From Trauma to Treatment: Bridging Nepal's Himalayan-Sized Mental Health Gap

From Trauma to Treatment: Bridging Nepal's Himalayan-Sized Mental Health Gap | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review From Trauma to Treatment: Bridging Nepal's Himalayan-Sized Mental Health Gap Nawa Raj Subba This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8440414/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: The primary objective of this paper is to review the systemic and societal basis of a massive mental treatment gap in Nepal and propose a shift in the paradigm of public healthcare to address this gap. Design: This review paper consists of a methodological literature review performed using peer-reviewed literature, governmental documents, and published policies that were written during the interval of 2005-2023. Setting: Nepal, a least developed country of South Asia, faces the challenges that are caused by post-conflict, natural disasters, impact of the pandemic, as well as massive migrant labor outflows. Main outcome measures: The study measured key mental health indicators: disorder prevalence, service coverage, treatment gaps, workforce density, budget allocation, and policy status. Results: Nepal has a treatment gap rate of over 90%. This is attributable to a syndemic of trauma because of conflict and disasters and migration. Systemic barriers encompass acute lack of human resources (0.22 psychiatrists/100,000), unreliability of drugs supply, and inadequately funded services that are below 1 percent of the health budget. In this context, care-seeking pathways for traditional healers and biomedical services are distinct, shaped by differing cultural beliefs and experiences of stigma. Although innovations relying on evidence, including task-shifting to community health workers and digital tools, have proven effective, they are limited to pilot projects because of the lack of funds and political will. The Mental Health Act of 2017 has no implementation and funding. Conclusions: In Nepal, mental health is an important part of the country's stability, unity, and fair growth as well as a public health problem. The paper argues that to bridge this divide will require a transformative shift away from an academic clinical model toward an emergent public mental health mission. This involves making guidelines work, investing in the future, sharing more tasks, using digital tools, and starting national prevention campaigns. Psychiatry Health Policy Health Economics & Outcomes Research Mental health Nepal treatment gap post-conflict disaster migration stigma health systems mental health policy public health. Full Text Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8440414","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":565090289,"identity":"aec6af28-230c-4e67-b76c-a9463850735f","order_by":0,"name":"Nawa Raj Subba","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA80lEQVRIiWNgGAWjYDCCA0DM2HCAgZ+Zsf3DByCHjZ1YLZLtzW2MM0BamInVYnDmeBszD0iEkBa+2weYP/PuuCPPcCOx7bHNr23yfMwMjB8+5uDWInkugU2a98wzw8YZie3GuX23DduYGZglZ27DrcXgDNDxvG2HGZslEhukc3tuMwK1AEXwawE6rO2wfRtIi2XPbXtitDBIA7Uk9vAcbJNm+HE7kaAWyTOMbZJzzzxLnsHe2GzY23A7uY2ZsRmvX/jOMB/+8HbHHdv9h9kfPvjx57bt/Pbmgx8+4tECihQkdhu6CGHwhxTFo2AUjIJRMFIAADKFV9vX6vy2AAAAAElFTkSuQmCC","orcid":"https://orcid.org/0000-0001-5700-2179","institution":"Nepal Public Health Association","correspondingAuthor":true,"prefix":"","firstName":"Nawa","middleName":"Raj","lastName":"Subba","suffix":""}],"badges":[],"createdAt":"2025-12-24 08:07:24","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-8440414/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8440414/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":99315626,"identity":"5ceeb1e4-1ff8-4977-abfb-392b07fedd5a","added_by":"auto","created_at":"2025-12-31 16:27:09","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":245702,"visible":true,"origin":"","legend":"","description":"","filename":"FromTraumatoTreatment.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8440414/v1_covered_73e32502-e8f3-40a2-8a7c-37fc9c16df79.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eFrom Trauma to Treatment: Bridging Nepal's Himalayan-Sized Mental Health Gap\u003c/strong\u003e\u003c/p\u003e","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Nepal Public Health Association","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Mental health, Nepal, treatment gap, post-conflict, disaster, migration, stigma, health systems, mental health policy, public health.","lastPublishedDoi":"10.21203/rs.3.rs-8440414/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8440414/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eObjective: The primary objective of this paper is to review the systemic and societal basis of a massive mental treatment gap in Nepal and propose a shift in the paradigm of public healthcare to address this gap.\u003c/p\u003e\n\u003cp\u003eDesign: This review paper consists of a methodological literature review performed using peer-reviewed literature, governmental documents, and published policies that were written during the interval of 2005-2023.\u003c/p\u003e\n\u003cp\u003eSetting: Nepal, a least developed country of South Asia, faces the challenges that are caused by post-conflict, natural disasters, impact of the pandemic, as well as massive migrant labor outflows.\u003c/p\u003e\n\u003cp\u003eMain outcome measures: The study measured key mental health indicators: disorder prevalence, service coverage, treatment gaps, workforce density, budget allocation, and policy status.\u003c/p\u003e\n\u003cp\u003eResults: Nepal has a treatment gap rate of over 90%. This is attributable to a syndemic of trauma because of conflict and disasters and migration. Systemic barriers encompass acute lack of human resources (0.22 psychiatrists/100,000), unreliability of drugs supply, and inadequately funded services that are below 1 percent of the health budget. In this context, care-seeking pathways for traditional healers and biomedical services are distinct, shaped by differing cultural beliefs and experiences of stigma. Although innovations relying on evidence, including task-shifting to community health workers and digital tools, have proven effective, they are limited to pilot projects because of the lack of funds and political will. The Mental Health Act of 2017 has no implementation and funding.\u003c/p\u003e\n\u003cp\u003eConclusions: In Nepal, mental health is an important part of the country's stability, unity, and fair growth as well as a public health problem. 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