Drug addiction is rife in Nepal, with a high relapse rate following treatment. Apart from basic psychosocial support, there are no evidence-based aftercare services for individuals in recovery. Recently, mindfulness-based interventions have shown promising results in preventing relapse. We discuss the context, challenges and opportunities of organising a 2-day intensive face-to-face mindfulness-based training for Nepalese mental health professionals to facilitate 8-week mindfulness-based relapse prevention (MBRP). Altogether, 24 participants completed the feedback questionnaire. Most were rehabilitation staff, along with a few psychologists and psychiatrists. Feedback suggested a high degree of satisfaction and provided comments to improve the programme. It has prompted us to design online MBRP training and set up a feasibility study for an MBRP programme in Nepal. If successful, this may help a huge number of individuals in recovery.

This article appraises cultural understanding and controversies regarding hikikomori (prolonged social withdrawal), with reference to research over the past 20 years. Initially viewed as a uniquely Japanese phenomenon, hikikomori is now recognised globally, prompting a re-evaluation of its cultural, psychological and socioeconomic demographics. A revision in lifestyle after the COVID-19 pandemic and ongoing technological advancements – particularly the rise of social media, gaming and the internet – have paradoxically both exacerbated isolation and provided new forms of social interaction for young adults who confine themselves at home. This phenomenon underlines the complex interplay between putative individual psychopathology, neurodiversity and broader societal shifts across the globe.

Commonly occurring mental health disorders have been well studied in terms of epidemiology, presentation, risk factors and management. However, rare or uncommon mental health disorders and events are harder to study. One way to do this is active surveillance. This article summarises how the Royal College of Psychiatrists Child and Adolescent Psychiatry Surveillance System was developed, as well as the key studies that have used the system and their impact, to make the case for a wider international surveillance unit for child and adolescent psychiatry. Keeping this surveillance active in different populations across the globe will add to existing knowledge and understanding of these uncommon disorders and events. This will in turn help in developing better frameworks for the identification and management for these disorders and events. It will also facilitate the sharing of ideas regarding current methodology, ethics, the most appropriate means of evaluating units and their potential applications.

Uzbekistan's mental health system is undergoing significant reform aimed at improving care and service delivery. This article provides a comprehensive evaluation of the current state of Uzbekistan's mental health system using the WHO 2010 monitoring and evaluation framework. It also details ongoing reforms designed to address systemic issues, enhance mental healthcare and ensure better health outcomes for the population.

This perspective article addresses the critical issue of equitable access to sustainable healthcare services for children with autism spectrum disorder (ASD). Despite the increasing prevalence of ASD globally, significant disparities persist in accessing appropriate healthcare services. The lack of comprehensive data on autism prevalence and incidence in many regions further exacerbates this challenge, hindering the development of targeted interventions and equitable resource allocation. This paper sheds light on barriers to equitable access, including geographical disparities, cultural stigma, communication barriers and inadequate training of healthcare providers. Strategies for achieving sustainable solutions are proposed, including the expansion of telehealth services, financial assistance programmes, competency training, community-based support programmes and investment in high-quality research. By addressing these challenges and implementing evidence-based interventions, we can work towards ensuring that all children with autism have access to the healthcare services they need for optimal development and well-being.

Through their study, George Ikkos & Nick Bouras reveal that the responsibilities of the psychiatric community are increasingly complex, especially amid the onslaught of globalisation and the confines of neoliberalism. ‘Metacommunity’ in this context refers not only to the history of psychiatrists but their role in strengthening and influencing mental health policies. A number of challenges continue to emerge in the public sphere, highlighting the need for psychiatry to adapt to society's evolving demands for inclusivity, equity and ethical governance. These challenges emphasise the importance of shaping the future of psychiatry that is responsive to the complexities of mental health care and aligned with democratic principles that prioritise transparency and social accountability. We have added several aspects that could complement psychiatrists' future theory and practice, including a more collaborative and evidence-based approach to dealing with increasingly complex mental health issues.

Mental health apps (MHAs) are increasingly popular in India due to rising mental health awareness and app accessibility. Despite their benefits, like mood tracking, sleep tools and virtual therapy, MHAs lack regulatory oversight. India's framework, including the Central Drugs Standard Control Organization (CDSCO) and Medical Device Rules 2017, does not cover standalone health apps, raising concerns about data privacy and accuracy. Establishing a centralised regulatory body with guidelines for MHAs is essential for user safety and efficacy. This paper examines the current regulatory landscape, compares international approaches and proposes a tiered regulatory framework to foster responsible innovation while safeguarding user interests in digital mental health services.