From stigma to care: Transforming mental health services in rural Nepal

When a frightened teenage girl exhibiting symptoms such as sudden body stiffening, loss of consciousness and memory lapses was brought to Uttarganga Health Post in Birendranagar Municipality, Surkhet, her family believed she was “possessed” by supernatural forces.

In the community, fear had given way to stigma, and few knew how to help her. At the health post, however, Jamuna Bhandari, an auxiliary health worker listened patiently as the girl described her fears and symptoms.

“I realized she was experiencing a convulsive disorder,” Jamuna recalls. Through careful counselling, she helped the girl receive proper care, something that might not have been possible before Jamuna’s training in the Mental Health Gap Action Programme (mhGAP).

Jamuna is one of dozens of frontline workers across Karnali and Sudurpashchim Provinces now better equipped to identify and support people facing mental distress, following targeted training supported by the Ministry of Health and Population (MoHP), WHO Country Office for Nepal and The European Commission.

To address long-standing gaps in mental health care, the Epidemiology and Disease Control Division (EDCD), under MoHP, launched the project “Integrating Mental Health into Health Systems and Services of Karnali and Sudurpashchim Province” with technical support from WHO. The initiative strengthens the ability of provincial systems to detect, respond to and care for people with mental health conditions, particularly during emergencies.

A key achievement of the project has been the integration of mental health and psychosocial support (MHPSS) into provincial emergency preparedness. With WHO’s guidance, both provinces are finalizing Standard Operating Procedures (SOPs) to ensure that mental health care is embedded in disaster response, rather than treated as an afterthought. MHPSS activities are now also being included in annual health plans, an important step toward long-term sustainability.

Jamuna Bhandari, an Auxiliary Health Worker, providing guided breathing exercises to a patient to support anxiety reduction at Uttarganga Health Post in Birendranagar Municipality, Karnali Province. Photo credit: WHO Nepal

“In these remote districts, communities face hurdles like distance, difficult roads and lack of trained human resources to get the needed health service. Now, it’s time to think health in broader concept including physical, mental and social aspects. In our society often mental health is overshadowed by physical health, so holistic approach is needed especially focusing on NCD due to its increasing burden,” said Dr Roshan Neupane, EDCD Director.

At the service-delivery level, WHO has trained health workers from health posts, primary health care centres and district hospitals of selected districts and local levels of Karnali and Sudurpashchim Provinces to identify and manage common mental health conditions. General practitioners and paediatricians were also included in the trainings to better support children and adolescents, groups often overlooked in traditional mental health systems.

Led by a clinical psychologist and a consultant psychiatrist, the training used role-plays, simulated emergency scenarios and group discussions to build practical skills in identifying mental health conditions and responding to psychosocial needs during crises.

A total of 133 health workers have been trained between June 2024 to September 2025. They can now recognize signs of depression, anxiety, alcohol dependence and other disorders, conditions that previously went untreated or misunderstood.

Like Jamuna, Bhupendra Bhandari, a Senior Auxiliary Health Worker at Kotbara Health Post in Salyan, Karnali Province, has found the training to be transformative.

“The training changed everything for me. Now I can identify problems better, manage them properly and truly understand my patients. My confidence has grown,” he says.

mhGAP trainings held in Rukum West (left) and Salyan in Karnali province. Photo credit: TPO Nepal

A patient he will never forget is a 42-year-old man who had slipped into psychosis after a personal trauma. Isolated and distressed, he became increasingly aggressive and suicidal.

“Before the training, he might have been admitted to OPD services, given medicines and sent home. We would have never asked about his deeper mental struggles,” Bhupendra reflects.

But with his new learnings, he took the time to talk, understand the man’s emotional pain and provide counselling along with proper treatment. Over time, the man stabilized and is gradually rebuilding his life. “Now he is living normally again. This would not have been possible before,” Bhupendra says with pride.

Bhupendra has since supported other organizations to train health workers on mental health counselling, which brings his municipality closer to their goal of becoming a model municipality for mental health services.

Operationalization of a dedicated mental health care unit at the district level, with the establishment of a mental health outpatient department (OPD) at Doti District Hospital following mhGAP-based capacity-building trainings. Photo credit: TPO Nepal

In the stories shared by many frontline workers, the change is clear: conversations about mental health are no longer whispered, they are welcomed. Each story of healing, from a teenage girl in Surkhet to a lonely man in Salyan, shows how strengthened systems and empowered workers can transform lives, one community at a time.

"The heart of this initiative lies in building human capacity in Nepal,” says Dr Rajesh Sambhajirao Pandav, WHO Representative to Nepal. “In times of crisis, when communities are most vulnerable, the need becomes even greater and the prevalence of common mental disorders such as depression and anxiety are expected to more than double in a humanitarian crisis. These simple but powerful interventions are changing lives, proving that when mental health services are available locally, people recover faster and rebuild stronger."