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International Journal of Mental Health Systems
Published in: International Journal of Mental Health Systems 1/2017

Open Access 01-12-2017 | Research

Service user and care giver involvement in mental health system strengthening in Nepal: a qualitative study on barriers and facilitating factors

Authors: Dristy Gurung, Nawaraj Upadhyaya, Jananee Magar, Nir Prakash Giri, Charlotte Hanlon, Mark J. D. Jordans

Published in: International Journal of Mental Health Systems | Issue 1/2017

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Abstract

Background

Service user and caregiver involvement has become an increasingly common strategy to enhance mental health outcomes, and has been incorporated in the mental healthpolicies of many developed nations. However, this practice is non-existent or fragmented in low and middle income countries (LMICs). Instances of service user and caregiver involvement have been rising slowly in a few LMICs, but are rarely described in the literature. Very little is known about the context of user and caregiver participation in mental health system strengthening processes in a low-income, disaster- and conflict-affected state such as Nepal.

Methods

This study explores (a) the extent and experiences of service user and caregiver involvement in policy making, service planning, monitoring, and research in Nepal; (b) perceived barriers to such involvement; and (c) possible strategies to overcome barriers. Key Informant Interviews (n = 24) were conducted with service users and caregivers who were either affiliated to a mental health organization or receiving menta health care integrated within primary care. Purposive sampling was employed. Data collection was carried out in 2014 in Chitwan and Kathmandu districts of Nepal. Data analysis was carried out in NVivo10 using a framework approach.

Results

The involvement of service users affiliated to mental health organizations in policy development was reported to be ‘tokenistic’. Involvement of caregivers was non-existent. Perceived barriers to greater involvement included lack of awareness, stigma and discrimination, poor economic conditions, the centralized health system, and lack of strong leadership and unity among user organizations. Increased focus on reducing public as well as self-stigma, improved policy frameworks and initiatives, and decentralization of care are some strategies that may facilitate service user and caregiver involvement.

Conclusion

The study highlighted need for user and caregiver networks free from competing interests and priorities. Improved policy frameworks and decentralization of care may support meaningful service user and caregiver involvement.
Appendix
Available only for authorised users
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Metadata
Title
Service user and care giver involvement in mental health system strengthening in Nepal: a qualitative study on barriers and facilitating factors
Authors
Dristy Gurung
Nawaraj Upadhyaya
Jananee Magar
Nir Prakash Giri
Charlotte Hanlon
Mark J. D. Jordans
Publication date
01-12-2017
Publisher
BioMed Central
Published in
International Journal of Mental Health Systems / Issue 1/2017
Electronic ISSN: 1752-4458
DOI
https://doi.org/10.1186/s13033-017-0139-1

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