title: Partnerships in mental healthcare service delivery in low-resource settings: developing an innovative network in rural Nepal.
abstract: Mental illnesses are the largest contributors to the global burden of non-communicable diseases. However, there is extremely limited access to high quality, culturally-sensitive, and contextually-appropriate mental healthcare services. This situation persists despite the availability of interventions with proven efficacy to improve patient outcomes. A partnerships network is necessary for successful program adaptation and implementation.
  
  
  
  We describe our partnerships network as a case example that addresses challenges in delivering mental healthcare and which can serve as a model for similar settings. Our perspectives are informed from integrating mental healthcare services within a rural public hospital in Nepal. Our approach includes training and supervising generalist health workers by off-site psychiatrists. This is made possible by complementing the strengths and weaknesses of the various groups involved: the public sector, a non-profit organization that provides general healthcare services and one that specializes in mental health, a community advisory board, academic centers in high- and low-income countries, and bicultural professionals from the diaspora community.
  
  
  
  We propose a partnerships model to assist implementation of promising programs to expand access to mental healthcare in low- resource settings. We describe the success and limitations of our current partners in a mental health program in rural Nepal.
authors.affiliation: Bayalpata Hospital, Possible, Sanfebagar-10, Achham, Nepal. Bibhav.Acharya@ucsf.edu.|Department of Psychiatry, University of California, San Francisco, 401 Parnassus Ave, Langley Porter, San Francisco, CA, 94143, USA. Bibhav.Acharya@ucsf.edu.|Shared Minds, Boston, MA, USA. Bibhav.Acharya@ucsf.edu.
authors.forename: Bibhav
authors.initials: B
authors.lastname: Acharya
authors.affiliation: Bayalpata Hospital, Possible, Sanfebagar-10, Achham, Nepal.|Department of Medicine, Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.|Department of Medicine, Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA.|Department of Medicine, Harvard Medical School, Boston, MA, USA.
authors.forename: Duncan
authors.initials: D
authors.lastname: Maru
authors.affiliation: Bayalpata Hospital, Possible, Sanfebagar-10, Achham, Nepal.|Department of Medicine, Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.|Department of Medicine, Harvard Medical School, Boston, MA, USA.|Department of Medicine, Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Schwarz
authors.affiliation: Bayalpata Hospital, Possible, Sanfebagar-10, Achham, Nepal.|Department of Anthropology, University of Washington, Seattle, WA, USA.|Department of Global Health, University of Washington, Seattle, WA, USA.|Henry M. Jackson School of International Studies, University of Washington, Seattle, WA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Citrin
authors.affiliation: Bayalpata Hospital, Possible, Sanfebagar-10, Achham, Nepal.
authors.forename: Jasmine
authors.initials: J
authors.lastname: Tenpa
authors.affiliation: Shared Minds, Boston, MA, USA.|Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Soniya
authors.initials: S
authors.lastname: Hirachan
authors.affiliation: Shared Minds, Boston, MA, USA.|Faculty of Medicine, Department of Psychiatry, B.P. Koirala Institute of Health Sciences, Dharan, Sunsari, Nepal.
authors.forename: Madhur
authors.initials: M
authors.lastname: Basnet
authors.affiliation: Bayalpata Hospital, Possible, Sanfebagar-10, Achham, Nepal.
authors.forename: Poshan
authors.initials: P
authors.lastname: Thapa
authors.affiliation: Bayalpata Hospital, Possible, Sanfebagar-10, Achham, Nepal.|Psychiatric Department, Kathmandu Medical College, Kathmandu, Nepal.
authors.forename: Sikhar
authors.initials: S
authors.lastname: Swar
authors.affiliation: Bayalpata Hospital, Possible, Sanfebagar-10, Achham, Nepal.|Henry M. Jackson School of International Studies, University of Washington, Seattle, WA, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Halliday
authors.affiliation: Research Department, Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal.|Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.|Global Health Institute, Duke University, Durham, NC, USA.|Department of Cultural Anthropology, Duke University, Durham, NC, USA.
authors.forename: Brandon
authors.initials: B
authors.lastname: Kohrt
authors.affiliation: Research Department, Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal.
authors.forename: Nagendra P
authors.initials: NP
authors.lastname: Luitel
authors.affiliation: Department of Psychiatry, University of California, San Francisco, 401 Parnassus Ave, Langley Porter, San Francisco, CA, 94143, USA.
authors.forename: Erick
authors.initials: E
authors.lastname: Hung
authors.affiliation: Bayalpata Hospital, Possible, Sanfebagar-10, Achham, Nepal.
authors.forename: Bikash
authors.initials: B
authors.lastname: Gauchan
authors.affiliation: Policy Planning & International Cooperation Division, Ministry of Health, Kathmandu, Nepal.
authors.forename: Rajeev
authors.initials: R
authors.lastname: Pokharel
authors.affiliation: Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Ekstrand
mesh_terms: D019058:Community Networks / Q000191:economics*; D003906:Developing Countries / Q000191:economics* / Q000706:statistics & numerical data; D006282:Health Personnel / Q000193:education; D006297:Health Services Accessibility / Q000191:economics / Q000592:standards; D006801:Humans; D001523:Mental Disorders / Q000191:economics* / Q000628:therapy; D008605:Mental Health Services / Q000600:supply & distribution; D009390:Nepal; D055818:Public-Private Sector Partnerships / Q000191:economics*; D012424:Rural Population / Q000706:statistics & numerical data
keywords: Global health; Low— and middle-income countries; Mental health; Nepal; Partnerships