Making medication available to people with mental health needs in Nepal

Padam Shrestha has been the Executive Director for LEADS Nepal since 2009. LEADS are one of only a handful of mental health NGOs active in Nepal. Their mission is to build inclusive communities, where people living with mental illness can access the treatment they need and their basic rights are recognised and respected.

LEADS have been partners of the UK-based global mental health charity BasicNeeds since 2010, working in Baglung and Myagdi districts in the Western region of Nepal.

How did you become interested in mental health?

Before LEADS Nepal, I worked in organisations advocating for the improvement of Nepal’s public health systems and yet I realized the government never understood or realised the importance of mental health. There were no community based mental health services anywhere and psychotropic medication wasn’t even included in the government’s list of available drugs. I noticed that poverty levels among people living with mental illness are extremely high, especially for families supporting a person with mental illness.

What is the current situation for people living with mental illness in Nepal?

There is only one mental health hospital based in Kathmandu, and the government’s budget for mental health is less than 1% of the total health budget. Psychotropic drugs are not supplied in any government health institutions in rural areas and this medication costs more than other medicines. At present there are only around 100 psychiatrists in the country, but all of them are based in cities.

Mental health is also not considered a public health issue and the government still views mental illness through a purely medical lens. To add to this, people with mental illness and epilepsy are faced with stigma and exclusion, even from family members.

What achievements are you most proud of?

Despite the challenges, our livelihood support programmes and mental health camps (where people can be assessed by a trained mental health clinician and receive treatment) have achieved impressive results.

• 3197 people with a mental illness and their carers have participated in our programmes with over 80% reporting reduced symptoms. 44% of participants and their carers now undertake productive work.
• Communities we work in have greater awareness of the needs and the rights of people with mental illness. This has led to a reduction in stigma, which is a major achievement, considering symptoms are often attributed to spiritual or religious causes.
• Progress is being made to involve the government in mental health programmes, emphasising the importance of mental health data being collected and monitored.
• Innovations have been adopted, including the use of mobile phones to connect patients in remote areas with psychiatrists.
• A strong network of female community health volunteers (FCHV) has been established and are highly effective for encouraging gender equality in programme participation.
• Capacity-building for health professionals has achieved good results, with large numbers of health staff and volunteers being trained in basic mental healthcare.

What are your hopes for the future of mental health in Nepal?

Continue to grow support for community mental health

Quite simply, this means that more people will shift from a position of hopelessness or ‘giving up’ on those living with a mental illness, to seeing the prospects for individuals to recover or improve and being a supportive part of this.

Make community mental health a government priority

An effective mental health system has been created in the districts in which LEADS and BasicNeeds are working. It is a system that supports the identification of people affected by mental illness, their referral for treatment and then a sophisticated follow-up process that enables them to achieve a level of recovery that usually allows them to return to a productive occupation. For this kind of health system to function effectively in the long-term, it needs to feature in government policy, planning and service delivery at village, district and regional levels.

Increase the capacity for mental healthcare delivery

This means increasing the number of doctors and nurses at district hospital and primary health care facilities, who are the main agents in the treatment process. However, increasing the number of community health volunteers and self-help groups is also very important so that individuals and families can be supported at a community level throughout the recovery process.

This interview was conducted and submitted to MHT by Basic Needs.