Nepal has a multitiered health system involving the Ministry of Health, nongovernmental organizations, private for profit, and faith-based organizations. There are national, district, and community-level health centers and health workers that come together to deliver services and input information into both the community and national level health information systems. In terms of mental health, there is a very small portion of the budget allocated to mental health and very few mental health interventions and programs. The system has strengths including that the service delivery is put together in an effective manner and there is some mental health integration in primary care and in the health information system. However, there are weaknesses including that there needs to be an increase in the number of health workers and the training given to the workforce to further integrate mental health and there also needs to be more attention brought to mental health overall. Nepal's COVID-19 response highlighted weaknesses within its health system, especially in the context of its essential medicine products. The COVID-19 response from Nepal was especially hindered by a shortage of medical supplies, personal protective equipment, medications, and coronavirus tests.

Objective: To create conditions favorable to social psychiatry overcoming constraints on the range of interventions that psychiatry makes available to patients and communities. Methods: The author reviewed the history of psychiatry's range of practices, research, and training from mid-20^th century to present and social concerns with future risks to mental health and well-being. Using Medline, Google, legislative sources, and major news reports, he ascertained the relationships among psychiatric activities, social policies, community resources, and public attitudes toward sciences relevant to health care. Results: Since mid-20^th century, psychiatry has become increasingly evidence based in molecular and related fields of biology. After mid-20^th century, this biological turn eclipsed social psychiatry functions quickly in the United States with the withdrawal of federal public funding and a constriction of commercial funding for patient care. By the 21^st century, professional priorities and governmental federalist funding priorities precluded most psychiatric activities beyond office and hospital-based patient care. With these shifts, American psychiatry did not support social psychiatry practices and other international needs for mental health services. Modern biologically oriented psychiatry limits its future abilities to meet national and international social psychiatry needs by not calling upon 21^st century evolutionary biological. By fostering balance and integration among individuals, populations, environments, and a group's historical cultural heritage, Darwin's biology validates social psychiatry adapting a full range of primary, secondary, and tertiary preventive mental health-care services, training, and research resources to meet individual and population's needs. Conclusions: A community's needs define psychiatry's social role in health care. Evolutionary biology promises social psychiatry a comprehensive conceptual grounding focused on how an individual and population affect and are affected by their environments and histories. Without this broad scientific foundation, psychiatry may forfeit the opportunity to gain public trust of how science comprehensively informs and supports human health and well-being.

Background: Little is known about the nature of service users who seek crisis community care in recent times in the Australian context. Objectives: The objective of this study was to describe the sociodemographic, clinical, and service provision characteristics and 12-month clinical outcomes of patients in a metropolitan crisis intervention team. Methods: Patients who were registered during the study period (May 1, 2015–October 30, 2015) for crisis intervention from a metropolitan community mental health team were included for this retrospective cohort study. The type of psychosocial stressor triggering the crisis was assessed by the social readjustment scale. Results: A situational crisis or adjustment disorder (26.6%) was the most common primary diagnosis, followed by an affective disorder. Deliberate self-harm behavior was the leading risk behavior (18.1%). Major injury or illness to self (16%) was the main psychosocial stressor associated with crisis presentation. The primary health sector was the main source of referral and discharge destination. Nearly 40% of patients were re-referred within a 12-month period since index contact. The characteristics of re-referred patients were men, living with a housemate or other family, triage category C, diagnosis of a mood disorder, needing medication supervision, and discharged to inpatient treatment during the index episode of care. Conclusions: A continuous and collaborative model of care between the primary health sector and community mental health services might be more beneficial in the early identification and management of the acute crisis in a subgroup of patients. A diverse range of skills are needed for clinicians working in the crisis intervention service in the current times.

