Mental health service readiness in Nepal: Insights from the 2021 Nepal Health Facility Survey.

Mental health conditions have risen across the world. However, evidence on the availability and readiness of mental health services in resource-poor countries like Nepal is scarce. This study examined the readiness of health facilities to deliver mental health services and factors associated with service readiness in Nepal. The study used data from the 2021 Nepal Health Facility Survey (n = 394 health facilities offering mental health services). Aligning with the WHO's Service Availability and Readiness Assessment framework, the mental health service readiness score was determined for staff, guidelines, and medicine domains. A weighted additive model to define both domain-specific and overall readiness was used, followed by ordinary least squares and quantile regression methods to examine the factors associated with service readiness. The results showed that one-quarter of health facilities were providing mental health services. The overall readiness score was 22.2%, with domain scores of 14% for staff and guidelines, and 30% for medicines. Ordinary least squares regression showed that health facility type (lower in private facilities and basic health centres), province (lower in Madhesh province), and user fee (higher in facilities charging a separate user fee) were significantly associated with service readiness. The quantile regression demonstrated that the effect of these variables varied with the order of the quantile groups. Service readiness for mental health services provision is sub-optimal in Nepal, with few trained health workers, an absence of guidelines and protocols, and limited access to medicines.