Luitel Nagendra P, Jordans Mark Jd, Adhikari Anup, Upadhaya Nawaraj, Hanlon Charlotte, Lund Crick, Komproe Ivan H
Research Department, Transcultural Psychosocial Organization (TPO), Kathmandu, Nepal.
Research and Development Department, HealthNet TPO, Lizzy Ansinghstraat 163, 1073 RG, Amsterdam, The Netherlands ; Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Box P029 De Crespigny Park, London, SE5 8AF UK.
Confl Health. 2015 Feb 6;9:3. doi: 10.1186/s13031-014-0030-5. eCollection 2015.
Globally mental health problems are a serious public health concern. Currently four out of five people with severe mental illness in Low and Middle Income Countries (LMIC) receive no effective treatment. There is an urgent need to address this enormous treatment gap. Changing the focus of specialist mental health workers (psychiatrists and psychologists) from only service delivery to also designing and managing mental health services; building clinical capacity of the primary health care (PHC) workers, and providing supervision and quality assurance of mental health services may help in scaling up mental health services in LMICs. Little is known however, about the mental health policy and services context for these strategies in fragile-state settings, such as Nepal.
A standard situation analysis tool was developed by the PRogramme for Improving Mental health carE (PRIME) consortium to systematically analyze and describe the current gaps in mental health care in Nepal, in order to inform the development of a district level mental health care plan (MHCP). It comprised six sections; general information (e.g. population, socio-economic conditions); mental health policies and plans; mental health treatment coverage; district health services; and community services. Data was obtained from secondary sources, including scientific publications, reports, project documents and hospital records.
Mental health policy exists in Nepal, having been adopted in 1997, but implementation of the policy framework has yet to begin. In common with other LMICs, the budget allocated for mental health is minimal. Mental health services are concentrated in the big cities, with 0.22 psychiatrists and 0.06 psychologists per 100,000 population. The key challenges experienced in developing a district level MHCP included, overburdened health workers, lack of psychotropic medicines in the PHC, lack of mental health supervision in the existing system, and lack of a coordinating body in the Ministry of Health and Population (MoHP). Strategies to overcome these challenges included involvement of MoHP in the process, especially by providing psychotropic medicines and appointing a senior level officer to facilitate project activities, and collaboration with National Health Training Centers (NHTC) in training programs.
This study describes many challenges facing mental health care in Nepal. Most of these challenges are not new, yet this study contributes to our understanding of these difficulties by outlining the national and district level factors that have a direct influence on the development of a district level mental health care plan.
全球范围内，心理健康问题都是一个严重的公共卫生问题。目前，低收入和中等收入国家（LMIC）中五分之四的重症精神疾病患者没有得到有效治疗。迫切需要解决这一巨大的治疗缺口。将精神科专科医护人员（精神科医生和心理学家）的工作重点从仅提供服务转变为同时设计和管理精神卫生服务；培养初级卫生保健（PHC）工作人员的临床能力，并对精神卫生服务进行监督和质量保证，可能有助于在低收入和中等收入国家扩大精神卫生服务。然而，对于尼泊尔等脆弱国家背景下这些战略的心理健康政策和服务情况，我们知之甚少。
改善精神卫生保健计划（PRIME）联盟开发了一种标准的情况分析工具，以系统地分析和描述尼泊尔目前在精神卫生保健方面的差距，为制定地区级精神卫生保健计划（MHCP）提供信息。该工具包括六个部分：一般信息（如人口、社会经济状况）；心理健康政策和计划；心理健康治疗覆盖范围；地区卫生服务；以及社区服务。数据来自二手资料，包括科学出版物、报告、项目文件和医院记录。
尼泊尔存在心理健康政策，该政策于1997年通过，但政策框架的实施尚未开始。与其他低收入和中等收入国家一样，分配给心理健康方面 的预算极少。精神卫生服务集中在大城市，每10万人口中有0.22名精神科医生和0.06名心理学家。制定地区级精神卫生保健计划时遇到的主要挑战包括：卫生工作者负担过重、初级卫生保健机构缺乏精神药物、现有系统缺乏心理健康监督，以及卫生与人口部（MoHP）缺乏协调机构。克服这些挑战的策略包括让卫生与人口部参与这一过程，特别是提供精神药物并任命一名高级官员来推动项目活动，以及与国家卫生培训中心（NHTC）在培训项目方面开展合作。
本研究描述了尼泊尔精神卫生保健面临的许多挑战。其中大多数挑战并非新问题，但本研究通过概述对地区级精神卫生保健计划的制定有直接影响的国家和地区层面因素，有助于我们理解这些困难。
