Home to the Himalayas, Nepal is a mecca for trekking and mountain climbing. And even if you don’t dream of summiting Everest at 8,848 m (29,029 ft), there’s a good chance that visiting Nepal is on your bucket list. Last week, Dr. Bibhav Acharya brought a bit of Nepal to New York. His home country came alive at our Global Mental Health University Seminar as he spoke about mental health needs, priorities, and the steep climb that Nepal faces in advancing mental health.
Nepal has hundreds of Sherpas, but only 84 psychiatrists and psychologists combined. Whereas well-trained guides for trekking and mountaineering are plentiful in meeting the demand for adventure, Nepal’s 84 mental health professionals cannot come close to meeting the treatment needs of its population of 30 million. And given that most doctors are located in densely populated centers like Katmandu, the situation is even more dire for the majority living in rural areas. At the other extreme, consider for a moment that our Department of Psychiatry at Columbia University alone has 1,000 psychiatrists and psychologists on faculty.
The earthquake of 25 April 2015, which registered 7.8 on the Richter scale, caused untold damage to communities and left thousands of Nepalese homeless. The disaster also dramatically multiplied the number of individuals with mental disorders, stressing an already overburdened system. Beyond the traumatic stress of living through a natural disaster, mental disorders are often highly stigmatized. Mental health problems are more difficult to see than broken bones and collapsed homes. Following disasters, some individuals become saddled with survivor’s guilt that interferes with seeking help for emotional problems. And many humanitarian aid organizations do not focus on mental health. As a result, estimates of 10-30% of the impacted Nepalese population reported untreated mental health needs post-disaster.
Nepal didn’t need an earthquake to be seriously overwhelmed by untreated mental health problems. Consider this sobering statistic, which caused its own shock wave when released in 2010: The leading cause of death for Nepalese women is suicide. And this represents just a fraction of a more widespread crisis of untreated mental health problems in Nepal, where four out of five individuals who have mental health problems never get care.
A journey of a thousand miles begins with the first step…
Psychological First Aid is the core theme for World Mental Health Day, which is this Monday, 10 October 2016. Hosted by the World Federation for Mental Health and supported by the WHO, World Mental Health Day rallies the world to focus on one key topic each year. Psychological First Aid (PFA) represents a set of basic interventions that can be taught to non-mental health specialists. Given that over 65 million people are displaced around the world today – either by manmade or natural disaster – PFA has become a frontline response to millions in need, including thousands in Nepal. Training in PFA is good news for mental health. Just one word of caution: before we start calling PFA the gold standard in post-disaster care, we need more research to demonstrate its impact and understand what works and what could be done better.
Collaborative care models that integrate mental health and primary care are getting much-needed services to many more people in Nepal. Dr. Acharya has not yet reached the summit, but his pioneering work is dramatically expanding mental health services in Nepal. He and his colleagues are spearheading efforts to educate primary care providers so that they can better recognize and treat common mental disorders. They are expanding services in community settings where mental health services were previously absent, and step by step, they are closing the mental health treatment gap in Nepal.
Mental health care in Nepal is similar to many other low-income countries – paltry budgets, weak infrastructure and a fledgling workforce. But Dr. Acharya and his colleagues are on a mission. Foolhardy? Wishful thinking? Let’s remember that in 1953, the world thought New Zealander Edmund Hillary and Nepalese Tenzing Norgay had lost their minds when they set out to summit Mount Everest. The rest is history.