Integrative Approach for the Mental Health Care under the healthcare system of Nepal.

Prashant Basnet — 2024-05-28

INTRODUCTION

Mental health refers to a person's emotional, psychological, and social well-being — it involves the individual's ability to handle stress, relate to others, make decisions, and cope with the challenges of life. Equally as vital as physical health is mental health when it comes to total well-being.[1] The main objective of integrative medicine, also referred to as integrative healthcare, is to address the environmental, social, mental, emotional, physical, and spiritual aspects that affect an individual's health and well-being. It is a medical approach that combines complementary and alternative therapies with modern, conventional medicine. Integrative medicine emphasizes the therapeutic relationship between the healthcare provider and the patient and focuses on the whole person rather than just treating symptoms or diseases in isolation.[2] The approach is popular across developed countries, and its adoption is influenced by cultural, social, and healthcare system factors. Nepal being the low— and middle-income countries (LMICs) country has undergone rapid changes and development, the mental well-being of its population emerges as a critical component of overall health. The context of the COVID-19, the mental wellbeing of Nepalese citizens was highly deranged.[3] Understanding mental health within the Nepalese context requires an appreciation for the intricate balance between modern practices and traditional healing methods deeply rooted in the community's heritage.[4] There is a need for fostering collaboration between healthcare providers, community leaders, Ayurveda and yoga practitioners, and traditional healers, and a model for providing an united approach to tackle the mental health issues within the healthcare system.

Burden of Mental Health The burden of mental health disorder is increasing globally each year. In 2019, 1 in every 8 people around the world were living with a mental disorder. In 2020, the number of people living with anxiety and depressive disorders rose significantly because of the COVID-19 pandemic.[5] Mental disorders have increased by 48.1% between 1990 and 2019.[6]

As per the report published in Nepal, the prevalence rate of any form of mental disorders was found to be 12.9%. And a total of 21% of adult participants with mental disorders sought for the treatment in the last 12 months of the survey whereas around 18% received the complete treatment. The study layout common reason for not seeking any treatment to be the patient’s insistence to solve their problem on their own. There were also knowledge and awareness related barriers that prevented the participants with mental disorders in receiving the appropriate treatment.[7] Stigma against mental disorder is prevalent widely in Nepal. Even among medical students, like worldwide, in Nepal also, stigma against Psychiatry was evident in a study, where almost a quarter of them did not enter anything in the option, while more than two-thirds denied the presence of any family history.[8]

Situation of Mental Health care system

In Nepal, mental health services are provided by the psychiatry units of medical colleges, provincial government hospitals and a few private hospitals.[9] Although over 80% of Nepal’s 30 million people live in rural regions,[10] approximately 50 psychiatrists in the country are clustered largely in the major cities with 0.22 psychiatrists and 0.06 psychologists per 100,000 population.[11] The total number of in-patient psychiatric facilities is 25 and the number of beds is 500.5 Non-governmental organizations (NGOs) have played a supportive role in the delivery of mental health services in many instances. For. e.g., Centre for Victims of Torture, Nepal (CVICT), KOSHISH Nepal. [12]

While efforts are underway to expand mental health services through both governmental and non-governmental initiatives, numerous obstacles persist. These challenges include cultural factors, insufficient financial and human resources, and the absence of resilient healthcare delivery systems capable of incorporating mental healthcare services. [13] Against the backdrop of mental health receiving less than 1% of the national health budget, these challenges are pronounced.[14]

Ayurveda Healthcare System of Nepal:

The Ayurveda Government Health System has the Ayurveda Dispensaries, District Ayurveda Health Centre at the basic level. There are few hospitals with In-Patient facilities (IPD) (around 5) of Ayurveda, and few others are in the process of functioning. Psychological counseling by a clinical psychologist is currently limited to Naradevi Ayurveda Hospital. Postgraduate degree course in Ayurveda Psychiatry (MD Mano Vigyana Avum Manasa Roga) is one of the speciality degrees that Ayurveda offers, but there is no opportunity of post graduation in this subject in Nepal. The Ayurveda Health system has an ample number of doctors and health workers in both government and private health care system, who can be trained for the primary diagnosis and management of the mental disorders, which can be an asset for the overall health sector. Adding to the value of mental health care, Ayurveda itself is a holistic medicine which stresses upon balancing both body and mind. Various lifestyle modification approaches like Dinacharya, Ritucharya, Yoga and Meditation are its strength for responding to the need of mental health care.[15]

Mental Health and Integration

Contrary to the widely accepted monocausal theory of disease in the earlier half of the 20th century, western medicine and medical epidemiology are now coming to the conclusion of the multifactorial chronic disease model as a result of the emergence of non-communicable diseases and psychiatric diseases in greater proportion in the latter half of the century.[16] In this regard, traditional medical systems that emphasize lifestyle management—like Ayurveda and yoga—make a significant contribution to healthcare and open the door for Integrative Medicine (IM) methods.

Integrative Mental Health Care

Integrative mental health care is an approach that recognizes the interconnectedness of physical, emotional, mental, and spiritual well-being. It aims to address the whole person and not just a specific symptom or illness. Ayurveda and Yoga are holistic systems of medicine.

Policy evidence indicates that Integration can also be useful for decreasing the financial burden of the patients as well as the nation, by dispensing the multiple types of health services under one roof. Integrative mental health care can be more cost-effective by promoting preventative care and focusing on the whole person, integrative mental health care can reduce the need for expensive medical interventions and hospitalizations.[17]

Currently, Ayurveda health centers and hospitals in Nepal are equipped with the Panchakarma theaters (detoxifying and rejuvenation procedure), Yoga halls, and required skilled manpower as well. Lifestyle modification and purification of the body to a healthy level of weight and body functions is achievable with involvement of these systems of medicine. Proven and promising medicinal herbs for use in mental illnesses for. e.g. Ashwagandha,[18] Brahmi,[19] etc. has potential utilization at those integrative centers under the supervision of trained mental healthcare manpower for therapeutic and research purposes.

Conclusion:

Addressing the substantial burden of mental illness in low- and middle-income countries like Nepal requires effective screening and management. In a context where challenges outweigh the efforts to implement initiatives for the expansion of mental health services through both governmental and non-governmental channels, with the limited national health budget allocation to mental health, there is a proposition to systematically integrate Ayurveda into mental health care across various health system levels, from local to tertiary. This integration can increase the workforce and health delivery resources on one hand while also can decrease the stigma related to mental illness and elevate the acceptability of mental health services at another.

Nepalese Journal of Integrative Medicine

Integrative Approach for the Mental Health Care under the healthcare system of Nepal.