Objectives: As COVID-19 spreads around the globe, parents are being presented with new challenges to meet their children needs. We investigated parental stress and its impact on their parenting practices during COVID-19 outbreak in Lahore, Pakistan. Methods: Following ethical approval, using web-based cross-sectional survey, data were collected in April 2020–May 2020. Symptoms of depression and anxiety were assessed among parents by the patient health questionnaire and generalized anxiety disorder scale. Respondents also reported on parenting practices and emotional and behavior changes noticed in their children. Results: Three hundred and fifty-five parents participated in the survey with a mean age of 35.3 years (standard deviation = 8.2) with 55% having at least one child between the ages of 1 and 5 years and 9% had children with special needs. The prevalence of depressive symptoms and anxiety was 25.6% and 21.6%, respectively. A significant proportion (77%) of parents were concerned about the outbreak fearing about family/self-being infected, losing love ones, and financial difficulties. Fifty percent of participants reported more than usual use of consequences (shouting at children, taking privileges away, and slapping child) in the past 1 month. However, the positive impact of parents spending more time with their children was also reported. Unhealthy eating and sleeping patterns (24.5%), irritability (21.1%), anxiety (16.3%), and aggression (14.6%) were the most common behavior and emotional problems noticed in children. Conclusions: Parental stress observed during COVID-19 outbreak can adversely impact the parenting practices and child's mental health. Provision of effective strategies to support parents to care for children is urgently needed.

Background: Health-care workers during the COVID-19 outbreak are vulnerable to psychological distress due to increased workload, inadequate equipment, isolation, and risk of infection transmission. The objective of this study was to assess the psychological status of health-care professionals in Lebanon and Iraq during the period of COVID-19 outbreak. The primary outcome was the prevalence of depression, anxiety, and stress among the health-care workers. Methods: We carried out a cross-sectional study to assess the psychological well-being of health-care professionals in Lebanon and Iraq during the COVID-19 pandemic. Psychological health was assessed using the validated “Depression, Anxiety, and Stress Scale-21.” Results: A total of 518 health-care professionals were included, of which 287 (55.4%) were from Lebanon and 231 (44.6%) were from Iraq. Overall, 60.0%, 42.9%, and 43.4% of all participants reported depression, anxiety, and stress, respectively. Health-care workers from Iraq had more severe symptoms on all measurements compared to those from Lebanon. Psychological distress was associated with caring for elderly parents, going home after duty only 2–4 times/week, working overtime, and in the front line. The results present concerns about the psychological health of nurses and physicians. Those who did not use protective equipment were more distressed. Participants who had direct or indirect contact with COVID-19 cases and those who tested positive had significantly higher depression, anxiety, and stress. Conclusions: This survey on health-care workers reported high rates of depression, anxiety, and stress during the COVID-19 pandemic. Protecting health-care professionals is a major public health measure for addressing COVID-19 outbreak.

Background: Video games are seen as a modality to manage stress. The study examined the role of playing violent gaming on stress. Materials and Methods: The observational design was used for the assessment of stress among 04 medical undergraduates in the age group of 18 years to 20 years. Salivary cortisol and stress subscale of Depression, Anxiety, and Stress scale were used to assess stress. Results: Salivary cortisol and psychological scale findings revealed the presence of higher stress among violent game players. Conclusions: The findings imply the need to evolve emotional regulation approaches for management of stress among gamers.

The novel coronavirus pandemic is both shaped by and an agent of the postmodern, posttruth, utilitarian times we live in. It is associated with an overload of both information and mis-information with an increasing loss of the distinction between the two. The disconnect between governance and the health-care professions and the lack of a consensus within health-care professionals have left us ill equipped to offer a unified response to the pandemic. Further, the difficult decisions that we have to make in allocating scarce resources during this crucial period has thrown open health care's divides – between health-care providers and patients and within health-care professionals. With the global lockdown, economic, social and gender disparities have been highlighted in an unprecedented manner. There are no easy ways out of this crisis; however, I advocate for inclusivity and parity in decision-making to navigate bioethical and moral pitfalls.