Status of mental health in Nepal

Service Delivery Providers for Mental Health Services in Nepal

Mental health services in Nepal are delivered through a mix of government, non-government, and private institutions. The main service delivery providers are:

1. Government hospitals and institutions – The primary provider. These include:

   • Nepal Government Mental Hospital, Lagankhel, Lalitpur – the only dedicated government mental hospital in the country.
   • Tribhuvan University Teaching Hospital (TUTH), Maharajgunj – runs a Psychiatry Department and a Child and Adolescent Psychiatry Unit.
   • Patan Hospital, Lalitpur – provides psychiatric OPD and inpatient services.
   • BP Koirala Institute of Health Sciences (BPKIHS), Dharan – has a full Psychiatry Department.
   • Regional and zonal hospitals – psychiatry OPDs in places like Pokhara, Nepalgunj, Biratnagar, and other districts.
   • Primary Health Care Centres (PHCs) and district health posts – provide basic mental health care, screening, and referral, especially after integration of mental health into primary health care.

2. Non-government organizations (NGOs) and INGOs – e.g., TPO Nepal (Transcultural Psychosocial Organization), Koshish, CMC (Community Mental Health Centre), Basic Needs Nepal, and INTERSOS. These focus on psychosocial counselling, community awareness, rehabilitation, and outreach, especially after disasters.

3. Private hospitals and clinics – e.g., Kathmandu Model Hospital, Grande International Hospital, Norvic International Hospital, and private psychiatric clinics in Kathmandu and other cities.

4. Academic and training institutions – e.g., Institute of Medicine (IOM), TUTH, and BPKIHS, which train mental health professionals and run service units.

5. Community-based rehabilitation centres and day-care centres – run by NGOs for persons with chronic mental illness.

Types of Professionals Involved

Note: The number of psychiatrists in Nepal is very low (roughly one per 100,000 people or less), and they are concentrated in Kathmandu and a few big cities. Most districts have no psychiatrist at all, so mental health care is largely carried out by NGOs, counsellors, and primary health care staff.

Status of Psycho-Social Counselling in Nepal

Psycho-social counselling in Nepal is still in a developing stage. It has grown over the last three decades, but it remains limited in reach, uneven in quality, and heavily dependent on non-government and donor support. Its present status can be discussed under the following points:

1. Historical background. Formal counselling began only after the restoration of democracy in 1990. The devastating earthquake of 2015 and the COVID-19 pandemic gave it further momentum, as large numbers of survivors needed trauma and grief support. Services were first introduced by INGOs and NGOs working in conflict- and disaster-affected districts, and were later slowly taken up by schools, hospitals and local levels.

2. Service providers. Counselling is provided mainly by clinical psychologists, counselling psychologists, psychiatric nurses, trained social workers, school counsellors, and community-based psychosocial counsellors. Many of them work under the Ministry of Health and Population, the Ministry of Education, Science and Technology, and the Ministry of Women, Children and Senior Citizens. NGOs such as TPO Nepal, CVICT, and the Centre for Mental Health and Counselling (CMC) are major providers.

3. Settings of service. Counselling is available in a few mental hospitals (e.g., Patan Hospital, TUTH, Kanti Children's Hospital), primary health care centres, school counselling rooms, women's shelters, safe houses, rehabilitation centres, and community mental health programmes. Helplines such as the National Suicide Prevention Helpline provide remote counselling.

4. Achievements. Awareness of mental health has increased. The National Mental Health Policy (1996) and the Mental Health Strategy and Action Plan recognise counselling as part of primary health care. School counselling is expanding in private and some community schools. Training programmes in counselling psychology are offered by universities such as TU, KU and Pokhara University. Community-based psychosocial support after disasters has reached many rural districts.

5. Problems and limitations. The main problems are:

• Severe shortage of trained and licensed counsellors, especially in rural areas.
• Weak legal framework — counselling is not yet a fully regulated profession with a licensing council.
• Limited government budget and poor integration into the public health system.
• Social stigma and lack of awareness; mental illness is still often attributed to witchcraft or fate.
• Cultural and language barriers — most counselling models are Western and not adapted to Nepali caste, ethnic and religious contexts.
• Unequal access — services are concentrated in Kathmandu and urban areas; remote districts have almost none.
• Poor follow-up, weak referral systems, and shortage of supervision for community counsellors.

6. Present trend. The number of counsellors, training institutes and helplines is increasing. Tele-counselling and online counselling expanded during COVID-19. Local governments have begun to allocate small budgets for psychosocial programmes. However, the profession still lacks a strong professional association and standard certification.

Conclusion. Psycho-social counselling in Nepal has made meaningful progress in awareness and service delivery, but it remains urban-centred, donor-dependent and inadequately regulated. Strengthening training, licensing, government funding and culturally sensitive practice is essential for its future development.

