This document provides an overview of Nepal's mental health programs and policies. It discusses the historical background of mental healthcare in Nepal, from ancient practices to the establishment of the first psychiatric services in the 1960s. It outlines key national policies and strategies, including the National Mental Health Policy of 1996, National Mental Health Strategy and Action Plan 2020, and Community Mental Health Care Package of 2074. It also describes several mental health programs and guidelines, and lists some of the major mental healthcare centers in Nepal.

1. UNIT IX
MENTAL HEALTH
PROGRAMME
Prepared By:
Sapana Dahal
M.Sc. Nursing 2nd Year

2. Objective
At the end of the session, all the participants will
be able to explain about Mental Health
Programme.

3. Contents
• Introduction
• Historical Background
• National Mental Health Policies
• National Mental Health Strategy and Action
Plan 2020
• Mental Health Gap Action Programme

4. Contents
• Community Mental Health Care Package,
Nepal, 2074
• PRogramme for Improving Mental health carE
(PRIME)
• Guidelines for Prevention and Management of
Psychiatric Illness during Isolation and
Quarantine
• Mental Health Care Centre in Nepal
• References

5. Introduction
• The current healthcare delivery system is
organized as a tiered referral system.
• Public mental healthcare in Nepal
is coordinated and delivered by the
Department of Health Services (DoHS)

6. Introduction Contd…
• Responsibility of the NCD and Mental Health
Section of the Epidemiology and Disease
Control Division (EDCD).

7. Historical Background
Ancient practices (before 1961: the monarchial
era)
• Mental asylums -first
point of contact for those
seeking mental healthcare in most nations.
• Patients in Nepal - towns in the northern part
of India to seek mental treatment

8. Historical Background Contd…
The era of modern psychiatry
After the December 1960: The first psychiatric
service in Nepal founded.
1961: Psychiatric out-patient department (OPD)
established at Bir Hospital.
1965 :The psychiatric OPD was extended by a
psychiatric in-patient comprising five beds, and
further increased by twelve beds in 1971

9. Historical Background Contd…
The era of modern psychiatry
In Tribhuvan University Teaching Hospital
1986 : A psychiatric OPD
1987 : 12-bed in-patient psychiatric service

10. Historical Background Contd…
The era of modern psychiatry
1984 : OPD at Bir Hospital was
incorporated into a new mental
hospital with 25 in-patient beds
at Lagankhel, Lalitpur, the first
and only central-level mental hospital in Nepal,
popularly known as Lagankhel Mental Hospital.

11. Historical Background Contd…
The era of modern psychiatry
1983–1984 : some NGOs also started to work in
the sector of intellectual disability.

12. Historical Background
Contd…
Community mental healthcare
• The history of community mental health
services dates to 1983.
• The United Mission to Nepal started its mental
health programme in 1984 as a 5-year pilot
project in Lalitpur, training paramedics to
provide a primary level of care.

13. Historical Background
Contd…
Community mental healthcare
• After its success, a similar mental health project
was launched by the Tribhuvan University
Teaching Hospital in 1989 with the support of
international NGOs.
• The Norwegian organisation Redd Barna (Save
the Children, Norway) provided mental health
training to teachers and nurses.

14. Historical Background
Contd…
Community mental healthcare
• The Narcotic Drugs Control Act was framed in
1976 and amended in 1981 and 1987.
• The Drug Abuse and Demand Reduction
Project was initiated in 1995 and several
demand-reduction activities are carried out by
national and international NGOs

15. Historical Background
Contd…
Community mental healthcare
• Several rehabilitation centers have been set up
by NGOs in response to the problem of drug
misuse.

16. National Mental Health Policies
1996 : A mental health policy for Nepal was
developed by the government.
A comprehensive National Mental Health Policy
was incorporated in the Ninth Five Year
National Plan by the Government of Nepal.

17. National Mental Health Policies
Contd…
• The mental health policy proposes several
strategies to develop human resources for mental
health services and ensure basic human rights of
people with mental illness.
• The mental health legislation which ensures the
human rights of people with mental illness was
drafted in 2006, but its endorsement by the
government is still pending.

