Child and Adolescent Psychiatry Unit, Kanti Children's Hospital, Kathmandu, Nepal.
Front Public Health. 2021 Feb 4;8:590002. doi: 10.3389/fpubh.2020.590002. eCollection 2020.
Nepal is a low and medium-income country (LMIC), situated in South-east Asia, with a population of 29 million, of which, 40-50% are children and adolescents. The Coronavirus Disease 2019 (COVID-19) pandemic has affected the lives of people around the world, including Nepal. The child and adolescent mental health (CAMH) needs and services in Nepal have a significant gap. CAMH in Nepal suffers from lack of specialized training in this field as well as scarcity of human resources and services. There is only one full-time child and adolescent psychiatry (CAP) out-patient clinic in the country. Some recent activities have focused on CAMH in Nepal but the COVID-19 pandemic has produced new challenges. Access to mental health services for children and adolescents (C&A) across Nepal has been adversely affected. Factors such as closure of schools, confinement at home, lockdown, transportation problems, uncertainty, loss of usual routine and fear of infection have affected the mental health of C&A. This has highlighted a need to build capacity of available local human resources, enhance community support, teach measures of coping with stress and improve CAMH service delivery by strengthening the referral system, but these have to be addressed overcoming problems of travel restrictions and limited resources. To address these needs, online platform can be a suitable approach. With this view, a multi-tier CAMH intervention model was developed, which utilizes online platform for training mental health professionals across Nepal, who would then facilitate sessions for C&A, teachers, parents and caregivers; and link them to CAMH services locally, and remotely through teleconsultation. This started as a pilot from June 2020 and will continue till end of February 2021, with the aim to reach 40,000 C&A, parents, teachers and caregivers. As of Nov 2020, this model has been used to successfully conduct 1,415 sessions, with 28,597 population reached. Among them, 16,571 are C&A and 12,026 are parents, teachers and caregivers, across all 7 provinces of Nepal. In this paper, the multi-tier intervention to address the COVID-19 related CAMH problems has been discussed as a feasible framework for resource limited settings and LMICs like Nepal.
尼泊尔是一个中低收入国家（LMIC），位于东南亚，人口 2900 万，其中 40-50%是儿童和青少年。2019 年冠状病毒病（COVID-19）大流行影响了世界各地人们的生活，包括尼泊尔。尼泊尔的儿童和青少年心理健康（CAMH）需求和服务存在显著差距。尼泊尔的 CAMH 领域缺乏专业培训，人力资源和服务也稀缺。该国只有一家全职儿童和青少年精神病学（CAP）门诊诊所。最近一些活动集中在尼泊尔的 CAMH 上，但 COVID-19 大流行带来了新的挑战。尼泊尔各地儿童和青少年（C&A）获得心理健康服务的机会受到不利影响。学校关闭、居家隔离、封锁、交通问题、不确定性、日常活动中断和感染恐惧等因素影响了 C&A 的心理健康。这凸显了需要建设现有当地人力资源的能力，加强社区支持，教授应对压力的措施，并通过加强转介系统来改善 CAMH 服务提供，但这必须在克服旅行限制和资源有限的问题的情况下进行。为了满足这些需求，在线平台可能是一种合适的方法。有鉴于此，开发了一个多层次的 CAMH 干预模型，该模型利用在线平台培训尼泊尔各地的心理健康专业人员，他们将为 C&A、教师、家长和照顾者举办会议，并通过远程咨询将他们与当地的 CAMH 服务联系起来。该模型从 2020 年 6 月开始试点，将持续到 2021 年 2 月底，目标是覆盖 40,000 名 C&A、家长、教师和照顾者。截至 2020 年 11 月，该模型已成功举办了 1415 次会议，覆盖了尼泊尔所有 7 个省的 28,597 人。其中，16,571 人是 C&A，12,026 人是家长、教师和照顾者。本文讨论了针对 COVID-19 相关 CAMH 问题的多层次干预措施，作为资源有限的设置和像尼泊尔这样的中低收入国家的可行框架。
