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In this debate the focus is on suicide which is a complex maze, wherein multiple parameters intersect. The first part of the paper questions many basic premises which have been taken as given in the discourse of suicide and currently form the substrate of conversations around suicide. The basic premise is that this societal problem has been expropriated by health professionals. They have assumed ownership without having the wherewithal to address the many contributory factors to suicide – social, economic, cultural, and moral. Suicide prevention plans are ritually rolled out despite a consistent record of repeated failures. There is a need to move against the tide and reimagine the subject in light of macrolevel evidence. The second part posits that for an issue as complex as suicide, it is important to think inclusively rather than looking for simplistic answers in either/or way, and the larger societal, economic and even political issues will need to be factored in.

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Background: While the social security programs offer financial assistance to patients with severe mental illness in high-income countries, no such systems exist in low- and middle-income countries. During recent years, poverty alleviation programs have been found to alleviate poverty in many countries. However, such programs have not been tried in persons with severe mental illness. We report 1-year outcomes of a microfinance program to alleviate poverty in patients with schizophrenia in a low-income country. Objectives: The objectives were to assess the feasibility and acceptability of a poverty alleviation program and to study the effect of the program on clinical and financial variables. Methods: Twenty-five (25) unemployed, young persons (19–35) with severe mental illness living with the family were recruited into a microfinance-based poverty alleviation program. Feasibility was assessed through recruitment and retention. Psychopathology and functioning were assessed through Positive and Negative Syndrome Scale (PANSS), Brief Psychiatric Rating Scale, and Global Assessment of Functioning at baseline and 12 months. Results: The program was feasible and acceptable, with excellent recruitment and retention rates. There were statistically significant improvements in PANSS-positive symptoms (P < 0.000), PANSS-negative symptoms (P < 0.000), PANSS-general score (P < 0.000), and functioning (P < 0.001). At 12 months, participants earned an average of $USD 40/month, with an average of $USD 10 spent on medication, $USD 12.5 on loan repayment, and $USD 17.5 contribution to family living. Conclusions: Poverty alleviation programs can be used to help younger persons with severe mental illness. However, this study has numerous limitations, and there is a need to conduct definitive trials in this area.

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Objectives: The objective of the study was to describe the prevalence and characteristics of disabilities attributed to mental disorders and their distributions in China, and to explore the determinants of disabilities attributed to the mental disorders. Methods: The current study is secondary data analysis for the Second National Sample Survey on Disability. The determinants of disability were assessed by applying the univariate and multivariable regression analysis. Results: Among 2,526,145 participants sampled in the survey, 15,928 participants were diagnosed as having disabilities attributed to mental disorders. The prevalence of disability attributed to mental disorders was 0.63%. Among 46,886 participants with single physical disability, 446 had comorbid mental disability, and the rate of physical disability with comorbid mental disability was 0.94%. The risk factors associated with coexisting mental disability in persons with physical disability included female gender, 30–44 and 45–59 years age groups, being unmarried, widowed or divorced, and urban background. Schizophrenia, autism spectrum disorder, and mental and behavioral disorders due to psychoactive substance were the main disorders associated with mental disability. Conclusions: Disabilities attributed to mental disorders in China should receive more attention. It is important to treat mental disorders for preventing the associated disability and develop related rehabilitation in China.

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Schizophrenia and related psychotic disorders cause significant disability and burden. Majority of these patients receive minimal psychosocial care. Globally, there has been explosive growth of telecom network with high internet penetration even in low-resource settings like India that has the second largest network in the world. Mobile apps for these patients have been designed in high-income countries. The studies from low and middle-income countries are lacking. Over this background, we aimed to develop a mobile app for patients with schizophrenia and related disorders for a funded project by an interdisciplinary team comprising of mental health professionals and computer science engineers. The plan was to conduct focused group discussions (FGDs) to assess needs and viewpoints of the stakeholders, followed by designing of text-based modules that would be digitally transformed into mobile-based application for use by the intended participants. Six key domains were identified in FGDs for intervention: medication adherence, activities of daily living, promoting physical health, engagement in meaningful work, building of social and support networks, and psychoeducation. We developed a mobile app (Saksham) for both patients with schizophrenia and their caregivers in English and Hindi. The development process was complex and passed through many phases. Saksham app was subsequently deployed in the research project. In this paper, we document the process of designing the mobile app with an aim to guide future developers and sensitize them about the inherent complexities in this endeavor.