18. National Mental Health Policies
Contd…
Policies
• To ensure the availability and accessibility of
minimum mental health services for all the
population of Nepal by the year 2000
• To prepare Human Resources in the area of
Mental Health in order to provide for the
above mentioned Mental Health Services.

19. National Mental Health Policies
Contd…
Policies
• To protect the fundamental human rights of the
mentally ill in Nepal.
• To improve awareness about mental health, mental
disorders, and the promotion of mentally healthy
lifestyles, in the community by participation of
community structures, and amongst health
workers.

20. The 2017 Draft Mental Health
Policy
In 2017, the MoHP drafted a mental health
policy in line with Nepal's constitution, ensuring
the right of every Nepalese citizen to mental and
psychosocial health and guaranteeing the right to
remain mentally sound and live a dignified life

21. The 2017 Draft Mental Health
Policy
Contd…
Aim:
• To ensure readily available and accessible basic
mental health services for all
• To train the necessary workforce to deliver mental
health and psychosocial services
• To protect the fundamental human rights of people
with psychosocial disability and mental illness

22. The 2017 Draft Mental Health
Policy
Contd…
Aim:
• To promote public awareness of mental health
and combat stigma against mental illness
• To develop and manage health information
systems and research

23. The 2017 Draft Mental Health
Policy
Contd…
• It proposed allocation of funding at federal and
provincial level based on burden of mental
illness, to be used for promotional, preventive,
and remedial and rehabilitation activities.

24. The 2017 Draft Mental Health
Policy
Contd…
It envisaged a mental health division set up
under the MoHP and the establishment of a
separate mental health unit in each government-
run hospital.

25. The 2017 Draft Mental Health
Policy
Contd…
Mental healthcare facilities would play a
coordinating role, engaging with the community
to promote mental health and ensure that
people's mental health needs were assessed and
addressed.

26. National Mental Health Strategy
and Action Plan 2020
It provides a more comprehensive description of
Nepal’s plans for mental health care. This
strategic Action Plan describes the provision of
free primary care mental health services for all
parts of the country.

27. National Mental Health Strategy
and Action Plan 2020 Contd…
Objectives
• To transfer long-term hospitalized
patients/clients with a predominance of social
needs (approximately 30% of patients/clients
hospitalized at psychiatric inpatient aftercare
providers) to the community

28. National Mental Health Strategy
and Action Plan 2020 Contd…
Objectives
and simultaneously reduce the number of aftercare beds
at psychiatric inpatient aftercare providers by 1,200 by
2022
• To set up health and social field teams to provide care
and rehabilitation for deinstitutionalized people with
mental illness – by 2022 this means 30 Mental Health
Centres (MHC)

29. National Mental Health Strategy
and Action Plan 2020 Contd…
Objectives
• To provide housing for deinstitutionalized persons
with mental illness in the community.
• To present how the division of competencies for
health and social services will be ensured, including
cooperation at the level of the Ministries of Social
Affairs and Health and a contribution to the funding
of the reform from the health and social budget

30. National Mental Health Strategy
and Action Plan 2020 Contd…
Key components
• Integration of mental health at Primary Health
Care level
• Strengthening mental health at Secondary
Health care level
• Service user engagement in policy
development and planning

31. National Mental Health Strategy
and Action Plan 2020 Contd…
Activities
In fiscal year 2074/75
Community based Mental health program has
been started at 6 districts (Panchthar, Mahottari,
Dolakha, Lamjung, Kapilvastu, Kanchanpur).

32. National Mental Health Strategy
and Action Plan 2020 Contd…
Activities
In FY 2075/76
Mental health program was scaled up in 14
districts as 2 districts per province (Morang,
Terathum, Parsa, Sarlahi, Sindhupalchowk,
Makawanpur, Syanja, Parbat, Arghakhanchi,
Gulmi, Jumla, Kalikot, Doti and Darchula).

33. National Mental Health Strategy
and Action Plan 2020 Contd…
In FY 2076/77
Mental health program was scaled up in 21 districts as
3 districts per province (Khotang, Taplejung, Sunsari,
Saptari, Dhanusha, Siraha, Dhading, Sindhuli, Lalitpur,
Mustang,Baglung, Nawalparai – East, Pyuthan, Palpa,
Dang, Salyan, Jajarkot, Dailekh, Dadeldhura, Bajhang
and Baitadi).

