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Chase, Liana E., Marahatta, Kedar, Sidgel, Kripa, Shrestha, Sujan, Gautam, Kamal, Luitel, Nagendra P., Dotel, Bhogendra Raj and Samuel, Reuben (2018) 'Building back better? Taking stock of the post-earthquake mental health and psychosocial response in Nepal.' International Journal of Mental Health Systems, 12 (44).

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BACKGROUND: The World Health Organization’s ‘building back better’ approach advocates capitalizing on the resources and political will elicited by disasters to strengthen national mental health systems. This study explores the contributions of the response to the 2015 earthquake in Nepal to sustainable mental health system reform. // METHODS: We systematically reviewed grey literature on the mental health and psychosocial response to the earthquake obtained through online information-sharing platforms and response coordinators (168 documents) to extract data on response stakeholders and activities. More detailed data on activity outcomes were solicited from organizations identified as most active in the response. To triangulate and extend findings, we held a focus group discussion with key governmental and non-governmental stakeholders in mental health system development in Nepal (n = 10). Discussion content was recorded, transcribed, and subjected to thematic analysis. // RESULTS: While detailed documentation of response activities was limited, available data combined with stakeholders’ accounts suggest that the post-earthquake response accelerated progress towards national mental health system building in the areas of governance, financing, human resources, information and research, service delivery, and medications. Key achievements in the post-earthquake context include training of primary health care service providers in affected districts using mhGAP and training of new psychosocial workers; appointment of mental health focal points in the government and World Health Organization Country Office; the addition of new psychotropic drugs to the government’s free drugs list; development of a community mental health care package and training curricula for different cadres of health workers; and the revision of mental health plans, policy, and financing mechanisms. Concerns remain that government ownership and financing will be insufficient to sustain services in affected districts and scale them up to non-affected districts. // CONCLUSIONS: Building back better has been achieved to varying extents in different districts and at different levels of the mental health system. Non-governmental organizations and the World Health Organization Country Office must continue to support the government to ensure that recent advances maximally contribute to realising the vision of a national mental health care system in Nepal.

Item Type: Journal Article
Keywords: Disaster, Mental health systems, Nepal, Building back better, Sustainability, Mental health and psychosocial support, Intervention, Earthquake
SOAS Departments & Centres: Departments and Subunits > Department of Anthropology & Sociology
SOAS Doctoral School
ISSN: 17524458
Copyright Statement: © The Author(s) 2018. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.
DOI (Digital Object Identifier):
Date Deposited: 15 Aug 2018 07:58
Funders: Other, Other, Other

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