Mental Health Challenge in Nepal: Lack of Adequate Care

Introduction: The Issue

Without a well-established mental health system, it is unlikely that a country’s population can exhibit positive levels of mental health. There is a lack of mental health professionals and treatment facilities in Nepal, which means that services are not readily available. With only one mental health hospital in the country, there is a poor mental health infrastructure that cannot meet population needs. Moreover, there is a lack of attention given to human resources, which results in overstaffing and overcrowding of psychiatric wards. There is no governmental structure for addressing mental health needs, and there is also no consumer/professional organizations advocating for mental health issues of populations affected by mental health.

The Mental Healthcare System

Since there is no governmental organization that serves the needs of individuals with mental health challenges in Nepal, Non-governmental agencies have been the ones tasked with addressing mental health concerns. Examples include the United Mission to Nepal (UNM) in the 1980s, the Center for Victims of Torture, Nepal (CVIT) in the 1990s and early 2000s, the Center for Mental Health and Counselling – Nepal (CMC-Nepal), and the Transcultural Psychological Organization Nepal (TPO Nepal), All of the mentioned organizations have had to work in the context of the absence of a social welfare net for the population.

Mental Disorder Epidemiology

The need for the increased attention to mental health services in Nepal is illustrated in mental disorder epidemiology in the country. The initial epidemiological field survey (1984) estimated a 14% mental illness prevalence (Rai et al., 2020), while a recent National Mental Health Survey reported 10% of adults having any mental health issues, with 4.3% having some disorder (Nepal Health Research Council, 2020). Besides, Nepal Health Research Council (2020) found a 3% prevalence of neurotic and stress-related disorders, a 7.2% rate of suicidality among adults, and a 5.2% mental disorder prevalence among adolescents. If mental health remains to be overlooked by the government, there are risks of the statistics exacerbating.

Mental health in Nepal is a hidden bit pre-existing crisis due to social stigma, with a survey conducted three years ago (the data can be seen on the graph on the slide) finding that 37.5% of the general population suffered from a mental health disorder, which is a different result compared to previously mentioned data. Therefore, it should be stated that mental disorder epidemiology is not being tracked adequately in the country (Awale, 2020).

According to the survey, populations residing in rural areas struggled the most with distress (42%), depression (30%), and anxiety (20%) (Awale, 2020). Internally displaced individuals struggled with anxiety the most (81%), followed closely by depression (80%) and posttraumatic stress disorder (53%) (Awale, 2020). 86% of torture survivors struggled with anxiety, 81% with depression, and 60% with PTSD (Awale, 2020). Despite these statistics, there is minimal attention of the government to the needs of the population, nor are there consistent efforts intended to address the identified challenges.

Global Learning: Culture, Personality, and Mental Health Correlation

When it comes to exploring mental health issues affecting a specific country, it is necessary to emphasize environmental/cultural factors affecting personality formation (Kelland, 2015). The cultural experiences of a nation are often shaped by reinforcement, punishment, and discriminative stimuli, which can challenge cross-cultural research. The latter only applies to studying the same concepts in different cultures, which results in issues with defining culture-specific phenomena (Kelland, 2015).

In addition, when comparing the same mental health issue in different cultures, there may be equivalence challenges, which entail that the same concept can mean different things in different cultures, which leads to invalid comparisons. It is essential to facilitate cultural flexibility through positive change and adaptation, which is not always possible in some cultures.

Therefore, culture has a significant influence on the “biological substrates of personality,” which increases the need to study the relationship between society, culture, and personality to the meaning and impact of the connections for better (Kelland, 2015, p. 34). When exploring how Nepal’s cultural context shapes personality and approaches mental health considerations, essential insights were revealed. Specifically, the country struggles with stigma and unfavorable cultural perception of mental illness: “spiritual dysfunction,” “weak mind,” “spirit possession,” and so on (Rai et al., 2020). There are also high levels of cultural discrimination against mentally ill individuals, which leads to low mental health literacy and the inability of healthcare providers to meet the population’s mental health needs.

Comparison: US vs Nepal

When comparing the ways in which the US and Nepal approach the issue of mental health acceptance and the provision of appropriate services for the population, there is only one common factor. In Nepal, due to the high levels of stigma in the country, any decisions regarding mental health treatment are made by senior family members, even if adults are concerned. In the US, stigma is also present, with half of the mentally ill individuals do not receive mental health help due to concerns of being treated differently by society.

However, in Nepal, there is still increased stigma among service providers toward mentally ill individuals as the main barrier to seeking help, while US service providers do not show high levels. In addition, the US has multiple legislations and policies to support the population, e.g., RISE, Mental Health Services for Students Act, Mental Health Parity Compliance Act, etc. In Nepal, there is an ineffectively implemented mental healthcare policy, the updated versions also require work.

The comparison of sociocultural factors affecting the provision of mental health care between the US and Nepal showed that in the States, the public is exposed to regular mental health support campaigns to eliminate stigma and increase acceptance, while in Nepal, media does not discuss the issue of mental health at length, limited public exposure.

The US has worked on establishing a culture where mental health issues are accepted and addressed, even though some limitations remain, while Nepal’s cultural framework does not allow for accepting mental health issues and individuals that are exposed to them in everyday life. In Nepal, suicide rates remain concerning, and there is no national suicide registry or suicide prevention strategy. In contrast, in the US, suicide rates are being tracked by the CDC and the National Institute of Mental Health. Finally, Nepal highly depends on NGOs for scientific research and evidence on mental illness, while the US implements extensive research implemented by both NGOs and governmental organizations.

Ethical Considerations

The research on Nepal’s key mental health problem has shown that culture is a crucial factor influencing the approach to the issue. However, there are some ethical considerations to be taken into account. Specifically, the cultural peculiarities of Nepal cannot be forcefully changed, which means that sociocultural distance would be inevitable. Global communities that are advanced in mental health care can only serve as positive examples for change. Because religion is a crucial component of Nepal’s culture, which cannot be compromised. Because change for the better will require time, enhancing mental health literacy in the country can facilitate improved mental health care provision.

Conclusions

To conclude, the exploration revealed that Nepal’s limited attention to the mental health concerns of the population limits service provision, which results in the lack of mental health literacy. The leading causes for the issue are cultural factors inherent to the country, the significant impact of religion, mental health stigma among the population and service providers, as well as the lack of services for meeting the needs of the population. The example of the US’s approach to mental health can serve as an inspiration for Nepal, although the sociocultural influences on mental health can only be changed internally. This calls for ongoing mental health education and raising awareness of the public regarding the problem.

References

  1. Awale, S. (2020). Post-pandemic mental health epidemic. Nepali Times. Web.
  2. Kelland, M. (2015). Personality theory in a cultural context. OpenStax-CNX.
  3. MHA. (2020). Current mental health legislation. Web.
  4. Nepal Health Research Council. (2020). The national mental health survey, Nepal. Web.
  5. Rai, Y., Gurung, D., & Gautam, K. (2020). Insight and challenges: mental health services in Nepal. BJPsych International, 18(2), E5. Web.

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