Stakeholders have said that despite the ongoing debate on mental health from parliament to the streets, most citizens with mental health problems in Nepal remain out of reach of treatment due to the lack of separate laws, adequate services, and budget.

In the House of Representatives, lawmakers have raised mental health as a serious public health challenge and drawn the government's attention to its legal and institutional management. MP Jagdish Kharel said that out of a population of about 30 million, about 7 million Nepalis will experience some kind of mental health problem in their lifetime, and that about 25 percent of citizens will be affected by such problems at some point in their lives.

MP KP Khanal said that the incidence of depression, anxiety, and suicide is increasing, and mental health services are still limited, unequal, and concentrated in the federal capital. He opined that mental health should be viewed not only as an issue related to disease but also as a matter related to biological, psychological, and social aspects.

According to the National Mental Health Survey 2020 of the Nepal Health Research Council, one in every 10 adults in Nepal has experienced some kind of mental health problem in their lifetime. During the survey period, 4.33 percent of adults were experiencing mental health problems. This means that the same or more people may be experiencing such problems even now.

The problem is not only in adults, but 5.2 percent of children in the age group of 13 to 17 years have been found to have mental health problems. In fact, anyone, be it children or adults, can have mental health problems, but if they are managed in time, the complex situations caused by this can be minimized.

If the problem is not identified and managed properly, the problem can reach a serious stage. The number of people seeking advice and treatment for mental health problems is increasing in the city market. People have also started going to psychiatrists or counselors when problems like depression or anxiety appear. The number of patients coming to hospitals in easily accessible locations, including mental hospitals Lagankhel and Tribhuvan University Teaching Hospital, is increasing. But ironically, due to the lack of adequate treatment services and sufficient awareness across the country, 80 percent of citizens with mental health problems still do not have access to health services.

According to experts, if mental health problems are identified and managed in time, the complexity can be reduced. But due to inadequate services, public awareness and social stigma, about 80 percent of patients are deprived of treatment.

Senior psychiatrist Dr. Ananta Adhikari said that despite the expansion of services, access is not proportional, acceptance of services is low and many patients do not reach treatment due to social stigma. He mentioned that the manpower and structure of mental health services in central hospitals like Bir Hospital are not sufficient.

Nepal does not have a separate Mental Health Act yet. Even though the government introduced a national mental health policy in 2053 BS, the expected progress has not been made. Although the draft of the act has been prepared, it is stuck in the Ministry of Health and Population.

Senior psychiatrist Dr. Saroj Ojha said that the enactment of the Mental Health Act will increase state investment, provide a clear legal definition of mental illness and help remove confusion among the public.

The Ministry of Health also says that multi-dimensional support is needed to reduce mental health problems. Although the resources are limited at present, the ministry is active in how to utilize them. Sameer Kumar Adhikari, joint spokesperson of the Ministry of Health, said that mental health has been prioritized under the Non-Communicable Diseases Program and efforts are being made to expand the service by making maximum use of the available resources. However, he admitted that more manpower and resources are needed.

The Supreme Court had issued a mandate in the name of the government to establish the necessary structures at the federal, provincial and local levels to effectively implement mental health services. The order issued in 2081 Mangsir stated that a separate mental health division would be established under the Ministry of Health and Population, a mental health unit would be formed at the provincial level, and a contact person would be appointed at the district hospital and district public health office at the local level to bring the service into operation.

The court had set a time limit of six months to implement the service, and it has been two years since then. But so far, the Ministry of Health has not done anything, including establishing the mental health division, as per the Supreme Court's order. Moreover, there has been no readiness to revise the policy. Therefore, it is too late to make separate and special legal provisions and bring access to treatment and counseling to those struggling with mental health problems.