Misinformation and disinformation

 

Misinformation and disinformation

 

Nepal is filled with temples. This country is also filled with gangsters who program the neural networks of brains of innocent masses with rubbish lies in the name of GOD. It's like a business, give and take! They brainwash innocent mass by encouraging them in “ bhakti tradition,  engage people in unnecessary rituals and customs in the name of God”. These gangsters are expert at spreading disinformation and misinformation.  No wonder good leaders are sidelined by people with criminal backgrounds. There is no GOD in a newborn brain until it’s infected with misinformation and disinformation.

Mothers worry about diet of their children. It’s is not only what children eat. It’s what children watch, what children listen to, what children read, the people children hang around. The news , social media are filled with disinformation and misinformation designed by gangsters with criminal minds. Mothers should also watch watch things children put into their body emotionally, spiritually and physically. People find it hard to think critically but they’re learning.

Comparative Regional Data

80% of Nepalis live in areas with no access to structured mental health services. 60% have key pad mobiles. Poor internet penetration in rural areas remains a barrier. As per the data available Nepal:  Psychiatrists, psychologists, nurses, and primary healthcare workers are essential for delivering mental health services. However, Nepal faces a shortage of these professionals, with approximately 0.36 psychiatrists per 100,000 population. It is essential that every healthcare facility has a psychiatric unit.

Sri Lanka: 2.2 psychiatrists per 100,000, India: 0.75; Bangladesh: 0.49 (WHO, 2023). Community groups can spread awareness through YouTube, WhatsApp, Facebook however infrastructure services are not implemented as per the standard.  Digital Infrastructure & Community Role.  Nepal’s growing digital health potential (teleconsultation, apps).

Current Mental Health Landscape in Nepal:

Limited Access to Professionals: Nepal has a low ratio of mental health professionals, with approximately 0.17 psychiatrists, 0.03 psychologists, and 0.21 mental health-specialized nurses per 100,000 people, significantly below the WHO’s recommended levels.  Urban-Centric Services: Mental health services are predominantly concentrated in urban areas, leaving rural populations underserved. Stigma and Cultural Barriers: Deep-seated societal stigma and cultural perceptions hinder individuals from seeking mental health care, exacerbating the treatment gap. Furthermore, many people avoid seeking mental healthcare because the high out-of-pocket costs of psychiatric care and medicines.

Case Study 

Require periodic ethics training for all practitioners/ Members of Rotary clubs can contribute a lot in reforming regulatory policies. Multiple patient families report coercion, sedation, and illegal confinement. Example of unethical neuropsychiatric rehab clinic operating without license. Citizens should be trained to leverage digital tools to expose abuse and demand accountability. No legal action taken despite complaints/ Public outcry on social media prompted informal shutdown. Protection of whistleblowers and patients from retaliation is important by the government. Mental health exploitation is a national crisis and a human rights issue. Without action now, tomorrow’s families remain unprotected. Persons affected by mental health conditions and their families offer valuable insights into service needs and play a crucial role in advocacy and support networks. 

Addressing ethical concerns and human rights issues within Nepal’s mental health sector requires a multifaceted approach involving policy reforms, professional training, community engagement, and robust legal frameworks.

 

1. Implementing regular AI assisted ethics training for mental health professionals is crucial for enhancing practitioners’ understanding of ethical standards, patient rights, and appropriate therapeutic practices, thereby reducing instances of coercion, unauthorized sedation, and illegal confinement including the painful trauma for caregivers. Integrating mental health services into general AI assisted healthcare can also promote ethical practices by providing basic mental health services to all. 

 

2. Organizations like Rotary Clubs can play a significant role in advocating for policy reforms involving communities in the policy reform process. By leveraging their networks and resources, concerned stakeholders can support the development and enforcement of regulations that ensure ethical practices in mental health care.

 

3. Addressing Unethical Practices:

Reports of unethical practices, such as coercion and illegal confinement in unlicensed neuropsychiatric rehabilitation clinics, including the painful trauma for caregivers, highlight the need for stringent regulatory oversight. Establishing a national registry of licensed mental health facilities and conducting regular inspections can help identify and shut down unauthorized operations.

 

4. Training citizens to use digital platforms can be effective in exposing abuses and demanding accountability. Harnessing technology can address the global mental health crisis by providing access to information and support. Communication infrastructure services should be improved in order to implement AI assisted monitoring systems and empowering citizens. 

 

5. Ensuring legal protections for whistleblowers and patients is vital. Advocacy for the enactment of laws that safeguard individuals who report unethical practices can encourage more people to come forward without fear of retaliation. The Chief Commissioner of Nepal’s National Information Commission has emphasized the need for such protective legislation. 