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Background: Motherhood is a unique phenomenon and not uncommon in women with severe mental illness (SMI). However, little attention has been paid to the voices of these mothers with SMI as to how they navigate it. A qualitative exploration with a social constructivist paradigm was used to understand lived experiences of mothers with SMI during the child-rearing period. Methods: The study used a qualitative design with social constructivist paradigm to obtain data from 30 mothers with SMI who had children <5 years of age. One-to-one in-depth semi-structured interviews were conducted with transcription, and inductive thematic analysis was used to explore transcripts using Charmaz's grounded theory. Triangulation and respondent validation were used to ensure rigor. Results: Emergent categories (themes) were thoughts/feelings about childbearing (considering children as prized and long-awaited possession, motherhood as “therapeutic,” concerns about child's mental health), the impact of mental illness (problems in emotional bonding, separation from children, improved healthcare to serve the maternal role), unmet needs (support groups, empathy, responsibility-sharing, home-based treatment), and caregivers' reactions (blame, discrimination, institutionalization for mental healthcare, custody-related threats). Motherhood as a central part of their identity and burden of balancing “childcare and mental illness” was the overarching categories. Conclusion: The complex emotional journey of a mother with SMI from child-bearing to child-rearing is fraught with many challenges. Developing sensitive and tailored mental health care interventions and policies for them needs to include their own voices, which will improve maternal-child bonding as well as service utilization.

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Background: People who Inject Drugs (PWID) show higher rates of comorbid psychiatric illnesses than the general population. We aimed to assess the rates of different psychiatric disorders and substance dependence among PWID in the state of Delhi, India. Methods: We conducted a community-based, cross-sectional study interviewing 104 adult male participants receiving various harm reduction and HIV prevention services. A semi-structured questionnaire assessed socio-demographics, drug use and injecting patterns, and opioid overdose experience. Mini-International Neuropsychiatric Interview Version 7.0.2 (for screening and diagnosing major psychiatric disorders), World Health Organization-Alcohol, Smoking, and Substance Involvement Screening Test for the pattern of other psychoactive substance use were used. Results: The mean age of participants was 27.9 years. The predominant opioid injected in the last 1 year was heroin. About 52% of participants had at least one psychiatric illness during their lifetime. Antisocial personality disorder (25%) was the most common psychiatric illness followed by suicidality (23.1%). About 23.1% had more than one psychiatric comorbidity other than substance use disorder. Being unskilled (χ² = 11.39; P = 0.03), having early mean age of tobacco onset (t = −2.416; P = 0.02), longer duration of tobacco (t = 2.033; P = 0.04), alcohol (t = 2.204; P = 0.03) use, less abstinent attempts for opioid use (χ² = 5.003; P = 0.03), longer duration of injecting drug use (t-test = 2.437; P = 0.02), higher vein-related complications (χ² = 9.27; P = 0.02), high HIV positivity rate (χ² = 8.54; P = 0.01), and high rates of nonfatal opioid overdose over lifetime (χ² = 4.87; P = 0.03) were significantly associated with having lifetime psychiatric illness. Conclusion: Our study found high rates of psychiatric illnesses and the use of other psychoactive substances among PWID from India. There is an urgent need to incorporate mental health services into the existing HIV prevention services directed at PWID in India.

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Background: Japan entered an aging society in the late 1990s. The aging of inpatients in psychiatric hospitals has increased the need for medical care, but the actual situation has not been fully investigated. Objectives: We investigated the actual situation of in-hospital deaths through death certificates. Methods: The survey was conducted at 15 of 26 psychiatric hospitals in Tochigi Prefecture, Japan that consented to the survey. We examined the death certificates of patients who died between 1996 and 2015 at these 15 hospitals. The number of the certificates was 2441 (1443 males and 998 females). The number of deaths and the average age of death per year were calculated. Then, we surveyed the data regarding the diagnosis of death described in the death certificates based on the International Classification of Diseases-10. Results: The average age of death was in the 60s from 1996 to 2000 in the first 5 years, but since 2001, it has exceeded 70 years. Respiratory diseases accounted for 40% of the total, cardiovascular diseases for 26%, and malignant neoplasms for 11%. On the other hand, extrinsic death such as suffocation was 4%, and suicide was 1%. Conclusions: The reason of the elevation of death age might be related to the implementation of novel antipsychotics in Japan since 1996 and the establishment of the long-term care insurance system for the elderly in 2000. It is considered that the reasons why respiratory diseases, cardiovascular diseases, and malignant neoplasms occupy the top ranks of death are that these diseases have a high risk of death in the elderly.

