Abstract
BackgroundMental and substance use disorders account for 30 % of the non-fatal disease burden and 10 % of the overall disease burden but the treatment gap is daunting. With just one psychiatrist per 200,000 populations in Nepal, the only convincing way to improve access to the services quickly is by mobilizing non-specialized medical practitioner. A robust mental health component within the training curriculum of general medical doctors could produce medical graduates with adequate knowledge and skills to deliver basic mental health service. We reviewed the mental health curricula for medical students of all the medical universities in Nepal.MethodsInformation on existing mental health curricula was collected from the faculty of the respective universities with respect to content coverage, teaching methods and evaluation patterns. The mental health curricula were described in relation to teaching duration, duration of clinical rotation, duration of internship, and the relative weight of mental health in examination marks. Teaching methods were classified broadly as passive and active. Assessment methods were documented. Content coverage of the curricula was evaluated with respect to history taking and general physical examination, the priority mental health conditions, topics on behavioural sciences, and child mental health or other topics.ResultsThe duration of teaching on mental health in general medical doctor training in Nepalese medical universities ranges from 25 to 92 h. All medical universities have a relative focus on the priority mental neurological and substance use disorders. The clinical rotation on mental health is mostly two weeks, except in one university where it can be extended up to 4 weeks with an elective clinical rotation. The relative weight of summative assessment ranges from 0.21 to 2.5 % total marks of the entire training.ConclusionsConsiderable disparities exist in course content, teaching/learning modalities and assessments for mental health across Nepalese medical universities. The relative proportion of mental health in medical curricula as well as teaching/learning and assessments are far below ideal in these universities. These findings suggest a need for increasing time allocation, adopting newer teaching learning methods, and also having a mandatory clinical rotation during training and during internship.
Highlights
Mental and substance use disorders account for 30 % of the non-fatal disease burden and 10 % of the overall disease burden but the treatment gap is daunting
Since1978, when the Institute of Medicine (IoM) of Tribhuvan University (TU) started training MBBS students for the first time in Nepal [21], the number of medical schools [22] offering MBBS has grown to 20, operating under four universities: eight medical schools are affiliated to TU;10 to Kathmandu University (KU);and one each to BP Koirala Institute of Health Sciences (BPKIHS) and Patan Academy of Health Sciences (PAHS)
The duration of teaching on mental health ranges from 25 h at KU to 92 h at PAHS
Summary
Mental and substance use disorders account for 30 % of the non-fatal disease burden and 10 % of the overall disease burden but the treatment gap is daunting. The unfolding global evidence strongly supports that mental health interventions delivered at the primary care level by nonspecialist health workers are cost effective and feasible even at low resource settings [11]. Based on this evidence, the World Health Organization’s Mental Health Action Plan 2013–2020 [12] has called for integrating mental health services into primary care. Nepal’s National Mental Health Policy [10] and multisectoral strategy for the prevention and control of Non-communicable Diseases (NCDs) [13] have strategized to expand mental health services at the Primary Health Care (PHC) level
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