34. National Mental Health Strategy
and Action Plan 2020 Contd…
FY 2077/78
No budget was allocated for strengthening of
previously scaled-up districts.

35. Mental Health Gap Action
Programme
Launched by WHO in 2008 and the mhGAP
Intervention Guide in 2010 with the aim of providing
evidence-based clinical guidance to PHC workers for
detection, diagnosis and treatment of mental disorders in
primary care.
It comprised intervention packages to be implemented
at community, health facilities and health service
organisation levels

36. Mental Health Gap Action
Programme Contd…
Community-level intervention packages
Community sensitisation programme, case
detection in the community by using the
Community Informant Detection Tool
(CIDT), treatment adherence support through
home-based care and community counselling.

37. Mental Health Gap Action
Programme Contd…
The health facility level packages :
Training and supervision of healthcare providers to
detect, diagnose and treat mental disorders based on the
WHO mhGAP Intervention Guide.
The health organization level packages :
Human resource mobilisation, procurement and supply
of psychotropic medicines and referrals for specialised
care

38. Article
A study conducted on Process evaluation of a
district mental healthcare plan in Nepal: a mixed-
methods case study concluded the following
barriers and facilitating factors:

39. Article Contd…
Health organisation level
Barriers
• Mental health not being a government priority,
no mental health focal unit/person in the MoH,
and lack of basic psychotropic medicines in
the free drug list.

40. Article Contd…
Facilitating factor
• Use of evidence-based intervention packages,
particularly the WHO recommended mhGAP
intervention guidelines.
• Supportive role of the district public health
office (DPHO) and psychiatrists in the district
hospital .

41. Article Contd…
Health facility level
Barriers
• low mental health literacy among PHC workers
• heavy workload among PHC workers
• frequent transfer of the trained health workers
• mental health stigma among service providers

42. Article Contd…
• lack of adequate physical facilities
• particularly lack of private rooms for
consultation
• lengthy and complicated drug procurement and
distribution process lack of a mental health
supervision system in primary care

43. Article Contd…
Health facility level
Facilitating factors
• Supportive role of the MoH and DPHO,
motivation of PHC workers to learn about
mental healthcare
• Procurement of new psychotropic medicines
through PRIME

44. Article Contd…
Facilitating factors
Initiation of case conferences by psychiatrist for
mentoring and clinical supervision of the trained
health workers.

45. Article Contd…
Community level
Barriers
• limited mental health awareness
• low perceived needs for mental healthcare and
high level of stigma

46. Article Contd…
Facilitating factors
• Involvement of FCHVs
• Use of CIDT as a strategy to increase demand
for services
• Mobilisation of a new cadre of psychosocial
counsellors to deliver psychological
interventions in the community.

47. Community Mental Health Care
Package, Nepal, 2074
• The MoHP developed the Community Mental
Health Care Package Nepal, 2074 in 2017 to
facilitate implementation of the 1996 National
Mental Health Policy.
• It is guided by the principles of integration of
mental health into primary care and the WHO
Mental Health Gap Action Programme.

48. Community Mental Health Care
Package, Nepal, 2074 Contd…
The package is developed for standardization
and uniformity in capacity building of non-
specialized mental health professionals ensuring
the availability and accessibility of integrated
mental health and psychosocial support services
(MHPSS) within the primary health care system
of the country.

49. Community Mental Health Care
Package, Nepal, 2074 Contd…
National Health Training Centre of the MoHP
has developed four different training modules for
building the capacity of non-specialist service
providers.

50. Community Mental Health Care
Package, Nepal, 2074 Contd…
General Objective
To facilitate integration of mental health services into
the primary health care delivery system of the country.
Specific Objectives
• To define the mental health and psychosocial
support service packages at different layers of
primary health care system

51. Community Mental Health Care
Package, Nepal, 2074 Contd…
• To define the minimum standard of the MHPSS
services at different layers of primary health care
system
• To set the standard of the training packages and
manuals for training and supervision of health
workers and community volunteer like FCHV.

