Insight and challenges: mental health services in Nepal

Rai, Yugesh; Gurung, Deoman; Gautam, Kamal

doi:10.1192/bji.2020.58

Cited by 32 publications

(28 citation statements)

References 10 publications

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“…Immediate health interventions must be considered, in order to prevent the deterioration of maternal psychological health during COVID-19 pandemic [ 36 ]. Government of Nepal has established mental health counselling services in public hospitals; however, the services were not prioritized for mental health screening and counseling for postpartum women [ 37 ]. Moreover, the routine mental health counseling services halted during the pandemic as other routine health services [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

Association of disrespectful care after childbirth and COVID-19 exposure with postpartum depression symptoms- a longitudinal cohort study in Nepal

Acharya

Bhattarai

et al. 2023

BMC Pregnancy Childbirth

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Background The COVID-19 pandemic has led to unprecedented mental stress to women after childbirth. In this study, we assessed the association of disrespectful care after childbirth and COVID-19 exposure before/during labour with postpartum depression symptoms assessed at 7 and 45 days in Nepal. Methods A longitudinal cohort study was conducted in 9 hospitals of Nepal among 898 women. The independent data collection system was established in each hospital to collection information on disrespectful care after birth via observation, exposure to COVID-19 infection before/during labour and other socio-demographic via interview. The information on depressive symptoms at 7 and 45 days was collected using the validated Edinburg Postnatal Depression Scale (EPDS) tool. Multi-level regression was performed to assess the association of disrespectful care after birth and COVID-19 exposure with postpartum depression. Result In the study, 16.5% were exposed to COVID-19 before/during labour and 41.8% of them received disrespectful care after childbirth. At 7 and 45 days postpartum, 21.3% and 22.4% of women reported depressive symptoms respectively. In the multi-level analysis, at the 7th postpartum day, women who had disrespectful care and no COVID-19 exposure still had 1.78 higher odds of having depressive symptom (aOR, 1.78; 95% CI; 1.16, 2.72). In the multi-level analysis, at 45th postpartum day, women who had disrespectful care and no COVID-19 exposure had 1.37 higher odds of having depressive symptoms (aOR, 1.37; 95% CI; 0.82, 2.30), but not statistically significant. Conclusion Disrespectful care after childbirth was strongly associated with postpartum depression symptoms irrespective of COVID-19 exposure during pregnancy. Caregivers, even during the global pandemic, should continue to focus their attention for immediate breast feeding and skin-to-skin contact, as this might reduce the risk for depressive symptoms postpartum.

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Section: Discussionmentioning

confidence: 99%

Association of disrespectful care after childbirth and COVID-19 exposure with postpartum depression symptoms- a longitudinal cohort study in Nepal

Acharya

Bhattarai

et al. 2023

BMC Pregnancy Childbirth

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“…Nepal was selected as the site for this study because of our extensive preliminary research in this setting and because it exemplifies a low-resource context where the treatment gap for mental illness is high [47]. In a country of 29 million people, Nepal has approximately 200 psychiatrists, i.e., 1.45 psychiatrists per 100,000 population [48], compared to 8 psychiatrists per 100,000 population in the USA. Nepal has high exposure to negative social determinants of health (war, environmental disasters, poverty, and gender-based and ethnic discrimination [49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66]), and the government is the main provider of healthcare throughout the country.…”

Section: Study Settingmentioning

confidence: 99%

Implementation strategy in collaboration with people with lived experience of mental illness to reduce stigma among primary care providers in Nepal (RESHAPE): protocol for a type 3 hybrid implementation effectiveness cluster randomized controlled trial

