The lockdown, curfews, self-isolation, social distancing, and quarantine that COVID-19 pandemic brought about have affected the overall physical, mental, spiritual and social wellbeing of the Nepalese. However, the people already suffering from mental health conditions are at a higher risk. The Government’s current attempt to integrate mental health services at primary care level is facing obstacles because of the lack of infrastructure, intermittent availability of medicines, and frequent change of trained health-care providers.

More than 4% of Nepal’s 29 million people (approx. 1.1 million individuals) are estimated to be currently experiencing mental disorder, with additional 5.2% of 13-18-year-olds. The situation has worsened after COVID 19 pandemic. A study[1] from 2020 based on data collected online between 23 April 2020 and 3 May 2020 that aimed to track the psychosocial status of Nepalese people during the pandemic showed that half of the respondents experienced at least one psychological symptom. Data[2] provided by the Nepal Police also showed an increasing number of deaths from suicide, resulting in 16 to 18 deaths by suicide every day in 2020.

WHO Country Office Nepal (WCO) assisted the Minister of Health and Population (MoHP) in developing a COVID-19 Mental Health & Psychological Support (MHPSS) intervention framework. WHO supported in developing a legal and policy frameworks for implementation of National Mental Health Strategy and Action Plan developed by MoHP it – the necessary guidelines, standard operating procedures (SoPs), and training manuals.

The Health Emergency Operations Centre (HEOC) of the MoHP coordinated the pandemic response and activated the Inter-Agency Standing Committee[3] (IASC) cluster and sub clusters including the Mental Health Sub-Cluster. The Epidemiology and Disease Control Division, Department of Health Services, led the Mental Health Sub-Cluster and WCO Nepal acted as a co-lead.  The WHO experts supported the national response intervention in coordination of MHPSS partners’ aligning to WHO and IASC guidelines.

Working closely with the sub-cluster partners, WCO led the drafting of a short-term plan for COVID-19 MHPSS Intervention Framework, which gave strategic direction to the partners’ work in mental health interventions during the pandemic response. The document also played a key role in to setting a benchmark on optimum MHPSS response at the subnational level especially in provinces. In addition, IASC guidelines have been translated and adapted to the national context in collaboration with the Psychosocial Working Group.

WCO held regular mental health sub-cluster meetings to co-ordinate work among partners; at the provincial level similar coordination was facilitated by WHO Provincial Health Officers (PHOs) deployed in all seven provinces, to support provincial health authorities. As a result, more than 40,000 people received some form of psychosocial support. More than 20,000 children and adolescents were provided essential mental health support and 3,000 health-care providers saw their mental health needs addressed through stress management workshops and webinars. Also, 160 community psychosocial counsellors were trained and multiple FM radio stations across the country were engaged to disseminate messages. The main partners[4] providing various mental health and psychosocial services are government hospitals, medical colleges, professional associations, and various NGOs with support from Government bodies or UN Agencies.

WCO also facilitated  in national adaption and translation of the International Federation  of the Red Cross Guideline on  Remote Psychological First Aid, in collaboration with the Nepal Association of Clinical Psychologists. This document served as a guide to adjust to the unique challenges posed by the pandemic in delivering the psychosocial support.  At least 120 counselors were oriented on this guideline to deliver PFA remotely.

Additionally, WCO collaborated with the Government, TPO Nepal and Tribhuvan University Teaching Hospital and launched an online platform[5] to support the mental health needs of health-care providers. The website offers tips on mental healthcare, modules on stress management, webinars, audio-visual and Information Education and Communication (IEC) materials, self-screening tools, and appointment and follow-up services.

Furthermore, the EDCD with WCO’s support, has developed a Program Implementation Guideline on Tele-mental Health.  WCO installed videoconference (VC) equipment at the National Health Training Center, the EDCD, Mental Hospital Patan and two district hospitals at Illam and Kailali. With this support, 50 doctors and health workers in these two districts are trained on delivering essential mental health care and are supervised distantly through VC.

With the long-term vision of strengthening mental health programs in the country, WCO  supported the Ministry of Health and Population in in developing the  National Mental Health Strategy and Action Plan. One of the main objectives of the strategy is improving the access to  quality of mental health services  and increasing the resource allocation for mental health in Nepal. WCO has been supporting in implementing the strategy with necessary guidelines, standard operating procedures (SoPs), and training manuals.

Photo caption: A psychiatrist helps an elderly couple at a recently expanded mental health outpatient service at the community ho spital at Bajrabarahi Municipality of Nepal.

Photo credit: WHO