There is long history of using social sciences theory and methods in the fields of health and development to examine a range of public health issues in Nepal. Anthropologists have used interdisciplinary approaches to make public health interventions more culturally relevant in community settings[1-3]. However, there is a lack of systematic approaches to identify and address barriers to development and uptake of community-based mental health and psychosocial programs [4].
This formative study aims to qualitatively identify resources, challenges, and potential barriers to development and implementation of culturally adapted community-based mental health programs in accordance with the mental health Gap Action Programme (mhGAP) for persons with severe mental disorders and epilepsy. Focus group discussions (n=9) and key informant interviews (n=26) were conducted in the community including key policy makers, health workers, service users, community leaders and traditional healers. Purposive and snowball sampling techniques were used to recruit participants. The coding structure included a priori themes based on the study objectives. Grounded theory was used to code emergent themes and analyses was conducted using the Framework Analysis Method [5].
The study led to a range of recommendations for the adaptation and implementation of community mental health programs. This included duration of mental health trainings, content for myths and facts related to mental health and treatment, availability of psychotropic medication, government medication policies, selection of community resource persons and using technology to support integration of mental health services into existing health systems with an ultimate aim to narrow the treatment gap in the sector of mental health in Nepal.
Reference:
1. Harper, I., Interconnected and interinfected: DOTS and the stabilisation of the tuberculosis control programme in Nepal. The aid effect: Giving and governing in international development, 2005: p. 126-149.
2. Pigg, S.L., The Politics of Development and the Politics of Health : Contradictions of AIDS Prevention in Nepal. Feminist Political Economy – Marie – France Labrecque, 2011: p. 1-24.
3. Justice, J., Policies, Plans, & People. Foreign Aid and Health Development, Berkeley. 1986, Los Angeles: University of California Press.
4. Jordans, M.J.D., et al., Setting priorities for mental health care in Nepal: a formative study. BMC psychiatry, 2013. 13(1): p. 332.
5. Lacey, A. and D. Luff, Qualitative data analysis. 2001: Trent Focus Sheffield.