Telepsychiatry during the second wave of COVID-19 in Nepal: Current initiatives, prospects, and challenges

The impact of the COVID-19 pandemic on mental health and psychiatric services has exposed the inequities in mental health across and within countries (Tandon, 2021a). Alike other low- and middle-income countries (LMICs), mental health is neglected in Nepal with insufficient human resources (0.22 psychiatrists and 0.06 psychologists per 100,000 populations), inadequate infrastructure, minimal budget, and inefficient policy (Luitel et al., 2015). During the COVID-19 pandemic, mental health care utilization has been fundamentally affected due to the pandemic itself along with containment strategies including hindrances in transportation and shut down of out-patient department services of nearby health institutes (Singh et al., 2021). Similarly, the functioning of ‘Satellite Clinic’ whereby psychiatrists provide services to deprived areas on an out-patient basis, monthly/bimonthly in order to minimize the treatment gap in mental care, has also been affected by this pandemic (Sharma, et al., 2020). During the first wave of the pandemic, a study reported 40 % of the participants to have poor mental wellbeing as per WHO well-being index (Shrestha et al., 2020). Studies reported increased prevalence of mental health outcomes including anxiety, stress, depression and psychological distress such as restlessness, fearfulness, worry and sadness (Gautam et al., 2020; Poudel and Subedi, 2020). The number of suicides increased during the pandemic and as per Nepal Police, 2218 people had committed suicide during the lockdown of first wave (Neupane, 2020). As of 29 May 2021 in the second wave, the official figures indicate Nepal having world’s second-highest bi-weekly increase in deaths at 291 % and highest test positivity rate of 40 %. These frightening figures are threatening and could raise stressors to mental health of Nepalese population. Telepsychiatry could be a way to tackle increasing mental health problems and their stressors during the current crisis as it provides easy access to care, saves time, reduces emergency room visits, and improves follow-up (Shore, 2015). Moreover, it is very important to educate people and all concerned stakeholders by disseminating the factual information regarding changing mental health contexts and available prospective controlling strategies against rising mental health issues during the pandemic via publications in the exclusive journals of mental health (Tandon, 2021a, b).

Along with the existing helpline numbers realizing the importance of telepsychiatry in this difficult circumstance of second wave of COVID-19 pandemic, Patan Academy of Health Sciences, an autonomous health sciences university in Nepal, has started providing telepsychiatry services twice a week two hours each day from 24th May 2021 with a service fee of 0.86 US$ per patient. The service can be booked by calling at +9779828071488. Other organizations including Danphe care and Nepal Health Corps have also been providing telepsychiatric services including diagnosis, treatment, and therapies.

There are more than 38.21 million mobile phone users and more than 22 million internet clients in Nepal and the customers of both mobile phones and internet are increasing sharply as per Nepal Telecom Authority (Balami, 2021). This increasing use of mobile phone and internet creates a way for Nepali people to use phone calls or video-conferencing to seek psychiatric/psychological help through telepsychiatry.

The initiation of telepsychiatry service in Nepal during this pandemic is commendable; however, it has several challenges in LMICs including poor internet, lack of adequate infrastructure, poor digital literacy, and absence of a functioning community mental health team (Shoib and Arafat, 2021). Speedtest Global Index by Ookla reported internet speed in Nepal to be one of the slowest in the world. This can make consultation by video-conferencing difficult and people may have to opt for cellular calls that add extra financial burden to patients. Paid service could make economically deprived people difficult to seek such care as the economic upheaval brought by the pandemic drives them to prioritize basic needs over mental health. Under limited service time only a few patients under distress can be counseled. Unsupervised service in absence of regulatory agencies could lead to negative effects of telepsychiatry by sharing or receiving deceiving information and rendering services by non-professional, and this may further generate additional load to the health system (Smith et al., 2020).

Despite telepsychiatry has been an effective and proven method in developed nations, the assessment of its effectiveness in countries with limited resources like Nepal should be considered as a service option to reach the unreached. Telepsychiatry to fight mental health problems during a pandemic must be under a special focus of the government and influential stake holders in Nepal. Telecom companies can provide toll-free numbers to seek services, internet service providers can provide free data packages and hospitals/medical colleges can increase the time for consultation, and decrease/removethe service fee particularly for deprived groups. Government should be pro-active in establishing a regulatory body to develop and enforce appropriate strategies and frameworks on telepsychiatry and must also run campaigns to raise awareness on mental illness and the availability of telepsychiatry.

Funding

We did not receive any financial support for this work that could have influenced its outcome.

Declaration of Competing Interest

We declare that we do not have any conflicts of interest.