52. PRogramme for Improving
Mental health carE (PRIME)
• PRIME was a (2011-2019) eight-year multi-
national research project funded by DFID
(Department for International Development)
UK to consortium partners in five countries
(South Africa, Uganda, Ethiopia, India and
Nepal)

53. PRogramme for Improving
Mental health carE (PRIME)
Contd…
The overall aim of PRIME was to generate world-
class research evidence on the implementation
and scaling up of treatment programs for priority
mental disorders in primary and maternal health
care contexts in low resource settings which could
be widely adopted by policy makers and
practitioners.

54. PRogramme for Improving
Mental health carE (PRIME)
Contd…
Focused on the four mental disorders which
contribute to the greatest overall burden of
disease; alcohol abuse, depression (including
maternal depression), psychosis and epilepsy,
and for which there was evidence of cost-
effective interventions.

55. PRogramme for Improving
Mental health carE (PRIME)
Contd…
PRIME developed an integrated a mental health
care plan (MHCP) comprising packages of
mental health care for delivery in primary health
care and maternal health care

56. PRogramme for Improving
Mental health carE (PRIME)
Contd…
It has been used to advocate for psychotropic
medications for the free drugs list; develop a
national level mental health curriculum for
health workers; and provide input into the
revision of the national mental health policy.

57. Guidelines for Prevention and
Management of Psychiatric
Illness during Isolation and
Quarantine
• Developed by the Psychiatric Association of
Nepal.
• To facilitate psychiatrists, other health care
workers and policy makers to address the
psychosocial aspects of Isolation and
Quarantine

58. Guidelines for Prevention and
Management of Psychiatric
Illness during Isolation and
Quarantine Contd…
Focused on delirium, anxiety, depression ,grief,
pre-existing psychiatric disorders, cognitive
disorders, substance use disorders.

59. Guidelines for Prevention and
Management of Psychiatric
Illness during Isolation and
Quarantine Contd…
Promotion of mental health during quarantine
and isolation which can be achieved through
keeping isolation and quarantine as short as
possible provide as much information as possible
about the disease condition.

60. Guidelines for Prevention and
Management of Psychiatric
Illness during Isolation and
Quarantine Contd…
Providing adequate supplies, plan to reduce the
boredom and provide communication, providing
special attention to health-care workers and
appealing for altruism.

61. Mental Health Care Centre in
Nepal
• Mental Hospital, Lagankhel
• Transcultural Psychosocial Organization
(TPO) Nepal
• Aasha Deep Nepal
• Centre For Mental Health And Counseling-
Nepal (CMC- Nepal)

62. Mental Health Care Centre in
Nepal
Contd…
• KOSHISH
• The Centre for Victims of Torture (CVICT)

63. Mental Hospital, Lagankhel
• Mental Hospital, Lagankhel is the first government
mental hospital in Nepal.
• It was established in 1985 and operated with 25
beds.
• In 2003, the hospital extended its total beds to 50;
there has been no further expansion. On average,
175 patients visit the OPD daily, many of them
requiring admission

64. Mental Hospital, Lagankhel
Contd…
• Oral Substitution Therapy was started in 1994
and phased out in 2002.It was again restarted
in 2011.
• Telephone hotline service was started from
July 1, 2010.
• Community mental health program was
started from February 2010 in Dhading and
Nuwakot

65. Mental Hospital, Lagankhel
Contd…
• Extended outpatient service was started in
2068 jestha.
• Emergency service in the hospitals was started
from November 16, 2012.
• Ambulance for service is available from 2014.
• EEG service was started in 2014.

66. Mental Hospital, Lagankhel
Contd…
• General OPD ticketing Hours – 8:30 AM to 12
PM
• Extended OPD ticketing Hours – 3 PM to 5
PM
• Emergency – 24 hours (OPEN)

67. Transcultural Psychosocial
Organization (TPO) Nepal
• Non-profit, non-governmental
organization, affiliated with
Health Net TPO Netherlands
located at Baluwatar, Kathmandu,
Nepal.
• Leading psychosocial organization

68. Transcultural Psychosocial
Organization (TPO) Nepal
Contd…
Focused to develop local psychosocial, mental
health and conflict resolution capacity and
systems that promote community resilience,
quality of life and self-reliance through
education, research, service delivery and
advocacy.