 

6. Mental health exploitation is not only a national crisis but also a human rights concern. Collaborative efforts among government agencies, non-governmental organizations, and civil society are necessary to protect vulnerable populations and ensure access to ethical and effective mental health care.

 

7. Involving individuals with live experiences and affected by mental health conditions and their families in the development and evaluation of services ensures that their insights and needs are central to mental health advocacy and support networks.

By implementing these measures, Nepal can work towards a more ethical, accountable, and effective mental health system that respects and upholds the rights of all individuals.

Ethical reform requires not just policy—but public vigilance and power. Team work     sharing of strengths  among coalition of patients, families, professionals, and regulators is needed. 

Policy and Regulatory Framework:

During the past three decades Nepal has gone through series of reforms to address the mental health needs of the Nepalese population by promulgation of an exclusive National Mental Health Policy and related Strategic Action Plan. Small but significant improvements have been achieved in Nepal with regard to mental health policies and plans. There are challenges to be overcome for their effective implementation. The National Mental Health Policy, adopted in 1997, has seen limited implementation, and efforts to update mental health legislation have been protracted and complex. There is an absence of a national registry and standardized licensing for mental health practitioners, leading to potential ethical and professional inconsistencies.

 

Recommendations for Improvement:

Create a comprehensive registry of licensed mental health providers to ensure accountability and standardize care quality. Form an independent licensing and ethics board composed of professionals adhering to ethical principles to oversee practices and address grievances. Expand mental health services into rural areas through community health programs and digital platforms to improve accessibility Launch initiatives to destigmatize mental health issues and promote awareness, encouraging individuals to seek care without fear of societal judgment. Develop and enforce legislation that protects patients’ rights, regulates mental health practices, and ensures ethical standards are upheld.

A collaborative effort among concerned stakeholders including government bodies, healthcare professionals, community organizations, and the public to build a more inclusive and effective mental health system in Nepal and the multifaceted challenges of mental health in Nepal, including service accessibility, stigma reduction, and policy implementation. Such partnerships can address existing challenges and enhance mental health service delivery across the nation.

 

Current Collaborative Efforts

The Government of Nepal, with support from the World Health Organization (WHO), has initiated the integration of mental health services into general healthcare. This strategy aims to extend mental health services to more districts, improving accessibility for underserved populations. Collaborations between non-governmental organizations (NGOs) and government institutions have been instrumental in expanding mental health services. For instance, partnerships have led to the establishment of district-level hospitals and community-based programs that offer comprehensive mental health care. Organizations like the Primary Health Care and Resource Center (PHCRC) in Chapagaun have developed integrated care systems involving community healthcare workers. These initiatives utilize electronic health records to connect rural communities with necessary mental health services. 

Empowering Guardians and Citizens

Nepal’s mental health care is 90% home-based. But caregivers  remain invisible, unsupported, and unprotected. When caretakers—often already under immense emotional and physical strain—face aggression from those they’re trying to support, and can’t rely on the systems meant to protect them, it creates a deep sense of isolation and helplessness. Community watchdogs can document abuse and pressure local institutions. Even in a corrupt system, documentation matters. Drug abuses are on rise. Reach Out to Mental Health Advocates or NGOs. 

Look for Human rights or mental health advocacy groups, Helplines with legal or social advice and Online communities for caregiver support and strategies. If police and lawyers are corrupt, it’s hard. But sometimes Public attention (through media, social media, or community networks) can pressure institutions to act. Public interest litigation or reaching out to legal aid societies can make a difference in some cases. Organize informal support groups to share strategies, vent, and back each other up. This can evolve into advocacy—pushing for systemic reforms. The toll this takes on caretakers is immense. Even a weekly check-in with a trusted friend, a counselor (if available), or a journal can help process the trauma. Organize informal support groups to share strategies, vent, and back each other up. Public education campaigns need to be strengthened on mental health rights. Societal stigma around mental health issues persists. Public education campaigns and community engagement are vital to changing perceptions and encouraging individuals to seek help. Digital infrastructure can escalate training for family caregivers to recognize exploitation involving local community oversight teams (trained civil society groups)

Fostering collaboration among government bodies, healthcare professionals, community organizations, and the public is essential to enhance Nepal’s mental health system. Such partnerships can address existing challenges and improve service delivery across the nation. 

