Mental health is a basic human right. It emphasises the right to be protected from mental health risks by having accessible, acceptable and quality care and being included in society. Mental health is more than the absence of mental disorders as it is the ability to live with financial and emotional stability and integrity. The World Health Organisation describes mental health as a “state of well-being in which the individual realises his or her capabilities, can cope with the normal stresses of life, can work productively and fruitfully and can contribute to his or her community.”

Globally, 1 in 7 adolescents experiences mental health conditions, and most remain undiagnosed and untreated. Seventy-one percent of people with psychosis do not receive mental health services and are vulnerable to social exclusion, discrimination, stigma, risk-taking behaviours, ill health and human rights violence. Mental health systems worldwide have major gaps in governance, resources, services, information and technologies. The fulfilment of such gaps is crucial as they affect the country’s mental health response.

A 2022 WHO report titled “World Mental Health Report: Transforming Mental Health for All” revealed the estimation that the loss of productivity across the life course attributed to mental health conditions will cost the global economy $6 trillion by 2030. The report draws attention to poor mental health services globally and the need for mental health change. This serves as a landmark to guide renewed efforts in mental health, address the needs and bridge the gaps.

Nepal’s mental health needs are high, but we are only taking baby steps in interventions. Nonetheless, the shift from seeking help from traditional healers to professional health specialists is gradually increasing. There are three main reasons to invest in mental health: Public health, human rights and socioeconomic development.

We have increased multisector intervention in mental health, including the National Mental Health Strategy and Action Plan 2020. The action plan focuses on integrating mental health services across all public health care system tiers. This strategic plan describes the provision of free primary mental health services nationwide. The Community Mental Health Care Package 2074 intends to facilitate the implementation of the National Mental Health Policy.

Even though community mental health programmes have been scaled up, there is a lack of clinical supervision of trained non-specialist service providers and a regular supply of psychotropic medications. These are essential for effectively implementing mental health services in primary care settings.

Implementing WHO quality rights

WHO Quality Rights is a global initiative to improve care in mental health and related services and to promote the rights of people with psychosocial, intellectual and cognitive disabilities. It is a new approach to mental health that is right-based and recovery-oriented. There has been a paradigm shift in providing mental health services from the treatment, focusing on pathology and medications, to a holistic approach to recovery, social functioning and quality of life. This initiative focuses on capacity building to combat stigma and discrimination, creating community-based, person-centred and recovery-oriented services that respect and promote human rights, improve the quality of care and reform laws and policies in line with the United Nations Convention on the Rights of Persons with Disabilities and other international standards. The moral transformation in the treatment of mental health problems is a must to protect people’s rights.

Implementation of WHO Quality Rights in Nepal is crucial. Not only does this help in the proper treatment, but it also encourages people to seek help, leading to early diagnosis. This unique and in-depth perspective can provide a new dimension in the treatment modalities and improve mental health. Facilitating human rights in mental health helps in healing.

Inadequate resources

Low-middle-income countries give less priority to mental health. Nepal has less than 5 percent of the health care budget allocated for mental health, which is inadequate. Investing in mental health is investing in strategies to ensure access to adequate, quality and affordable mental health care for all. Moreover, it tackles stigma, discrimination and abuse and addresses underlying social and economic realities that shape people’s mental health.

A huge scarcity of personnel-trained mental health workers prevails in our country. There is less than one mental health worker per 100,000 population, justifying the need for training and resources in the mental health sector. Female community health volunteers and health assistants should be given basic mental health training to identify mental health disorders.

Additionally, the government should focus on initiating various programmes in child, adolescent and geriatric psychiatry. Prioritisation of mental health research should be encouraged to detect the gaps in mental health services.

Furthermore, the essential drug list should include the drugs needed for mental health. As most people can’t afford them, they should be available in the primary health care centres so that the relapse rate decreases and compliance increases. Counselling and psychotherapeutic services should be available for the proper management of mental health disorders.

Quality rights in mental health are a “global emergency” as there is a strong connection between mental health and human rights. We must intensify our collective actions to promote and protect mental health. As former United States Surgeon General Dr David Satcher said, “There is no health without mental health,” a holistic approach to promoting mental health and protecting human rights is imperative.