69. Transcultural Psychosocial
Organization (TPO) Nepal
Contd…
Aim
Promoting psychosocial well-being and mental
health of children and families in conflict
affected and other vulnerable communities.

70. Transcultural Psychosocial
Organization (TPO) Nepal
Contd…
Vision and Mission
Supporting peace, reconciliation and local
capacity by improving psychosocial and mental
health care in areas of chronic crisis and post
conflict situations.

71. Transcultural Psychosocial
Organization (TPO) Nepal
Contd…
Major activities and services
• Research
• Psychosocial intervention/program design and
management
• Capacity building
• Clinical/ Counseling services
• Advocacy

72. Transcultural Psychosocial
Organization (TPO) Nepal
Contd…
TPO Coverage
Professional staff of more than 40, including
program/ project managers, a research team of
15, a training team of 10, clinical/counseling
staff, and administrative, finance and support
staff.

73. Transcultural Psychosocial
Organization (TPO) Nepal
Contd…
TPO partners
Works in partnership with multilateral, INGO and
local organizations including UNICEF, UNHCR,
Save the Children US, Nepal National Human
Rights Commission (NHRC), CERI, World
Education, International Committee of the Red
Cross (ICRC), International Rescue Committee
(IRC) and MS Nepal.

74. ASHADEEP NEPAL
Established in 1991 as a non-profit and non-
governmental, voluntary social
organization located in Sundarijal
,Kathmandu.
It started its work in partnership
with the Sisters of Nazareth to release men and
women who were in jail solely due to their
mental illness

75. ASHADEEP NEPAL
Contd…
• Agreement with the Directorate of Jail
Administration in 1995 to stop the
imprisonment of mentally ill people without
criminal offenses in jails of Kathmandu valley.
• 34 out of the 46 mentally ill women from the
prison were treated and rehabilitated in the first
year.

76. ASHADEEP NEPAL
Contd…
• Currently it provides care to patient with total
capacity of 40 beds in which 20 for male and 20 for
female patients.
• Separate male and female ward present with
separate toilets and bathrooms.
• Patients can be admitted for 3- 6 months duration
only and taken by family members as per rule of the
institution.

77. ASHADEEP NEPAL
Contd…
Vision:
Vision of a healthy society where all can live
with dignity, justice and respect.
Objectives:
• To treat people with mental health problems
and rehabilitate them

78. ASHADEEP NEPAL
Contd…
• To provide psycho social support to family of
mentally affected
• To educate people on the importance of mental
health
• To motivate people to live with dignity and
respect

79. ASHADEEP NEPAL
Contd…
Areas of work
• Residential Program
• Day Care Program
• Outreach Program
• Family/guardian counseling
• Family Welfare
• Public Awareness
• Training

80. Centre for Mental Health and
Counseling- Nepal (CMC- Nepal)
Non-governmental organization
established in May, 2003
located in Jitjung Marg,
Thapathali , Kathmandu.

81. Centre for Mental Health and
Counseling- Nepal (CMC- Nepal)
Contd…
Working in mental health and development by
providing mental health and psychosocial
services and by imparting training for developing
human resources in mental health and
psychosocial counseling.

82. Centre for Mental Health and
Counseling- Nepal (CMC- Nepal)
Contd…
• Embedded at all levels of that system, from the
smallest village to the district hospital right
through to government policymakers.
• Over two decades of work, they have
expanded across 42 districts.
• 12 medicines are free for psychiatric patient.

83. Centre for Mental Health and
Counseling- Nepal (CMC- Nepal)
Contd…
Mission
To promote mental health and psychosocial well-
being of the people living with mental health
problems in Nepal, especially children and
women, by working closely working with the
Line Ministries

84. Centre for Mental Health and
Counseling- Nepal (CMC- Nepal)
Contd…
to develop human resource and with
communities and community-based
organizations to create public awareness and
community empowerment.

