From Trauma to Treatment: Bridging Nepal's Himalayan-Sized Mental Health Gap

Objective: The primary objective of this paper is to review the systemic and societal basis of a massive mental treatment gap in Nepal and propose a shift in the paradigm of public healthcare to address this gap. Design: This review paper consists of a methodological literature review performed using peer-reviewed literature, governmental documents, and published policies that were written during the interval of 2005-2023. Setting: Nepal, a least developed country of South Asia, faces the challenges that are caused by post-conflict, natural disasters, impact of the pandemic, as well as massive migrant labor outflows. Main outcome measures: The study measured key mental health indicators: disorder prevalence, service coverage, treatment gaps, workforce density, budget allocation, and policy status. Results: Nepal has a treatment gap rate of over 90%. This is attributable to a syndemic of trauma because of conflict and disasters and migration. Systemic barriers encompass acute lack of human resources (0.22 psychiatrists/100,000), unreliability of drugs supply, and inadequately funded services that are below 1 percent of the health budget. In this context, care-seeking pathways for traditional healers and biomedical services are distinct, shaped by differing cultural beliefs and experiences of stigma. Although innovations relying on evidence, including task-shifting to community health workers and digital tools, have proven effective, they are limited to pilot projects because of the lack of funds and political will. The Mental Health Act of 2017 has no implementation and funding. Conclusions: In Nepal, mental health is an important part of the country's stability, unity, and fair growth as well as a public health problem. The paper argues that to bridge this divide will require a transformative shift away from an academic clinical model toward an emergent public mental health mission. This involves making guidelines work, investing in the future, sharing more tasks, using digital tools, and starting national prevention campaigns.