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Open Access Research article

Setting priorities for mental health care in Nepal: a formative study

Mark JD Jordans12*, Nagendra P Luitel3, Mark Tomlinson45 and Ivan H Komproe16

Author Affiliations

1 Research and Development, HealthNet TPO, Amsterdam, The Netherlands

2 Center for Global Mental Health, King’s College London, London, UK

3 Research Department, Transcultural Psychosocial Organization (TPO), Kathmandu, Nepal

4 Psychology Department, Stellenbosch University, Stellenbosch, South Africa

5 Center for Public Mental Health, University of Cape Town, Cape Town, South Africa

6 Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands

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BMC Psychiatry 2013, 13:332  doi:10.1186/1471-244X-13-332

Published: 5 December 2013

Abstract

Background

There is an urgent need to address the massive treatment gap for mental health problems, especially in low income settings. Packages of care integrated in routine primary health care are posited as a strategy to scale-up mental health care, yet more needs to be known about the most feasible and effective way to go about this.

Methods

The study follows a combined methods design that includes engaging an expert panel in a priority setting exercise, running workshops to develop a Theory of Change and conducting in-depth qualitative interviews and focus group discussions with key stakeholders. The results of each research step were taken forward to inform the subsequent one.

Results

There was strong endorsement for a system of care that encompasses both the perspectives of health facility and the community. Issues related to increasing access and demand, guaranteeing a sustainable supply of psychotropic medicine, adequate human resourcing, and ensuring positive family involvement came up as priority areas of attention.

Conclusion

The study underlines many of the known barriers in developing mental health services. At the same time it provides a distinct pathway and concrete recommendations for overcoming these challenges in Nepal.

Keywords:
Nepal; Mental health care packages; Formative research; Development