services in Nepal
remained unknown until 1961 AD. First psychiatric OPD services were started in 1961 in Bir hospital, Kathmandu by the first Nepalese Psychiatrist Dr. Bishnu Prasad Sharma. A five-bedded in-patients unit was established in the same hospital in 1965, which was further extended to 12 beds in 1971.
In 1984, a 12-bedded psychiatry Department at Bir Hospital was separately established, which was then shifted to Lagankhel, Lalitpur in 1985. It then had 25 beds. It is the only Mental hospital of Nepal which has been named as Mental Hospital, Lagankhel, Lalitpur and it has got 50 beds at present.
• Mental Health in Nepal: Mental health is highly overlooked and neglected in Nepal
For 26.6 (Census 2011) Million Population, there are:
1 government hospital ( Mental Hospital with 50 bed capacity since 2003)
HR- 92+ psychiatrists, a dozen of clinical psychologists, few psychiatric social workers, few dozens of psychiatric nurses.
Few rehabilitation centers, few drug treatment centers, psychiatric dept. in 23 medical college hospitals with a 2-3 psychiatrist and 10-15 inpatient beds on average.
- 500+ beds for in-patients in the whole of Nepal.
- Nepal government spends 0.08% of its total healthcare budget on mental health
- Population in Himalayan: 6.7 %, Hilly Region: 43.1% and Terai plain region: 50.2% (Census 2011).
- Of the 26.6 (approx.) million population, 83% live in villages and rural areas (Census 2011).
- First OPD started in Bir Hospital, Kathmandu in 1961. Dr. Bishnu Prasad Sharma was the first psychiatrist in the country.
- 5 bedded in-patient in 1965 and 12 bedded in 1971.
- 12 bedded psychiatric department shifted from Bir Hospital to Lagankhel (current location) in 1985.
- Only Mental Hospital in Nepal with 25 IP beds until extending to 50 beds with indoor complex in 2003..
Mental Hospital services:
--Indoor In-patients and OPD
--Lab and Emergency
--Oral Substitution Therapy (MMPT)
--Community Mental Health (Outreach programs)
--Psychiatric social work
-- Clinical Psychologist, Psychologist
--Ambulance service from the 2014-EEG device and ECT service.
• Services: Indoor In-patients (2003-present only 50 beds for In-patients)
• OPD (total psychiatrist in the MH: 5)
• Emergency (Emergency started on November 16, 2012) and Lab services.
• Oral Substitution Therapy (MMTP)
---Oral Substitution Therapy program that was started in Nepal in the year 1994 at the mental hospital, which was phased out in 2002 AD.
---The program was restarted in Kathmandu at the TU Teaching hospital in 2007, and currently, it has been again started at the mental hospital from 2011
• Telephone hotline started on July 1, 2010, with average calls of 4-5.
• Community Mental Health ( Outreach programs) started in February 2011
Once in a month in each of the three districts:
--- Dhading, Nuwakot, and Sindhupalchowk.
--- Average patient flow: 50
• Academic Programs:
-- MD psychiatry residency program- Started 2 year ago 2012
--- At present:
2 Graduated in 2015
5 residents: one 3rd year, two 2nd year and two 1st year students
• Number of OPD cases in Mental hospital
2010/2011 = 26,822
2011/2012 = 28,022
2012/2013 = 28,722++
• Problems and challenges
--Capacity building and professional development of mental health workers needed.
--Lack of rehabilitation facilities and psycho-social support system for mentally disabled people
--Unavailability of proper training materials for different levels of health workers.
• Policy level national initiatives:
--NMHP (National Mental Health Policy of 1997. Not implemented and outdated at present.
--Mental Health Legislation
o 3 drafts prepared at different times without any successful work.
o The last draft of MHL submitted to MoHP ( Ministry of Health and Population) in 2014 to be incorporated in the proposed “Nepal Health Act” of MoHP.
--Non-communicable disease (NCD) Multisectoral Strategic Action Plan 2014-2020 prepared by
MoHP and WHO which includes mental health too.
--Nepal Health Policy-2014 includes mental health as priority agenda.
--CRPD of 2006 ratified and endorsed by Nepal which incorporates issues of mental disability.
• International coordination and collaboration in:
--E-learning for post-graduate education
--Development of Tele-psychiatric medicine.
--Exchange programs for faculty members, resident doctors, and other mental health professionals.
--Collaboration for development of Community-based mental health services.
• Future plans:
--Strengthen and expand the Department of Clinical psychology and Psychiatric social work including academic activities and training programs.
--Expand public mental health activities.
--Upgrade Mental Hospital Lagankhel into National Centre of Mental Health.
--Strengthen community-based and integrated mental health service.