Abstract
BackgroundDespite the availability of evidence-based treatment, there is a substantial gap between the number of individuals in need of mental health care and those who receive treatment. The aim of this study was to assess changes in treatment coverage and barriers to mental health care among adults with depression and alcohol use disorder (AUD) before and after implementation of a district mental health care plan (MHCP) in Nepal.MethodsThe repeat population-based cross-sectional community survey was conducted with randomly selected adults in the baseline (N = 1983) and the follow-up (N = 1499) surveys, 3 years and 6 months apart. The Patient Health Questionnaire and Alcohol Use Disorder Identification Test were used to screen people with probable depression and AUD. Barriers to seeking mental health care were assessed by using a standardized tool, the Barriers to Care Evaluation Scale (BACE).ResultsThe proportion of the participants receiving treatment for depression increased by 3.7 points (from 8.1% in the baseline to 11.8% in the follow-up) and for AUD by 5.2 points (from 5.1% in the baseline to 10.3% in the follow-up study), however, these changes were not statistically significant. There was no significant reduction in the overall BACE score in both unadjusted and adjusted models for both depression and AUD. The possible reasons for non-significant changes in treatment coverage and barriers to care could be that (i) the method of repeat population level surveys with a random sample was too distal to the intervention to be able to register a change and (ii) the study was underpowered to detect such changes.ConclusionThe study found non-significant trends for improvements in treatment coverage and barriers to mental health care following implementation of the district mental health care plan. The key areas for improvement in the current strategy to improve treatment coverage and barriers to mental health care included change in the content of the existing community sensitization program, particularly for changing attitude and intention of people with mental illness for seeking care.
Highlights
Despite the availability of evidence-based treatment, there is a substantial gap between the number of individuals in need of mental health care and those who receive treatment
Mental health services are restricted to a few hospitals located in big cities in Nepal; in Chitwan, mental health services are available in the district hospital and private medical colleges operating in the district
Studies conducted in 10 Low and middle income countries (LMIC) as a part of World Health Organization (WHO) world mental health survey initiatives reported that 52.6% of people with a need for depression care had contacted any service provider in the past 12 months [32]
Summary
Despite the availability of evidence-based treatment, there is a substantial gap between the number of individuals in need of mental health care and those who receive treatment. The aim of this study was to assess changes in treatment coverage and barriers to mental health care among adults with depression and alcohol use disorder (AUD) before and after implementation of a district mental health care plan (MHCP) in Nepal. There is an increasing evidence base of cost-effective interventions for mental health problems, it is reported that more than half (56%) of people with depression [7] and 87% people with alcohol abuse and dependence do not receive any treatment [8]. A recent study conducted among adults in Chitwan district (southern Nepal), reported a very large treatment gap for depression (91.5%) and alcohol use disorder (94.9%) [18]. The most commonly reported barriers to treatment were inability to afford care, fear of being perceived as weak for having mental health problems, fear of being perceived as crazy and being too unwell to ask for support [14]
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