Mental health: Government’s proverbial stepchild

Nepal’s approach to mental health care is a tragic comedy of errors, a patchwork of underfunded programs, neglected policies, and insufficient services that barely scratch the surface of a growing crisis. Take Patan Mental Hospital, for example. It is the country’s only government-run mental hospital with as little as 50 beds, and is overburdened with the rising number of patients requiring inpatient care. As a result, individuals with severe conditions such as alcohol dependence syndrome, bipolar disorder, and schizophrenia are often turned away due to the lack of available beds. This is a dire situation, considering that mental health problems are becoming increasingly prevalent, particularly in the aftermath of the Covid-19 pandemic. In a country where mental illness is still widely viewed as a result of bad karma, and the mentally ill are often subjected to stigmatization and abuse, the state of psychiatric care is nothing short of a human rights disaster.

The main root of this problem is however glaringly obvious: Nepal’s mental health sector is woefully underfunded. Various health forums reveal approximately 30 percent of Nepal’s population suffers from some form of mental health issue, yet over 90 percent of these individuals lack access to appropriate mental health services. This disparity is further exacerbated by the government’s negligible investment in mental health, which receives less than one percent of the total healthcare budget. This lack of funding perpetuates a cycle of inadequate services, leading to dire consequences for those who genuinely need help the most. Similarly, it has also been estimated that the number of psychiatrists in the country is as low as 144 while the number of psychologists in private practice is estimated to be around 30. This statistic is not something to be proud of; it’s an indictment of a system that has consistently failed its most vulnerable citizens.

This is not just a healthcare crisis; it is a human rights crisis. The lack of political will, combined with deep-seated stigma and cultural attitudes amongst people, means that mental health issues will remain on the back burner. Even when action plans are proposed, they are often crippled by insufficient funding, inadequate infrastructure, and bureaucratic incompetence. The government’s neglect has condemned people to suffer in silence, with little to no hope of recovery or social rehabilitation. Without significant reform, Nepal’s mental health crisis will continue to be sidelined, leaving an already vulnerable population even further behind. 

So what can the government do? For starters, let’s talk about funding. Currently, Nepal invests a negligible portion of its budget to this critical area, a figure that pales in comparison to other expenditures. By reallocating even a modest percentage of the funds currently allocated as “miscellaneous expenses,” the government could make substantial progress in addressing the mental health crisis. This additional funding could support the recruitment of more mental health professionals, establishment of new treatment centers, and the expansion of important facilities like the Mental Hospital in Patan. 

But beyond throwing money at the problem, there’s a need for a cultural shift. Discussion among people about mental health must be normalized. The government, alongside NGOs and INGOs, must take charge in education and awareness programs that destigmatize mental illness and seek help. More importantly, every school should incorporate mental health education into their curriculum from primary classes itself. 

More importantly, the government should draft and implement a separate and comprehensive mental health policy that addresses the entire spectrum of mental health care, from prevention to treatment to rehabilitation. It should not only improve psychiatric services but also integrate mental health into primary care, so that a visit to the local health post includes a mental health screening as well.

Another area for improvement is the training and retention of mental health professionals. The government should provide scholarships or some sort of incentives for students pursuing psychiatry or psychology which will help reduce the shortage of professionals in the field as it motivates other students to join the field as well. Furthermore, providing continuous training for existing health care workers would ensure that they are able to handle mental health issues competently.

Similarly, in today’s hyper connected world, tele-psychiatry and online counseling services would be a game changer in a country where many people live in remote areas with limited access to transportation and health care facilities. The government or the concerned stakeholders should consider partnering with tech companies that are able to develop and promote these kinds of services, making mental health care more accessible to those who need it.

It is not too late to change our course. With the right investments, policies, and cultural shifts, our country can begin to address the mental health crisis that has been hiding in plain sight. After all, a nation’s true strength is measured not by the height of its tallest buildings but by the well-being of all its people.

Aishwarya Koirala

BA IIIrd Year

St Xavier’s College, Maitighar