Building back better? Taking stock of the post-earthquake mental health and psychosocial response in Nepal

Abstract

BackgroundThe World Health Organization’s ‘building back better’ approach advocates capitalizing on the resources and political will elicited by disasters to strengthen national mental health systems. This study explores the contributions of the response to the 2015 earthquake in Nepal to sustainable mental health system reform.MethodsWe systematically reviewed grey literature on the mental health and psychosocial response to the earthquake obtained through online information-sharing platforms and response coordinators (168 documents) to extract data on response stakeholders and activities. More detailed data on activity outcomes were solicited from organizations identified as most active in the response. To triangulate and extend findings, we held a focus group discussion with key governmental and non-governmental stakeholders in mental health system development in Nepal (n = 10). Discussion content was recorded, transcribed, and subjected to thematic analysis.ResultsWhile detailed documentation of response activities was limited, available data combined with stakeholders’ accounts suggest that the post-earthquake response accelerated progress towards national mental health system building in the areas of governance, financing, human resources, information and research, service delivery, and medications. Key achievements in the post-earthquake context include training of primary health care service providers in affected districts using mhGAP and training of new psychosocial workers; appointment of mental health focal points in the government and World Health Organization Country Office; the addition of new psychotropic drugs to the government’s free drugs list; development of a community mental health care package and training curricula for different cadres of health workers; and the revision of mental health plans, policy, and financing mechanisms. Concerns remain that government ownership and financing will be insufficient to sustain services in affected districts and scale them up to non-affected districts.ConclusionsBuilding back better has been achieved to varying extents in different districts and at different levels of the mental health system. Non-governmental organizations and the World Health Organization Country Office must continue to support the government to ensure that recent advances maximally contribute to realising the vision of a national mental health care system in Nepal.

Mental health initiative after the 2015 disaster in Nepal

“…A recent study after the 2015 earthquake on post-earthquake MHPSS responses in Nepal suggested that the activities had extraordinarily improved the process of building mental health system in Nepal. 24 The funding for mental health from the government and NGOs increased remarkably after the earthquake which was almost non-existent previously. The MOHP, with the support from the WHO and other NGOs, helped in establishing a coordinated response and reporting systems for MHPSS.…”

“…MHPSS was included in the comprehensive disaster response teams at all 14 severely affected districts in Nepal during the recovery period. 24 Immediately after the earthquake, the government had declared a state emergency and called for international and national support which helped in increasing the global attention as well as in resources to provide immediate MHPSS. The immediate disaster response after the earthquake followed the IASC guideline on cluster approach and included different areas such as basic support for nutrition, health, water and sanitation, and shelter, etc.…”

“…22 In the early recovery to late recovery phases, the key NGOs working in mental health helped in increasing the pool of primary health care providers trained in mental health treatment by two-fold. 24 These NGOs also worked together with the government to train the female community health volunteers and other volunteers at the grassroots level on psychological first aid, reaching out to thousands of people in the communities. 24 The comprehensive disaster response had also strengthened the health system by establishing a standard referral mechanism for specialized care, and enabling regular supervision of the MHPSS programs by the mental health professionals which were also in line with the SDG targets of reducing the gaps for mental health care.…”

“…24 These NGOs also worked together with the government to train the female community health volunteers and other volunteers at the grassroots level on psychological first aid, reaching out to thousands of people in the communities. 24 The comprehensive disaster response had also strengthened the health system by establishing a standard referral mechanism for specialized care, and enabling regular supervision of the MHPSS programs by the mental health professionals which were also in line with the SDG targets of reducing the gaps for mental health care. 24 Though some of the activities were initiated on an ad-hoc basis, 22 the coordination improved gradually during the recovery period leading to some long-lasting impact on building the mental health system in Nepal.…”

“…24 The comprehensive disaster response had also strengthened the health system by establishing a standard referral mechanism for specialized care, and enabling regular supervision of the MHPSS programs by the mental health professionals which were also in line with the SDG targets of reducing the gaps for mental health care. 24 Though some of the activities were initiated on an ad-hoc basis, 22 the coordination improved gradually during the recovery period leading to some long-lasting impact on building the mental health system in Nepal. 24 Indeed, all actions were in line with the SDG targets of reducing the gaps for mental health care.…”