Out of the shadowInvesting in mental health is the need of the hour
World Mental Health Day is observed every year on October 10. The aim is to raise awareness about mental health issues and discuss expanding access to care for people suffering from them. Like in most countries, mental health is becoming a growing concern in our country too. As Nepal carries out its first National Mental Health Survey, around 2.2 million Nepalis, aged between 16-40 years, are estimated to suffer from mental health issues. Psychiatrists have warned that the number of cases among children is rising. This is a worrying trend. Public conversation has grown louder in recent years, but mental health is still far down in the state’s priority list.
The decade-long civil war undoubtedly took a huge mental toll on the public, especially those from areas most affected by the insurgency, and burdened tens of thousands more with various forms of psycho-social disorders. Add to that the Gorkha Earthquake of 2015. And with the increasing cases of rape and sexual assault, a huge proportion of children, especially girls, are being sexually abused. All these events have long-term physical, psychological, behavioural and societal consequences. Couple that with economic hardship, illiteracy, discrimination (caste- and gender-based, for example)—all defined as ‘risk factors’ that contribute to mental health problems—and we can get a sense of the scale of the problem. Despite the enormity of the issue and the need for improved services, we have not invested in the sector the way we should.
According to Dr Basudev Karki, a psychiatrist at Mental Hospital in Patan, there is only 0.58 bed per 100,000 population in Nepal for mental health treatment. Further, hospitals providing mental health services are concentrated only in urban areas. When it comes to child psychiatrists to cater to children, there are only two while outpatient department (OPD) service is available only at Kanti Children’s Hospital. Mental Hospital in Patan, the oldest neuropsychiatric hospital in the country, has only 50 beds. On the legislative front, the National Mental Health Policy 1996 alludes to the need for providing treatment, but offers only one solution: community-based rehabilitation.
The government allocates a minimal budget for mental health. Mental health is receiving increasing attention in policy forums, but improvement on the ground is quite negligible. The social stigma regarding mental health, lack of mental health infrastructure and insufficient human and material resources for mental health services continually constrain efforts. Very few schools have counsellors who can help the children deal with everyday problems. We will need a lot more psychiatrists, OPDs for children and counsellors to effectively address this issue besides more free-flowing dialogue to destigmatise mental disease.
No doubt, our health sector needs reforming, but it is also necessary to establish mental health system governance procedures. Mental illness is not just a health issue, for failure to address the gravity of mental illness could
ultimately prove to be a socio-economic burden on the country, given the sheer number of people suffering from it. The cost of inaction for the health system and the economy will simply be too high. Investing in mental health is the need of the hour, and the government must pay heed to it.