Mental health and COVID-19 in Nepal: A case of a satellite clinic.

COVID-19 began in Asia. Countries have taken novel approaches to anticipate and manage this challenge. There are unique circumstances across different nations of Asia in terms of refugee crises, and political/economic realities (Tandon, 2020). Nepal is a country landlocked between India and China. It is one of the Lower Middle-Income Countries (LMICs) with limited resources. The allocation of resources on mental health services is minimal (Upadhaya et al., 2017) with a vast treatment gap (Jha et al., 2019). A unique concept currently impletemed to address this treatment gap in Nepal is the ‘Satellite Clinic’ whereby access to specialist services is increased. In this modality, psychiatrists provide services to rural areas on an out-patient basis, monthly/bimonthly. A local community health center or a pharmacy hosts these outpatient services by charging a nominal consultation fee of three to five USDs.

Nepal is in a state of lockdown following the global COVID-19 pandemic. The disruption in travel will affect a larger chunk of patients receiving satellite clinics services. The health care needs of this patient population are to be addressed immediately. An immediate solution to address this problem would be to link these patients to primary care centers, equipped with human resources, trained in the mental health Gap Action Program (mhGAP) (Jordans et al., 2016). The reluctance to visit the health care center at the time of pandemic remains a major concern. The effective use of telepsychiatry could be another potential solution to this problem (Canady, 2020). Telepsychiatry is one of the most cost-effective modalities for providing psychiatric treatment. It is also the most accessible means at the time of the current pandemic (Kar et al., 2020). In practicing telepsychiatry we connect the clients via the internet for direct interview and assessment (Shore, 2013). In case of unavailability of the internet, a local health worker or a pharmacist could manage simple telephonic conversation or short message service (SMS). This can be an immediate and accessible way of providing health care remotely. However, telepsychiatry is not a part of routine patient care and standard consensus guideline for its implementation does not exist in Nepal. Hence, the use of telepsychiatry might be a daunting task for many.

Psychotropic medications are not easily available in rural areas. Local pharmacists could mediate the availability of psychotropic medications. This will be an effective solution for a lack of accessibility and compliance with the medications. Some measures to ease out the regulations for the sales of psychotropics should also be implemented. The local pharmacist can be made able to dispense based on telephonic or internet-based consultations.

Nepal along with the world is facing a major crisis. At this time, the effective delivery of psychiatric services in resource-poor settings is one of the major public health concerns. We need to use all the available resources and plan effective actions to address this problem.

Funding

None.

Declaration of Competing Interest

None.