Implementation Status of the Mental Health Policy in Nepal

Nepal first adopted a National Mental Health Policy in 1996 (2053 BS), which was later revised, and the Ministry of Health and Population developed a National Mental Health Strategy and Action Plan (2077 BS / 2020) to put it into practice. Implementation has been partial and slow:

• Mental health has been brought into the Basic Health Care Package and primary health care, but coverage and quality are uneven.
• The budget is very small, a tiny fraction of the health budget, and depends heavily on donors and NGOs.
• Psychiatrists, psychiatric nurses and clinical psychologists are few and concentrated in Kathmandu and other cities; many districts have none.
• Stigma, superstition (faith healers) and weak coordination among ministries and local governments slow progress.
• The framework exists on paper, but delivery at the grassroots level is still inadequate.

Five Major Provisions of the Policy

1. Integration of mental health into primary health care, so that basic care is available at health posts and district hospitals.
2. Development of trained human resources: psychiatrists, psychiatric nurses, psychologists, counsellors and training of general health workers.
3. Community-based services and rehabilitation, shifting care away from long-stay institutions towards family and community.
4. Mental health promotion, public awareness and reduction of stigma, including school programmes.
5. Protection of the rights of persons with mental illness, with a legal framework against discrimination and abuse.

(Other provisions: adequate budget, availability of essential psychotropic medicines, inter-sectoral coordination, research and monitoring.)

Mental health treatment in Nepal has gradually moved from a custodial, hospital-based model towards community-based care. The main measures adopted are:

1. Policy and programme: the National Mental Health Policy (1996) and later the Mental Health Strategy and Action Plan (2020) set the direction for mental health care.
2. Integration into primary health care: health workers at health posts and district hospitals are trained to recognise and manage common mental disorders and to refer severe cases.
3. Community mental health services and outreach camps: NGOs such as TPO Nepal and CMC-Nepal run community programmes with screening, free medicine and counselling in remote districts.
4. Hospital-based services: the Government Mental Hospital (Lagankhel), and psychiatry departments of TUTH, Patan Hospital, BPKIHS (Dharan) and regional hospitals provide diagnosis, medication, psychotherapy and inpatient care, and train specialists.
5. Counselling and helplines: school and community psychosocial counsellors and helplines such as the suicide prevention helpline (1166).
6. Legal and human-rights protection: provisions in health laws and policy to protect patients from abuse and neglect.
7. Awareness and anti-stigma activities: campaigns on World Mental Health Day (10 October), FM radio and street drama.

Explanation of one measure: community mental health services and outreach camps

Because most psychiatrists are in the Kathmandu valley while most people live in rural areas, a mobile team (psychiatrist, psychiatric nurse, psychosocial counsellor) goes to the community instead of waiting for patients to come to the hospital. The steps are:

1. Screening: with local health workers and Female Community Health Volunteers (FCHVs), people with mental health problems are identified.
2. Diagnosis and treatment: the psychiatrist examines patients and gives medicines, often free for a fixed period.
3. Counselling: patients and families receive counselling and education about the illness.
4. Referral: severe cases go to a district hospital or city centre.
5. Follow-up and training: the team revisits and trains local health workers and FCHVs to continue basic care.

Example: In a village of Jumla, a woman is severely depressed after her husband's death. The trained FCHV tells the visiting team. The psychiatrist diagnoses depression and prescribes an antidepressant for three months, the counsellor counsels her and her family, and the health worker checks that she takes the medicine. On the next visit her sleep, appetite and mood have improved and she has returned to work in her field. Thus treatment reaches her door at low cost, without separating her from her family.

Shortage of trained mental health professionals and limited availability of mental health services in rural areas.

Nepal has very few psychiatrists and psychiatric nurses, most of whom are concentrated in urban centres like Kathmandu, leaving rural districts without adequate mental health care.

Psychiatrist and clinical psychologist.

A psychiatrist is a medical doctor who diagnoses and treats mental disorders and can prescribe medication, while a clinical psychologist provides psychological assessment and therapy (such as counselling and psychotherapy) for mental health problems.

Five roles taken by the Government of Nepal for the improvement of mental health:

1. Policy and legal framework. The government adopted the National Mental Health Policy (1996), later revised, and the Mental Health Strategy and Action Plan (2020), and includes mental health in national health policies. These set the direction, priorities and standards for services.

2. Integration into primary health care. Basic mental health services are provided through health posts, primary health centres and district hospitals, so that diagnosis, counselling and referral reach rural and remote areas.

3. Establishing and running facilities. The government runs the Mental Hospital at Lagankhel and psychiatric services in public hospitals such as TUTH and Patan Hospital, with free or subsidised treatment and medicines for poor patients.

4. Human resource development. It supports postgraduate training in psychiatry (for example at the Institute of Medicine) and short trainings for doctors, nurses, health assistants and FCHVs, increasing trained manpower at the local level.

5. Public awareness and helpline services. Through the Ministry of Health and Population it conducts awareness campaigns (such as World Mental Health Day, 10 October), uses the media, and supports suicide prevention and counselling helplines (such as 1166).