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Background: Mental Healthcare Act (MHCA) has been implemented on May 29, 2018. Patients with mental illness show high rates of medication nonadherence as well as human rights violation. Hence, it is important to study the impact of this new law on persons with mental illnesses (PMI) and the human rights awareness with emphasis on the two modes of admissions, i.e., supported and independent. Aim: Influence of MHCA, 2017 on medication adherence in patients with severe mental illness (SMI) admitted under-supported and independent category and its correlation with human rights awareness of PMI. Material and Methods: Patients diagnosed with SMI (NIMH definition, 2006) were admitted to the psychiatry ward. Baseline sociodemographic, psychopathology severity, global functioning, adherence rates, insight, and human rights awareness were assessed. Patients were divided into independent and supported groups. Weekly assessments were done during admission, subsequent assessments were done post discharge at week 1 and week 6. It was a prospective follow-up in design. Results: A total of 65 patients were included. The emotional needs dimension of human rights showed P < 0.01 at baseline as well as final follow-up. Statistically significant correlation was seen in human rights awareness and adherence at baseline in the independent admission group (IAG). Medication Adherence Rating Scale (MARS) score and Clinician Rating Scale score were lower (4.29 ± 2.13; 4.06 ± 1.73 and 3.38 ± 1.98; 3.26 ± 1.91) in supported admission group (SAG). Insight showed a statistically significant higher value in IAG than SAG (12.80 ± 7.26 and 8.18 ± 6.96) at baseline. Conclusion: No significant difference could be seen in illness specifiers and adherence patterns between the two groups. Findings reflect statistically lower fulfillment of emotional needs in SAG and positive correlation between medication adherence and human rights awareness. Therefore, adherence is an important determinant of human rights awareness.

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Coronavirus disease 2019 (COVID-19) disease led to the disruption of many nonessential activities in health care across the globe including various non-COVID-19-related research activities. Various issues need to be addressed while conducting research during the pandemic. It is important to ensure the social and scientific value of research while ensuring to maintain ethical standards of the research. Taking the informed consent is of utmost priority irrespective of the platform of research. Any deviations from the protocol must be informed to the ethics committee. The confidentiality and privacy concerns should also be maintained higher up in the priority. Other concerns include regular audits with the management of the data, managing the workforce while ensuring their safety, handling administrative issues, and addressing researchers' burnout. During the pandemic, the research could either be conducted online or offline with both researchers and participants following covid-related protocol such as wearing mask, maintaining safe social distance, and maintaining hand hygiene. During the pandemic, authors were working on three funded research projects. The pandemic period can be divided into two phases in India: March 2020 to February 2021 and April 2021 to August 2021. During the first phase, our research activities proceeded in three stages. First stage (March 2020–May 2020) was characterized by uncertainty and complete stoppage of work. In second stage (Jun 2020–Sep 2020), work was done in online mode with recalibration of goals. In third stage (October 2020–March 2021), physical working had started with certain restrictions. During the second phase, all stages were shorter.

