BehavioR: a digital platform for prevention and management of behavioural addictions

Behavioural addictions have been identified as an emerging public health problem. The unprecedentedpace of the digital revolution, resulting in an ever-increasing use of internet-based technologies,provides the opportunity to create a unique resource to assist in offering public health interventions inthe World Health Organization South-East Asia Region. The ability to deliver evidence-based treatmentand preventive programmes that can be accessed by mobile phones, for example, increases access toa wide range of populations, including hidden or hard-to-reach populations. BehavioR (the Behavioraladdictions Resource hub) has been established with the aim of offering a one-stop resource centre forbehavioural addictions. The expected end-users of this digital platform include patients, caregivers, thegeneral public, health-care providers, academics, researchers and policy-makers. The platform can beused to offer digital health interventions to patients; strengthen the capacity of health-care providers forearly detection of, screening for, intervention in and management of behavioural addictions; and serveas an online repository for reliable information on behavioural addictions for the general public.

Post-disaster mental health and psychosocial support: experience from the 2015 Nepal earthquake

On 25 April 2015, an earthquake of magnitude 7.8 struck Nepal, which, along with the subsequentaftershocks, killed 8897 people, injured 22 303 and left 2.8 million homeless. Previous efforts to provideservices for mental health and psychological support (MHPSS) in humanitarian settings in Nepal have beenlargely considered inadequate and poorly coordinated. Immediately after the earthquake, the Governmentof Nepal declared a state of emergency and the health sector started to respond. The immediate responseto the earthquake was coordinated following the Inter-Agency Standing Committee (IASC) cluster approach.One month after the disaster, integrated MHPSS subclusters were initiated to coordinate the activities ofmany national and international, governmental and nongovernmental, partners. These activities were largelyconducted on an ad-hoc basis, owing to lack of focus on MHPSS in the health sector’s contingency plan foremergencies. The mental health subcluster attempted to implement a mental health response accordingto World Health Organization and IASC guidelines. The MHPSS response highlighted many strengths andweaknesses of Nepal’s mental health system. This provides an opportunity to “build back better” throughreform of mental health services. A strategic response to the lessons of the 2015 earthquake will deliver bothimproved population mental health and increased preparedness for the future

Depression and physical noncommunicable diseases: the need for an integrated approach

Depression is globally the third-leading cause of disability in terms of disability-adjusted life-years. Depressionin patients with diseases such as cancer, diabetes mellitus, stroke or cardiovascular disease is 2–4-foldmore prevalent than in people who do not have physical noncommunicable diseases, and may have amore prolonged course. The significant burden due to depression that is comorbid with chronic physicaldisease, coupled with limited resources, makes it a major public health challenge for low- and middle-incomecountries. Given the bidirectional relation between depression and chronic physical disease, the clear wayforward in managing this population of patients is via a system in which mental health care is integratedwith primary care. Central to this integrated approach is the Collaborative Care Model, adapted to the localsociocultural context. In this model, care is jointly led by the primary care physician, supported by a casemanager and a mental health professional. Various successful initiatives in low- and middle-income countriesmay be used as templates for collaborative care in other low-resource settings. The model involves a rangeof interwoven components, such as capacity-building, task-sharing, task-shifting, developing good referraland linkage systems, anti-stigma initiatives and lifestyle modifications. Policies based on adoption of thisapproach would not only directly address depression that is comorbid with physical noncommunicabledisease but also facilitate achievement of Sustainable Development Goal 3, to “ensure healthy lives andpromote well-being for all at all ages”.