Prioritizing mental health of children is our collective responsibility

     

Dr Arun Raj Kunwar
UNI229978
NICEF/UNI229978/Prasad Ngakhusi
09 December 2021

Worldwide, an estimated 20 per cent of children suffer from mental health issues which require treatment. In Nepal, a 2020 National Mental Health Survey found that more than 4 per cent of the country’s 29 million inhabitants had a mental illness, including more than 5 per cent of children aged 13 to 18.

This troubling situation was worsened by COVID-19. The pandemic placed significant additional stress on children who were forced to stay home for more than a year, fearful for their health as well as their families’, and worried about their education and livelihood. A significant number of children lost parents and loved ones to the pandemic.

Since the beginning of the pandemic, there has been an increase in the number of suicides. There has also been increased demand for mental health services even though access to services was more limited due to the lockdown and limitations on people’s mobility.

Over the last decade, Nepal has nonetheless seen significant progress in the provision of child and adolescent mental health care services. In 2015, a collaboration between CWIN, a child rights organization, and the Government of Nepal led to the establishment of a full-time Child and Mental Health (CAMH) unit at Kanti Children's Hospital. This unit provides the country’s only specialist outpatient child mental health services and is in the process of establishing inpatient services for the first time. Last year, the unit provided care to more than 4,000 children.

The unit has also developed what is thought to be the first package of interventions designed to address the mental health needs of children and adolescents at the community level. This programme has been piloted and is presently being scaled up in several municipalities.

In response to the pandemic, the team at Kanti Children’s Hospital developed guidance for managing COVID-related stress among children and adolescents. Over 100 counselors have received online training, and over the past year, more than 60,000 children and adolescents and caregivers received mental health support.

Since most children and adolescents were not able to visit the Kanti Hospital unit due to the lockdown, the clinic opened a toll-free helpline and started online consultations. This made it much easier for children and adolescents living outside Kathmandu Valley to receive mental health care. 

However, such positive developments are a drop in the ocean compared to the needs. Children and adolescents make up more than 40 per cent of Nepal’s population, and between 10 and 20 per cent of them suffer from some form of emotional and behavioural problems. Yet only a small number are getting the care they need. To date, apart from the team at Kanti hospital, there is only one full time CAMH unit in the country, and less than 10 specialist mental health professionals. Most Nepalese are unaware of children’s and adolescents’ mental health needs. The funding allocated by the Government to mental health services is limited and almost negligible in the case of children and adolescents. 

The priority going forward is to increase the number of staff trained in child and adolescent mental health, and to develop more specialized centres. Community mental health programmes for early diagnosis and treatment are also required. Since a significant proportion of the population lives in remote areas, new technologies and video consultations will be essential to ensure they are able to access the services they need.

Continued advocacy to promote awareness of children’s mental health in society is vital. The Government recently adopted a National Mental Health Strategy and Action Plan. It will be important to follow its implementation and work continuously with the Government to expand mental health services for children and adolescents.

 

By  Dr Arun Raj Kunwar, Child and Adolescent Psychiatrist, Kanti Children’s Hospital, Kathmandu