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Background: Elderly, a high-risk population for COVID-19, are further vulnerable to mental health sequelae due to several pandemic-related restrictions. This study aimed to assess fear and information-seeking behavior related to COVID-19 among older Indian adults. Methodology: It was an online, observational cross-sectional study. An open-access e-invite to the questionnaire (on Google forms) was circulated through social media. The form contained sociodemographic details, fear of COVID-19 scale (FCV-19S), and an original questionnaire on information-seeking behavior in COVID-19. Responses of adults ≥60 years of age were noted. Analyses were done with SPSS v20, and Mann–Whitney U test was used to compare the FCV-19S scores among information-seeking variables. Results: A total of 150 completed responses were obtained. Mean age of respondents was 67 ± 5.44 years; median FCV-19S score was 11; 9.33% of respondents had significant fear of COVID-19. TV/Radio (55.3%) followed by newspaper/magazines (40.7%) were the most preferred source of information. Preventive measures (75.3%) and symptoms of disease (70%) were the most sought-after information. Those who spent more time than intended searching for information have significantly higher fear scores (P = 0.025). There was no significant difference in fear score for other parameters of information-seeking behavior and its consequences. Conclusion: Less than 10% of study population of older adults had a significant fear of COVID-19. Information sought is mostly on symptoms of disease, preventive measures, and guidelines and sought through passive sources rather than active searching or in-person. Those with higher fear scores are likely to spend more time searching for information than intended and are less likely to perceive any dysfunction due to said behavior.

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The psychological assistance of a person requires a certain number of competencies: psychiatric competencies to comprehend neuropsychiatric disorders and psychotherapeutic competencies to discern psychological disorders or psychological suffering plus being able to take into account the social determinants. The author describes all the different approaches when it comes to provide ethical answer and help concerning migrants and refugees, focusing on social determinants and cultural references, without the risk of the stigmatization. All scientific approaches are available and it is important to insist on the necessity to train mental professionals to master this complex psychotherapeutic setting and to keep in mind a person centered approach.

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The COVID-19 pandemic of the last 2 years has changed everything about life. There is wide recognition that following the pandemic, the world will be a different place than it was. The social factors have come to the forefront with regard to the vulnerabilities to infection, severity of illness, access to medical care, hospitalization, intensive care unit care, mortality, post-COVID complications, and work and social lives. The pandemic has held a mirror to the social situations of countries and communities. It also provides opportunities for the application of principles and practices of social psychiatry to build resilience of individuals, families, and communities.

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has completely changed how the world looks at medicine. Unfortunately, the larger focus has been on the physical health only – epidemiology, clinical features, prevention of transmission, and management and there is very little focus on mental health and stigmatization. The 2019 coronavirus disease (COVID-19) has caused universal psychosocial impact by causing emotional disturbances, economic burden, and financial losses on a massive scale. Effects such as posttraumatic stress disorder, depression, anxiety, obsessive–compulsive symptoms, and insomnia in the post infection period have been reported among COVID-19 survivors. With disease progression, clinical symptoms become severe and infected patients may develop psychological problems. With exponential growth in the number of daily COVID-19 cases since March, 2021, India reported more than 400,000 new cases daily on May 1, 2021. India's COVID-19 surge could have become a regional disaster impacting all of south Asia. However, India has successfully avoided that disaster by strengthening the surveillance systems, imposing travel restrictions, lockdowns, and mandatory travel quarantine for individuals returning from infected areas. These were necessary to control the spread of SARS-CoV-2. The situation in India required urgent, bold measures and close cooperation between India and the global community. Currently, free vaccinations for the whole population are being given. With 1.4 billion people, this is going to be a massive effort. The pandemic and the aftermath need a paradigm shift from our traditional medical care models to one that is person centered. A person-centered model of care will be best solution here and all across the world. This is especially so, when we are fighting a disastrous pandemic.

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Multimorbidity is the co-occurrence of more than one chronic condition. Multimorbidity is likely to rapidly rise in the lower- and middle-income countries (LAMICs). Multimorbidity involving noncommunicable diseases and mental illness negatively impacts the quality of life and clinical recovery in both conditions. Most health systems and programs cater to single diseases. In this article, we discuss the extent of the problem, potential challenges, and opportunities with focus on LAMIC exemplified by India. Integration of care is required in the context of multimorbidity. These can be provided in the existing national programs in India. Service provision needs to become personal recovery oriented. Service users should be engaged in the development of services and research in this area. Existing models emphasize on self-management/self-care and provider–patient partnership. These need to be adapted and tested for feasibility in LAMIC.

