Partnerships in mental healthcare service delivery in low-resource settings: developing an innovative network in rural Nepal

Bibhav Acharya, Duncan Maru, Ryan Schwarz, David Citrin, Jasmine Tenpa, Soniya Hirachan, Madhur Basnet, Poshan Thapa, Sikhar Swar, Scott Halliday, Brandon Kohrt, Nagendra P. Luitel, Erick Hung, Bikash Gauchan, Rajeev Pokharel, Maria Ekstrand

Mental illnesses are the largest contributors to the global burden of non-communicable diseases. However, there is extremely limited access to high quality, culturally-sensitive, and contextually-appropriate mental healthcare services. This situation persists despite the availability of interventions with proven efficacy to improve patient outcomes. A partnerships network is necessary for successful program adaptation and implementation. We describe our partnerships network as a case example that addresses challenges in delivering mental healthcare and which can serve as a model for similar settings. Our perspectives are informed from integrating mental healthcare services within a rural public hospital in Nepal. Our approach includes training and supervising generalist health workers by off-site psychiatrists. This is made possible by complementing the strengths and weaknesses of the various groups involved: the public sector, a non-profit organization that provides general healthcare services and one that specializes in mental health, a community advisory board, academic centers in high- and low-income countries, and bicultural professionals from the diaspora community. We propose a partnerships model to assist implementation of promising programs to expand access to mental healthcare in low- resource settings. We describe the success and limitations of our current partners in a mental health program in rural Nepal.