted flaxseed flour was incorporated along with commercially available instant oat flakes at the rate of 5, 10, 15 and 20% to prepare Cereal (Oat) bar. Effect of flaxseed flour incorporation was studied in proximate composition, calcium, iron and phosphorus content of cereal bar. The addition of flaxseed flour increased (p<0.05) the nutritional value of the cereal bar in terms of crude protein, crude fat, crude fiber and total ash however, the carbohydrate content significantly decreased. Sensory evaluation of cereal bars were carried out in terms of appearance, color, odor, taste, texture and overall acceptability. Cereal (Oat) Bar prepared by incorporating 10% flaxseed flour was found to be significantly (p<0.05) superior from sample with no flaxseed flour in terms of texture and overall acceptability.