Kohrt

Turner

Gurung³

et al. 2022

Implementation Sci

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Background There are increasing efforts for the integration of mental health services into primary care settings in low- and middle-income countries. However, commonly used approaches to train primary care providers (PCPs) may not achieve the expected outcomes for improved service delivery, as evidenced by low detection rates of mental illnesses after training. One contributor to this shortcoming is the stigma among PCPs. Implementation strategies for training PCPs that reduce stigma have the potential to improve the quality of services. Design In Nepal, a type 3 hybrid implementation-effectiveness cluster randomized controlled trial will evaluate the implementation-as-usual training for PCPs compared to an alternative implementation strategy to train PCPs, entitled Reducing Stigma among Healthcare Providers (RESHAPE). In implementation-as-usual, PCPs are trained on the World Health Organization Mental Health Gap Action Program Intervention Guide (mhGAP-IG) with trainings conducted by mental health specialists. In RESHAPE, mhGAP-IG training includes the added component of facilitation by people with lived experience of mental illness (PWLE) and their caregivers using PhotoVoice, as well as aspirational figures. The duration of PCP training is the same in both arms. Co-primary outcomes of the study are stigma among PCPs, as measured with the Social Distance Scale at 6 months post-training, and reach, a domain from the RE-AIM implementation science framework. Reach is operationalized as the accuracy of detection of mental illness in primary care facilities and will be determined by psychiatrists at 3 months after PCPs diagnose the patients. Stigma will be evaluated as a mediator of reach. Cost-effectiveness and other RE-AIM outcomes will be assessed. Twenty-four municipalities, the unit of clustering, will be randomized to either mhGAP-IG implementation-as-usual or RESHAPE arms, with approximately 76 health facilities and 216 PCPs divided equally between arms. An estimated 1100 patients will be enrolled for the evaluation of accurate diagnosis of depression, generalized anxiety disorder, psychosis, or alcohol use disorder. Masking will include PCPs, patients, and psychiatrists. Discussion This study will advance the knowledge of stigma reduction for training PCPs in partnership with PWLE. This collaborative approach to training has the potential to improve diagnostic competencies. If successful, this implementation strategy could be scaled up throughout low-resource settings to reduce the global treatment gap for mental illness. Trial registration ClinicalTrials.gov, NCT04282915. Date of registration: February 25, 2020.

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“…11 , 12 It has so far extended to three of the seven provinces of Nepal. The Ministry of Health and Population has endorsed a new National Mental Health Strategy and Action Plan (November 2020) 4 , 13 to combat increasing mental health problems, including those arising from the current COVID-19 pandemic. Its objectives are to provide free, approachable and basic mental health services through multi-sectoral collaboration.…”

Section: National Mental Health Strategy and Action Plan 2020mentioning

confidence: 99%

“…1.5 beds per 100 000 people), just 200 psychiatrists (0.68 psychiatrist per 100 000 people) and 50 psychiatric nurses (0.17 psychiatric nurse per 100 000 people). 4 Moreover, most of the available mental health services are concentrated in urban areas, where only 21.4% of the Nepalese population resides. 3 …”

Section: Introductionmentioning

confidence: 99%

History of psychiatry in Nepal

Singh¹,

Gupta

Singh

et al. 2021

BJPsych Int.

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The history of psychiatry as a discipline in Nepal has been poorly studied. We have attempted to summarise historical landmarks to explore how it began and its evolution over time in relation to contemporary political events. Although Nepal has achieved several milestones, from establishing a psychiatric out-patient department with one psychiatrist in 1961 to having more than 500 psychiatric in-patient beds with 200 psychiatrists by 2020, the pace, commitment and dedication seem to be slower than necessary: the current national mental health policy dates back to 1996 and has not been updated since; there is no Mental Health Act; the number of psychiatric nurses and in-patient psychiatric beds has increased only slowly; and there is a dearth of professional supervision in rehabilitation centres. Thus, despite making significant progress, much more is required, at greater intensity and speed, and with wide collaboration and political commitment in order to improve the mental health of all Nepali citizens, including those living in rural areas and or in deprived conditions.

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Insight and challenges: mental health services in Nepal

Cited by 32 publications

References 10 publications

Association of disrespectful care after childbirth and COVID-19 exposure with postpartum depression symptoms- a longitudinal cohort study in Nepal

Association of disrespectful care after childbirth and COVID-19 exposure with postpartum depression symptoms- a longitudinal cohort study in Nepal

Implementation strategy in collaboration with people with lived experience of mental illness to reduce stigma among primary care providers in Nepal (RESHAPE): protocol for a type 3 hybrid implementation effectiveness cluster randomized controlled trial

History of psychiatry in Nepal

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