Recently, through the various community sessions I have been part of, I came to realise a very obvious issue in Nepal’s mental health sector. This problem is closely tied to how we are trying to prioritise mental health. Surprisingly, the issue is not that mental health is being ignored anymore. In fact, the government has introduced important initiatives, including the National Mental Health Strategy and Action Plan 2077, as well as the National Mental Health Programme 2022.
These initiatives have increased conversations around mental health and brought greater awareness, but the issue here is actually on the implementation side.
If mental health has become a national priority, as these initiatives suggest, why do we fail to see any real change?
These programmes were introduced to reduce stigma, improve mental health services and train government employees to recognise and respond to mental health concerns. Yet, from what I have observed while working in different communities, very little seems to have changed. Many of the individuals attending these sessions still have a limited understanding of why mental health matters, while some even see it as something unnecessary. This raises a question of whether the problem lies not in the policies themselves, but in the way we are implementing them.
Mental health is different from many other public health interventions. It depends heavily on human relationships, communication, empathy and professional judgement. Building these skills takes lots of time. Simply introducing a policy and conducting a one-time training programme will not create lasting change. At best, these programmes introduce people to a topic. Developing competence requires gradual learning, repeated practice and continuous behavioural change over time, which is beyond the realm of these programs.
Ironically, this is where many of our mental health initiatives appear to contradict one of psychology’s most fundamental lessons. Lasting change rarely occurs after a single intervention. We would never expect someone struggling with depression or anxiety to recover after attending one counselling session. However, we assume that a single workshop or intervention is sufficient for individuals to understand mental health. That is not realistic. Meaningful psychological change requires repetition, reinforcement, practice, feedback and continued support. Most mental health professionals have been in this field for many years.
Across Nepal, numerous awareness programmes, workshops and training sessions are organised every year. Healthcare workers, teachers, community volunteers and local stakeholders attend these programmes with enthusiasm. Attendance is recorded, certificates are distributed, and reports proudly document the number of individuals trained. But participation is not the same as competence. Exposure is not the same as learning. Attendance does not bring change.
One of the biggest misconceptions surrounding training is the belief that knowledge automatically translates into practice. In reality, learning is only the first step. The real challenge begins after participants leave the training hall and return to busy health posts, classrooms and communities where they must apply what they have learned under real-world conditions.
Without ongoing supervision, mentoring, and follow-up training sessions and opportunities to practice new skills, much of that learning gradually fades. This is not a failure of the participants. It is simply how human learning works.
Educational psychology has long demonstrated that people retain information more effectively when learning is reinforced over time rather than delivered as a one-time event. Competence develops through repeated application, constructive feedback and continuous improvement.
A healthcare worker may understand the symptoms of depression during a workshop, yet still feel uncertain when sitting across from a distressed patient months later. Confidence cannot be developed through information alone. It develops through experience supported by guidance. This is exactly why implementation matters just as much as policy itself.
The National Mental Health Programme outlines important goals, including integrating mental health into primary healthcare and strengthening healthcare workers’ capacity. That is exactly what we need. However, achieving these goals requires more than just delivering these one-off training sessions. It requires building a system that can continue to support professionals long after the training has ended.
Another issue is that we often measure what is easiest to count rather than what actually matters. It is easy to count the number of workshops conducted. It is easy to count the number of participants who attended. It is easy to report how many people were trained. But the far more important question is, did the participants become more confident in identifying mental health concerns?
Are they still using these skills six months later? Do they have someone they can consult when faced with difficult cases? Has the quality of mental health support actually improved because of these programmes? These are the questions that actually tell us if we are making a real difference.
There is another aspect that deserves attention as well—the people delivering these training sessions. Mental health training cannot simply be facilitated by anyone available. It should be led by experienced mental health professionals who understand the realities of working in the field and who can answer difficult questions that arise during community discussions.
More importantly, their involvement should not end when the workshop finishes. Training should be the beginning of a longer process of supervision, mentoring and continuous support.
Ultimately, we do not need policies that simply sound good on paper. We need policies that are implemented with care, consistency and commitment. This is not only the responsibility of the government but also of every organisation that claims to value mental well-being.
If we genuinely want to improve mental health in Nepal, we must invest in long-term conversations, continuous learning and sustained action. Talking about mental health is important, but talking alone has never changed anyone’s life. Meaningful action does.
As another fiscal year comes to an end, I remain hopeful. I hope that mental well-being will receive more than policies that remain on paper or training that ends with a certificate. It deserves action that actually brings some change.
