A paradigm shift in access to mental health services
A psychiatrist reflects on the potential and promises inherent in the innovative tele-mental health system set up with UNICEF support to provide remote treatment and counselling services for children and adolescents across Nepal
Kathmandu, Nepal: Within the premises of the Child and Adolescent Psychiatry Unit at the Kanti Children’s Hospital in Kathmandu are a number of rooms, each occupied by a healthworker, often found talking in soothing tones on their phones or headsets. This is the tele-mental health OPD, a facility under which a team of psychiatrists and clinical psychologists provide remote mental health treatment and counselling services for children and adolescents across Nepal.
Among the four members of the team is psychiatrist Dr. Ayushree Gurung, who has been working in the field for over six years, and has been part of the tele-mental health OPD since its very inception in 2022. The OPD was established at Kanti Children’s Hospital with support from UNICEF in collaboration with local partner CWIN (Child Workers in Nepal Concerned Center) Nepal – made possible with the generous funding support of the Office of Innovation (OOI).
For Dr. Ayushree, this initiative “just makes sense” for a country like Nepal.
“Nepal’s geography is so diverse and challenging, and the journey to Kathmandu is not easy for everyone to make, especially those from far-flung communities,” she says. “And there are the financial implications – costs of travelling back and forth, accommodation, meals – all that can add up to be a big burden for families for one appointment or a follow-up.”
Remote counselling, she adds, offers caregivers the opportunity to avoid those costs while seeking treatment for their children.
Although mental health has long been a key challenge for children and adolescents in the country, which has one of the highest rates of suicide among adolescents in the South Asia region, the COVID-19 pandemic truly laid bare the urgency of expanding access to support services. As per data from the Nepal Police, suicide among adolescent girls increased by almost 40 per cent during the first four months of the COVID-19 lockdown in 2020 compared to the same duration the previous year.
It was with this urgency in mind that the tele-mental health OPD had established at Kanti Children’s Hospital, to bring services closer to people by capitalizing on the possibilities offered by digital connectivity. A second such unit is also in the process of being established at the Karnali Provincial Hospital in Surkhet in partnership with the provincial government.
The OPD staff currently fields around 10 to 20 calls a day, primarily from caregivers and parents from all over Nepal. “Some of the most common mental health conditions that we come across relate to anxiety, depression, developmental issues, intellectual disabilities, as well as behavioural problems,” Dr. Ayushree says.
The approach has been effective, with the team citing many cases of improvement and recovery among young patients. One among these was an adolescent from Dolakha District in north-central Nepal with a substance abuse problem. Through multiple online counselling sessions with the boy and his family members and consistent therapy, he was finally able to break out of his addiction.
Apart from supporting children and adolescents through caregivers, Dr. Ayushree says that the facility also addresses the issue of disproportionate concentration of mental health expertise and services in urban areas. In fact, Kanti Children’s Hospital is the only full-time mental health clinic for children and adolescents in the country.
“Specialists in child and adolescent mental health are heavily centralized,” says Dr. Ayushree. “The tele-mental health OPD has also helped in connecting service providers located in communities across Nepal to specialists at the centre and expand the pool of experts.”
“This has the potential to shift the paradigm of mental health services as well as the capacity for universal or nation-wide health coverage for child and adolescent mental health support.”