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Departing from the notion that psychiatry as a discipline renovates through invention, innovation, and transformation, this paper presents an approach to the syncretic characteristics of Ibero-American psychiatry stressing the essential role of translation in the reception, adoption, and implementation of knowledge and practices developed in other regions of the world. This applies both to scientific and humanistic dimensions of psychiatry, considering that as a praxiology or science of actions deals with embodied persons embedded in cultures that need to be considered in the process of diagnosis, treatment, and prevention. This involves translational humanities considering that basic axioms concerning human nature need a reflective equilibrium between beliefs, constructs and real conditions of practice. The innovations put forward by Ibero-American psychiatry, and expressed through modifications in institutions and concepts, can be studied against the background of the moral determinants of health, a comprehensive concept beyond the usual conceptualization of social determinants. The limitations imposed by scarce resources, shortage of trained practitioners, political instability, poverty, and economic dependence are a reminder that the challenges ahead are not only technical but moral as well.

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India is one of the oldest civilizations in the world and has a rich cultural heritage. Ancient Indian scriptures (Vedas, Upanishads, and Bhagavad Gita) and epics (Ramayana and Mahabharata) are a great source of knowledge. Some of the principles, described in these texts, have applicability to the discipline of psychiatry in the contemporary scene. Ayurveda, the Indian system of medicine with history dating back to the Vedic period, also recognizes mental disorders, giving their descriptions, and explaining their etiology and management. Bhagavad Gita has given detailed description of crisis management and dealing with anxiety, stress, and depression and elucidated the principles of psychotherapy. Buddhism, one of the religions with origin in India, describes the principles of meditation and ways of dealing with stress and anxiety. Yoga, an important gift of ancient India, has been found to be effective in the management of anxiety and psychosomatic disorders. Various meditation techniques practiced today make the use of principles that date back to ancient India. Epics such as Ramayana and Mahabharata include multiple descriptions of dealing with stress and mental health issues which have relevance in the contemporary psychiatry. The methods of stress and crisis management as described in the ancient Indian literature have also applicability in dealing with certain mental health issues during the crisis situations such as the COVID-19 pandemic.

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Health and well-being of medical learners' is important in itself and is a necessary precondition to good patient care. Medical learners suffer from high levels of mental illhealth due to challenging demands and pressurized learning/ work environments. These factors are aggravated by learners' tendency to avoid seeking help and support when unwell or under pressure and by a perceived stigma among them about mental illness. Many pressures that threaten learners' well-being as well as the health and effectiveness of the organisations in which they learn are systemic. While certain initiatives have been implemented to improve the ability of medical learners' to withstand pressure, fundamentally many of the modifiable risk factors for poor mental health and wellbeing have not been addressed. It is becoming increasingly clear that successful interventions to tackle learners' mental ill-health would have to be multidimensional, aimed at multiple levels and involve multiple stakeholders. Leaders of organizations designing interventions must improve learning/ work cultures to emphasize the importance of looking after one's own health, to normalize discussions of struggle in the context of educational/ work challenges, and to understand how and when to seek help. Finally, it may be mentioned that the evidence base for individual and systemic interventions to improve medical learners' well-being and mental health is very limited, hence there is need for much research to help develop new approaches to medical learners' mental health and wellbeing.

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India is a large country with a huge population, high mental illness burden, and a substantive treatment gap, with inadequate infrastructure, human resources, and funding related to mental health care. Given this challenging scenario, innovations utilizing social psychiatric principles have come from the government sector, nongovernmental organizations, and like-minded professional associations. The focus has been on integrating mental health care with primary health care, reducing stigma, early detection, enhancing access to affordable care, continuity of care, and promoting recovery and social integration. Digital technology is being increasingly explored to partly further these goals. Although there have been appreciable improvements, there is a long way to go!

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Early Career Psychiatry (ECP) sections have had a considerable impact on the way psychiatric associations function around the world. Early inclusion and participation of young professionals in an association's activities often is beneficial to both the participants and objective of the Association. The World Association of Social Psychiatry (WASP) has incorporated activities for early career psychiatrists uring many of its Congresses right from the early days. This article will look at the evolution of the ECP section of the WASP, its vision, the activities, and the need for a potential shift in the way early career organizations function around the world. It also highlights the WASP-ECP section program held in the recent WASP Asia Pacific Hybrid Congress 2021.

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