In Nepal, the mental health sector comprises a diverse array of stakeholders, each playing a pivotal role in shaping and delivering mental health services. Key stakeholders include:

1. Government Bodies:

• Ministry of Health and Population (MoHP): Responsible for formulating and implementing national mental health policies and integrating mental health services into the broader healthcare system. Technical support for stakeholders is required to make healthcare systems interoperable through foundational digital health frameworks, international standards, and emerging technologies (IHE, FHIR, Blockchain, etc.). Nepal is to adopt a transformative approach to healthcare technology, where seamless interoperability is the norm rather than the exception. Concerned Stakeholders should envision a digital health ecosystem, where healthcare systems and applications seamlessly exchange information, enhance efficiency, improve outcomes, and ultimately transform the delivery of health services.
• Primary Health Care Revitalization Division (PHCRD): Developed the Community Mental Health-Care Package (CMHCP) to address gaps in mental health services. 

1. Non-Governmental Organizations (NGOs):

• Transcultural Psychosocial Organization Nepal (TPO Nepal): Engages in community-based mental health programs and research. 
• KOSHISH: Provides emergency psychosocial support and advocates for the rights of individuals with mental health conditions. 
• Mental Health Society of Nepal (MHSN): Focuses on mental health awareness and recently launched the National Mental Health Network to enhance collaboration among stakeholders. 

1. Community Organizations and Civil Society:

• Local community groups and civil society organizations contribute to mental health awareness, support, and advocacy, often bridging gaps between formal healthcare systems and the public. rotary clubs are also now focusing on this area. 

1. Academic and Research Institutions:

• Universities and research centers conduct studies to inform policy and practice, contributing to the evidence base for effective mental health interventions.  Mental hospitals and universities should share resources and  to capitalize on new emerging international opportunities like Biomedical Science and Engineering. 

1. International Organizations:

• Entities such as the World Health Organization (WHO) collaborate with the Nepalese government and local organizations to support mental health initiatives and policy development. 

Understanding the patterns of violent behavior among psychiatric patients and the experiences of caregivers who face abuse is crucial for developing effective interventions and support systems.

 

Patterns of Violent Behavior in Psychiatric Patients

 

Research indicates that aggressive behavior is relatively common among psychiatric inpatients. A meta-analysis found that between 8% and 44% of patients in acute psychiatric settings exhibited aggressive behavior during treatment.  Factors contributing to such behavior include the severity of the mental disorder, comorbid substance abuse, and environmental stressors. 

 

To systematically assess and document aggression, tools like the Modified Overt Aggression Scale (MOAS) are employed. The MOAS evaluate the frequency and severity of aggressive episodes across categories such as verbal aggression, aggression against objects, self, and others. 

 

Abuse Experienced by Caregivers

 

Caregivers of individuals with severe mental illnesses often face significant challenges, including exposure to violence. Studies have shown that a substantial proportion of caregivers experience various forms of abuse, such as verbal, physical, and emotional abuse, from the individuals they care for.  This exposure can lead to increased stress, burnout, and mental health issues among caregivers.

 

Importance of Data Collection

 

Collecting comprehensive data on both patient aggression, social scientists, psychologists, neuro psychiatrists, cognitive scientists and caregiver experiences is essential for understanding the underlying causes and triggers of violent behavior can inform prevention strategies, developing Support Systems. Data can guide the creation of targeted interventions and support services for both patients and caregivers.

 

Implementing standardized assessment tools and ensuring regular data collection can aid in monitoring trends, evaluating interventions, and improving the overall quality of mental health care services.

Policy Recommendations
There is an urgent need of establishing national registry of licensed mental health providers i Nepal. There is an of independent licensing & ethics board driven by professionals with ethical principles. Enforcement of mandatory grievance redressal mechanism accessible to families is required. Evidence-based policies can be developed to address the needs of this population effectively.

Challenges and way forward

Despite the formulation of mental health policies, effective implementation remains a challenge. Strengthening governance and ensuring that policies translate into actionable programs is essential. Limited financial and human resources hinder the expansion of mental health services. Collaborative efforts should focus on mobilizing resources, training healthcare professionals, and leveraging technology to bridge gaps. Factors including an insufficient workforce, limited training and frequent transfer of healthcare workers that limits those trained in mental health from providing continuing care are further barriers to attaining the goals of the Strategic Action Plan on mental healthcare. 

 

The government plan focuses on coordination with the health insurance programme to provide super-specialized mental health services at community level along with a tele mental health service. However, this will be a challenge, as the national health insurance system is in its juvenile stage and there is inadequate digital health literacy among Nepalese people, especially those living in rural areas. Therefore, enhancing both mental and digital health literacy might be an appropriate strategy to improve mental healthcare utilization. All the concerned stakeholders including citizens should be clear about roles and responsibilities at each level of government to improve accountability and transparency in mental healthcare and create good governance to monitor both tele mental health services and mental healthcare in Nepal.