85. Centre for Mental Health and
Counseling- Nepal (CMC- Nepal)
Contd…
Vision
People in Nepal become aware of mental health
issues and persons living with mental health,
and psychosocial problems live a dignified life
and enjoy their rights to health services

86. Centre for Mental Health and
Counseling- Nepal (CMC- Nepal)
Contd…
Programme
• Community Mental Health and Psychosocial Support
Programme (January 2022 – December 2025)
• School Mental Health Program (January 2022 –
December 2025)
• Psychosocial support in SaMi (Safer Migration)
Project Phase III (2019-2022)

87. Centre for Mental Health and
Counseling- Nepal (CMC- Nepal)
Contd…
• Inclusive Community Mental Health
Programme (January 2020-December 2022)
• Psychosocial Counselling to Conflict Victims
(CVs) (September 2021 – July 2024)
• GBV Response Project in COVID-19 in Nepal
(1st September 2021 to June 2022)

88. Centre for Mental Health and
Counseling- Nepal (CMC- Nepal)
Contd…
• Psychosocial Support in GBV Prevention and
Response Project – II (July 2021 to June 2024)
• Promotion of Child Mental Health &
Psychosocial Wellbeing in Community
(February 2021 to December 2024 )
• Human Resource Development Unit (HRDU)

89. Centre for Mental Health and
Counseling- Nepal (CMC- Nepal)
Contd…
Human Resources
• Clinical psychologist (36)
• Psychiatrist (200)
• Psychiatric nurse (75-80)

90. KOSHISH Nepal
• Established in 2008 as a
National Mental Health
Organization located in Kusunti,
Lalitpur.
• Working in the promotion of mental health and
psychosocial well-being in Nepal.

91. KOSHISH Nepal Contd…
It aims to create model recovery oriented person
centered mental health services, which includes
mental health and psychosocial support
(MHPSS) in health as well as beyond the health
system (i.e. social protection, employment, etc).

92. KOSHISH Nepal Contd…
It conducts the advocacy and awareness
program, community empowerment approach,
MHPSS during emergency and crisis.

93. The Centre for Victims of
Torture, Nepal (CVICT)
• Non-profit, non-governmental
organization that rehabilitates
victims of torture, advocates
the eradication of torture and
promotes human rights within Nepal.
• Established on 15 December 1990.
• Located at Bansbari, Kathmandu.

94. The Centre for Victims of
Torture, Nepal (CVICT) Contd…
Provides professional medical, psychosocial and
legal services to Nepalese men, women and
children who are victims of torture, trauma
associated with torture or inhuman treatment.

95. The Centre for Victims of
Torture, Nepal (CVICT) Contd…
CVICT has been providing comprehensive
rehabilitation services for victims of torture and
other human rights abuses to restore their human
dignity .

96. References
• Rai Y, Gurung D, Gautam K. Insight and challenges: mental
health services in Nepal. BJPsych international. 2021
May;18(2).
• Singh R, Gupta AK, Singh B, Basnet P, Arafat SY. History of
psychiatry in Nepal. BJPsych International. 2022 Feb;19(1):7-
9.
• Luitel NP, Jordans MJ, Adhikari A, Upadhaya N, Hanlon C,
Lund C, Komproe IH. Mental health care in Nepal: current
situation and challenges for development of a district mental

97. References Contd…
• Gupta AK, Joshi S, Kafle B, Thapa R, Chapagai M, Nepal S, Niraula
A, Paudyal S, Sapkota P, Poudel R, Gurung BS. Pathways to mental
health care in Nepal: a 14-center nationwide study. International
Journal of Mental Health Systems. 2021 Dec;15:1-9.
• Nepal WHO Special Initiative for Mental Health Situational
Assessment. Available from : https://cdn.who.int/media/docs/default-
source/mental-hea Ith/special-initiative/who-special-initiative-country-
report.

98. References Contd…
• National Mental Health Strategy & Action Plan
2077.Available from:
https://publichealthupdate.com/national-mental-
health-strategy-action-plan-2077/
• Available from : https://www.tponepal.org/
• Available from : https://www.cmcnepal.org.np/
• Available from: https://www.koshishnepal.org/
• Available from:
https://sujenman.wordpress.com/2010/09/20/ngos-
hospit als-related-to-mental-health-psychology-in-
nepal/

99. THANK YOU