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Mental Health in Nepal
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Sharma VD
Professor and Head, Department of Psychiatry, Institute of Medicine, Kathmandu, Nepal.
History of mental health services in Nepal
Hospital-based mental health services
Psychiatric services remained virtually unknown in Nepal till 1961. Unlike other countries where the mental asylum first marked its presence in the care of mentally ill, mental health services started in a general hospital setting in Nepal. The first psychiatric OPD service was started in 1961 at Bir Hospital (General Hospital), Kathmandu, when the first psychiatrist of Nepal returned after completing his DPM from Great Britain. A 5-bedded inpatient unit was established in the same hospital in 1965, which was further strengthened to 12 beds in 1971. In 1972, a 10-bedded neuro-psychiatric unit was established in the Royal Army Hospital, Kathmandu. In 1976, Father Thomas Gaffney started a rehabilitation center for Nepali drug abusers. During 1983-84 a number of non-governmental organizations were started in the field of mental retardation and drug abuse. In 1984, the 12-beded Psychiatry department at Bir Hospital was separated and a separate mental hospital was created, which was then shifted in 1985 to the current site at Lagankhel, Patan. It then had 25 beds, which were later increased to 39 beds. It is the only mental hospital of Nepal. Four hundred and one bedded T. U. Teaching Hospital was established in 1983 and Psychiatric OPD services started in February 1986 followed by the addition of a 12-bedded psychiatric inpatient unit in December 1987, which was later, increased to 22 since 2000. Since 1997 clinical psychological services were also started in T.U. Teaching Hospital.
Community mental health service
Nepal's own community mental health service came into existence following Shrestha et al's (1983) report. Following this survey, training was arranged in mental health for health assistants and health-post staff in and around Bhaktapur. This led to the setting up of a satellite mental health clinic in Bhakatapur, staffed by Mental Hospital doctors, for the referrals from these health post workers.
United Mission to Nepal's Mental Health Program was started in 1984. In Nepal health-posts are staffed by paramedicals, and these were the people who were trained. The aims of the program were:
· To provide mental health services integrated into existing physical health delivery systems, rather than setting up specialist structures.
· To increase knowledge and awareness of mental health issues in Nepal.
· To support the existing mental health services of HMG.
In 1989, the Department of Psychiatry of T.U. Teaching Hospital started the Mental Health Project by launching a Community Mental Health Program in Morang (one of the eastern districts of Nepal) where there was already a psychiatrist. This program was successful and soon attracted new staff and a good deal of professional interest. Mental Health Project further started two programs, one in the western region and another in Banke district with the help of a psychiatrist in each place.
At present, UMN and Mental health project has been phased out and this work is being continued from a NGO and has expanded to cover 26 districts. This model involving ‘task shifting’ has been incorporated into the mental Health Policy.
Private and NGO sector
A few NGOs, with the help of local psychiatrists, are running rehabilitation programs. Apart from this, private psychiatrists are also contributing to the treatment of mentally ill patients through regular OPD, in-patient, and satellite clinics. Substitution therapy has been set up in a model basis using buprenorphine and methadone.
Other important milestones
1990 : Establishment of Psychiatrists' Association of Nepal.
1997 : National Mental Health Policy was adopted by the His Majesty’s Government of Nepal.
1997 : Three year residency program started in IOM.
1998 : Two year residency program in Clinical Psychology at IOM.
1999 : Establishment of Bachelor in Psychiatric Nursing at IOM.
Mental Health Act has been drafted and ready for adoption at the senate.
Current status of Mental Health Services in Nepal
|
Number of Psychiatrists working in Nepal at the present moment (Total 56) |
Number of psychiatric beds (Total 390 beds) |
|
In government sector |
18 |
105 |
In teaching institutions |
27 Nepalese and 4 non Nepalese |
220 |
In private sector |
7 |
65 |
|
Population of Nepal |
28584975 |
Mental hospital |
1 |
Number of general hospitals providing out-patient psychiatric services |
23 |
Number of general hospitals providing in-patient Psychiatric services |
17 |
Total number of beds in mental hospital |
50 |
Number of Psychiatric beds in general hospitals |
240 |
Number of psychiatrists working in country |
56 |
Trained Psychiatric Nurses |
36 |
Number of clinical psychologists |
9 |
Number of psychiatric social workers |
Nil |
Number of Psychiatrists per million population |
0.1959 |
Number of Psychiatric beds per million population |
1.364 |
