Strengthening mental health systems in fragile setting: Opportunities and challenges for strengthening mental health systems in low and middle income countries: A case example from Nepal

Abstract

Mental, neurological and substance use (MNS) disorders account for about 10% of the global disease burden. Despite this high disease burden, many people with MNS disorders do not receive the treatment they need, resulting in a treatment gap. To address this, the World Health Organization (WHO) launched the Mental Health Gap Action Program (mhGAP) guidelines, which aims to integrate mental health services in primary health care. For mhGAP based interventions to be successful, health system level interventions need to be implemented and evaluated simultaneously. This dissertation followed WHO’s health systems building blocks framework to explore the challenges and opportunities for mental health system strengthening in a low resource setting like Nepal. The dissertation combined qualitative data with survey data from Chitwan district, a demonstration site for the evaluation of a district-wide mental health care plan. The study findings show that mhGAP based interventions can only be sustainable with provisions of regular training, supervision, administrative support and financial incentives to the primary health care workers and a strong coordination mechanism at the national and district level. Second, active participation of service users and caregivers is vital for mental health system strengthening efforts. Third, strengthening the mental health infrastructure within the government, especially at the Ministry of Health, is a pre-requisite for scaling up mhGAP based interventions. Fourth, for successful scale up, the issues of vested interest, commission and malpractices currently existing in the supply chain of psychotropic drugs need to be addressed.