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

Brenman NF, Luitel NP, Mall S, Jordans MJ - BMC Int Health Hum Rights (2014)

Bottom Line: 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.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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Transcultural Psychosocial Organization (TPO), Baluwatar Kathmandu, Nepal. luitelnp@gmail.com.

ABSTRACT

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.

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Related in: MedlinePlus

Theory of change map as a framework for data analysis.
© Copyright Policy - open-access
Related In: Results  -  Collection

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Figure 1: Theory of change map as a framework for data analysis.

Mentions: FigureĀ 1 shows the section of the ToC that is relevant to demand and access. This illustrates the basic conceptual framework for the findings: influences on demand and access at community and health facility levels, and strategies to improve demand and access at community and health facility levels. The use of the ToC to guide data analysis is a novel means to link formative research to the design and implementation of such a programme.


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

Brenman NF, Luitel NP, Mall S, Jordans MJ - BMC Int Health Hum Rights (2014)

Theory of change map as a framework for data analysis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4126616&req=5

Figure 1: Theory of change map as a framework for data analysis.
Mentions: FigureĀ 1 shows the section of the ToC that is relevant to demand and access. This illustrates the basic conceptual framework for the findings: influences on demand and access at community and health facility levels, and strategies to improve demand and access at community and health facility levels. The use of the ToC to guide data analysis is a novel means to link formative research to the design and implementation of such a programme.

Bottom Line: 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.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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Transcultural Psychosocial Organization (TPO), Baluwatar Kathmandu, Nepal. luitelnp@gmail.com.

ABSTRACT

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.

Show MeSH
Related in: MedlinePlus