Demand and access to mental health services: a qualitative formative study in Nepal

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dc.contributor.authorBrenman, Natassiaen_ZA
dc.contributor.authorLuitel, Nagendraen_ZA
dc.contributor.authorMall, Sumayaen_ZA
dc.contributor.authorJordans, Marken_ZA
dc.date.accessioned2015-11-27T09:29:12Z
dc.date.available2015-11-27T09:29:12Z
dc.date.issued2014en_ZA
dc.description.abstractBACKGROUND: Nepal is experiencing a significant 'treatment gap' in mental health care. People with mental disorders do not always receive appropriate treatment due to a range of structural and individual issues, including stigma and poverty. The PRIME (Programme for Improving Mental Health Care) programme has developed a mental health care plan to address this issue in Nepal and four other low and middle income countries. This study aims to inform the development of this comprehensive care plan by investigating the perceptions of stakeholders at different levels of the care system in the district of Chitwan in southern Nepal: health professionals, lay workers and community members. It focuses specifically on issues of demand and access to care, and aims to identify barriers and potential solutions for reaching people with priority mental disorders. METHODS: This qualitative study consisted of key informant interviews (33) and focus group discussions (83 participants in 9 groups) at community and health facility levels. Data were analysed using a framework analysis approach. RESULTS: As well as pragmatic barriers at the health facility level, mental health stigma and certain cultural norms were found to reduce access and demand for services. Respondents perceived the lack of awareness about mental health problems to be a major problem underlying this, even among those with high levels of education or status. They proposed strategies to improve awareness, such as channelling education through trusted and respected community figures, and responding to the need for openness or privacy in educational programmes, depending on the issue at hand. Adapting to local perceptions of stigmatised treatments emerged as another key strategy to improve demand. CONCLUSIONS: This study identifies barriers to accessing care in Nepal that reach beyond the health facility and into the social fabric of the community. Stakeholders in PRIME's integrated care plan advocate strategic awareness raising initiatives to improve the reach of integrated services in this low-income setting.en_ZA
dc.identifier.apacitationBrenman, N., Luitel, N., Mall, S., & Jordans, M. (2014). Demand and access to mental health services: a qualitative formative study in Nepal. <i>BMC International Health and Human Rights</i>, http://hdl.handle.net/11427/15377en_ZA
dc.identifier.chicagocitationBrenman, Natassia, Nagendra Luitel, Sumaya Mall, and Mark Jordans "Demand and access to mental health services: a qualitative formative study in Nepal." <i>BMC International Health and Human Rights</i> (2014) http://hdl.handle.net/11427/15377en_ZA
dc.identifier.citationBrenman, N. F., Luitel, N. P., Mall, S., & Jordans, M. J. (2014). Demand and access to mental health services: a qualitative formative study in Nepal. BMC international health and human rights, 14(1), 22.en_ZA
dc.identifier.ris TY - Journal Article AU - Brenman, Natassia AU - Luitel, Nagendra AU - Mall, Sumaya AU - Jordans, Mark AB - BACKGROUND: Nepal is experiencing a significant 'treatment gap' in mental health care. People with mental disorders do not always receive appropriate treatment due to a range of structural and individual issues, including stigma and poverty. The PRIME (Programme for Improving Mental Health Care) programme has developed a mental health care plan to address this issue in Nepal and four other low and middle income countries. This study aims to inform the development of this comprehensive care plan by investigating the perceptions of stakeholders at different levels of the care system in the district of Chitwan in southern Nepal: health professionals, lay workers and community members. It focuses specifically on issues of demand and access to care, and aims to identify barriers and potential solutions for reaching people with priority mental disorders. METHODS: This qualitative study consisted of key informant interviews (33) and focus group discussions (83 participants in 9 groups) at community and health facility levels. Data were analysed using a framework analysis approach. RESULTS: As well as pragmatic barriers at the health facility level, mental health stigma and certain cultural norms were found to reduce access and demand for services. Respondents perceived the lack of awareness about mental health problems to be a major problem underlying this, even among those with high levels of education or status. They proposed strategies to improve awareness, such as channelling education through trusted and respected community figures, and responding to the need for openness or privacy in educational programmes, depending on the issue at hand. Adapting to local perceptions of stigmatised treatments emerged as another key strategy to improve demand. CONCLUSIONS: This study identifies barriers to accessing care in Nepal that reach beyond the health facility and into the social fabric of the community. Stakeholders in PRIME's integrated care plan advocate strategic awareness raising initiatives to improve the reach of integrated services in this low-income setting. DA - 2014 DB - OpenUCT DO - 10.1186/1472-698X-14-22 DP - University of Cape Town J1 - BMC International Health and Human Rights LK - https://open.uct.ac.za PB - University of Cape Town PY - 2014 T1 - Demand and access to mental health services: a qualitative formative study in Nepal TI - Demand and access to mental health services: a qualitative formative study in Nepal UR - http://hdl.handle.net/11427/15377 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/15377
dc.identifier.urihttp://dx.doi.org/10.1186/1472-698X-14-22
dc.identifier.vancouvercitationBrenman N, Luitel N, Mall S, Jordans M. Demand and access to mental health services: a qualitative formative study in Nepal. BMC International Health and Human Rights. 2014; http://hdl.handle.net/11427/15377.en_ZA
dc.language.isoengen_ZA
dc.publisherBioMed Central Ltden_ZA
dc.publisher.departmentCentre for Public Mental Healthen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an Open Access article distributed under the terms of the Creative Commons Attribution Licenseen_ZA
dc.rights.holder2014 Brenman et al.; licensee BioMed Central Ltd.en_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/2.0en_ZA
dc.sourceBMC International Health and Human Rightsen_ZA
dc.source.urihttp://www.biomedcentral.com/bmcinthealthhumrights/en_ZA
dc.subject.otherNepalen_ZA
dc.subject.othertreatment gapen_ZA
dc.subject.othermental health careen_ZA
dc.titleDemand and access to mental health services: a qualitative formative study in Nepalen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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