The recently published full text of the Supreme Court’s December 2 verdict has ordered the government to undertake an overhaul of the nation’s mental health policy and services.

The court had issued the verdict acting on a Public Interest Litigation filed by Koshish, an NGO working on mental health. It said the government had neglected mental health issues and failed to implement existing policies, including the National Mental Health Policy (2053 BS).

The top court’s directive concerns budgetary commitment, enactment of mental health legislation, development of multidisciplinary workforces, awareness against stigma and discrimination, integration of people with mental health issues in the communities, and promotion of alternative therapies, among others.

But the ministry has neither the budget nor a trained workforce to implement the court’s order in the current fiscal year, officials at the Ministry of Health and Population said.

What they can do is bifurcate the Non-communicable Disease and Mental Health Section of the Epidemiology and Disease Control Division.

“We have a five-member workforce at the Non-communicable Disease and Mental Health Section,” said Dr Pomawati Thapa, chief of the section. “Three staff can serve in one section and two in the other.”

Of late, both mental health and non-communicable diseases have been emerging as major public health burdens in Nepal. Despite the rise in cases of mental health and non-communicable diseases, the five-member team has been working to address the problems with a shoestring budget.

Moreover, the government has lowered the budget ceiling for the section for the upcoming fiscal year.

“We had around Rs47 million to spend in the current fiscal year, but for the next fiscal year 2025-26, we are given a ceiling of Rs35 million,” said Thapa. “Guess what we can do to address the growing burden of mental health and non-communicable diseases with that amount.”

Thapa added, “A huge amount of human and financial resources is required to implement the SC order, which is impossible immediately.”

A study carried out by the Nepal Health Research Council in the past shows that about 13 percent of Nepalis suffer from some form of mental disorder. This means around one in eight Nepalis have mental health issues. Many seek help first at nearby health facilities, but due to the lack of basic infrastructure and trained human resources, among others, patients often face discrimination, stigma, and even humiliation.

Likewise, non-communicable diseases—hypertension, diabetes, renal disease, liver problems, heart problems, and cervical cancer, among others—have emerged as major killers in recent years, accounting for around 71 percent of total deaths.

According to a 2019 study on the prevalence of non-communicable diseases by the Nepal Health Research Council, 71 percent of total deaths at the time were due to non-communicable diseases, and an additional eight percent were linked to injuries.

A recent report published in The Lancet, a leading international medical journal, warned that half of Nepal’s adult population will be overweight or obese by 2050.

Officials say they have requested the Department of Health Services to deploy doctors who pursued a medical degree under the government scholarship programme, and those who have not received a posting for a long time, to the planned mental health and non-communicable disease section to address the staff crunch.

The court had issued comprehensive directives, including revising the National Mental Health Policy of 1996 and introducing a new inclusive mental health policy.

As per the directive, issued by a joint bench of Supreme Court justices Hari Prasad Phuyal and Nripa Dhwaj Niraula, the government must gradually increase investment in mental health through annual allocation, based on a detailed assessment of existing challenges, and enactment of new law ensuring parity between mental and physical health.

Likewise, the court directs the deployment of multidisciplinary teams of psychiatrists, psychologists, psychiatric nurses, social workers, and psychotherapists across federal, provincial, and district-level hospitals. The court has also ordered the incorporation of mental health services into community health programmes, health insurance, disability certification, and employee services, ensuring broad reach and long-term support.

Additionally, public awareness campaigns must be launched to deal with stigma, with legal penalties for acts of discrimination or abuse against individuals with mental health conditions. The Supreme Court has also directed individuals currently dependent on institutional care to be reintegrated into families and communities through community-based rehabilitation, which includes ensuring access to social security and self-employment opportunities.

The court order also includes promoting Ayurveda and Yoga for holistic careers and complementary support for mental well-being.

Meanwhile, experts on mental health say that even if the government has numerous responsibilities and budget limitations, it cannot ignore the order.

“Although mental health issues are serious public health problems, our policies and programmes did not come accordingly,” said Dr Basudev Karki, a mental health expert. The court order has encouraged policymakers and government officials to take mental health care as a constitutional right and implement the programme accordingly, he added.