Challenges of setting up psychiatric services in Nepal: Lessons from the first year of Janakpur Project.

In Nepal psychiatric services outside big cities are virtually non-existent. This paper reports the observations and findings of a mental health project jointly run by private and voluntary sector organisations at Janakpur in southeast Nepal. The services included monthly outpatient clinics, day care, home visits and psychiatric training for medical students. At the monthly clinic, altogether 396 patients attended the service in 2009: a high proportion had psychoses (30% schizophrenia and 25% bipolar disorder); most (54%) were young; they came mainly from rural areas. Medical students also benefited from the clinical exposure, but the intake of the day care service was poor. The overall success of the innovative project shows how low-cost basic psychiatric services can be delivered in Nepal by private and voluntary sectors in the absence of state health care system.