Report of national mental health survey Nepal 2020.

Research Report.

SUMMARY:

Mental health is an integral part of overall health and is a foundation for effective functioning of an individual. The consequences of mental health problems span across almost every aspect of an individual’s life. In addition, they also affect the family directly and indirectly, with impacts being inter generational. Mental disorders account for a large portion of Disability Adjusted Life Years (DALYs) and Years Lived with Disability (YLD). Increase in the burden of mental diseases ultimately increases the financial and logistic burden on the nation’s health system. However, despite the rising prevalence and significant effects of mental disorders across different spheres, there is a large treatment gap for these disorders, particularly in the Low and Middle-Income Countries. Nepal faces similar challenges in tackling the issue of mental disorders. While on the one hand, the prevalence has been steadily rising, on the other hand, the unmet needs for mental health services are striking. Although, some of this may be attributed to limited mental health care facilities, and mental health professionals, across the nation; another major contributor to the treatment gap is societal beliefs, traditions and stigma associated with mental disorders. An important fact to consider is that prior to the National Mental Health Survey (NMHS), there were no national level studies on mental disorders conducted in Nepal. Granted there were smaller studies, but they were based on limited population samples and thus were not generalizable at the national level. Thus, the objective of the survey was to assess the prevalence of mental disorders, pathway of receiving care and the barriers to accessing care among people with mental disorders in Nepal. The NMHS is a quantitative, cross-sectional community-based survey, including adult (age 18 years and above) and adolescent (aged 13 to 17 years) participants. The planning of the survey began from November 2017, while data collection was done between January 2019 and January 2020. The survey used the Mini International Neuropsychiatric Interview (MINI) tool for the diagnosis of mental disorders, which is a validated tool that has been used extensively in various countries and contexts, including national surveys. Prior to initiating the survey, pilot study was done and field enumerators as well as supervisors were given extensive training. Throughout the process of the survey, ethical consideration has been upheld to the highest standards. During and after data collection, information related to mental health was distributed among all participants, and anyone identified as having severe mental problems were referred to the nearest healthcare facility as well as to psycho-social counsellor. The analysis of 15088 data (9200 among adults and 5888 among adolescents) revealed that 10% of the adults had any mental disorder in their lifetime whereas, 4.3% currently (in the past month) had any mental disorder. Among the adolescents, 5.2% were found to have any mental disorder in their lifetime. Major depressive disorder was found to be prevalent among 2.9% of the adults and 0.6% of the adolescents. While 6.5% of the adults were observed to have current suicidal thoughts and 1.1% had attempted to commit suicide in their lifetime, 3.9% of the adolescents had current suicidal thoughts and 0.7% had attempted to commit suicide in their lifetime. Alcohol use disorder and other substance use disorder were found to be prevalent among 4.2% and 0.2 % of the adults respectively. Whereas in adolescents, substance use disorder (both alcohol use disorder and other substance use disorder) was found to be prevalent among 0.6%. The prevalence of current mental disorders was highest among adults in Bagmati Province (5.9%), among 40-49-year-olds (6.3%), and among females (5.1%). In adolescents, the prevalence of mental disorders was highest in Province 1 (11.4%), among 16-year-olds (7.7%), and among females (5.3%). Analysis of pathways to receiving care (help seeking behavior) questionnaire showed that 40.1% of the adults had talked about their symptoms of mental disorder with anyone, and 21.1% adhered to the treatment. Non-specialist doctors (8.8%), faith healers (6.7%), and psychiatrists (6.5%) were the service providers most sought by adults for the treatment of mental disorders. The major barriers to access to care were related to attitudinal barriers. For example, ‘Thinking they do not have a problem’, ‘Thinking the problem will get solved on its own’, ‘wanting to solve the problem on their own’, and ‘being unsure where to get professional care’. Whereas, ‘might be seen as weak or ‘crazy’ and ‘being ashamed’. were the major stigma related barriers. Major limitation of this survey was language barrier in some parts of the country mainly in Madhesh Province. Since mental disorders are associated with stigma, there is a possibility of under -reporting of the disorders. Based on the results of the survey, it is recommended to include and integrate mental health agenda in all policies and programs related to health and other sectors of welfare, education and employment. It is also recommended to integrate mental health with the routine health care system to increase accessibility and availability to basic mental health services and also to develop specific strategies to address economic barriers and stigma related barriers to help seeking by people. It is recommended to integrate mental health training into professional education of non-specialist health workers to enhance their ability to manage common mental disorders since the study found that non-specialist doctors are more commonly sought out by participants. Finally, it is also recommended to conduct more regional translation and cross-cultural adaptation of validated survey instruments to continue to improve the precision of mental health studies in the future.