Sir: The Second International Conference of the Psychiatrists' Association of Nepal (PAN) was held on 13-14 November 1999 in Kathmandu. The lecture entitled ‘Mental Health at the Doorsteps’ marked the PAN journal launch. The conference centre was a large hotel where hospitality was generous, and the gardens provided a relaxed setting for networking.

Delegates from Asia, Australia and Britain attended. The topics included: mental health in women; psychiatric training of health workers and its evaluation; liaison with traditional healers; child psychiatry in the context of a changing culture; substance misuse, and mental health needs of a growing elderly population.

Many speakers referred to two major constraints on mental health care delivery: the very small number of psychiatrists (20 for a population of 21 million) and the provision in remote areas. The introduction of telepsychiatry to overcome these constraints was canvassed and debated. The expenditure required for the network could be offset by the consultation costs for patients and their relatives who customarily accompany a patient (cost of journey, food, accommodation, loss of income during travel and the hospital attendance — it is common to travel for several days for an appointment). Reduced patient-doctor contact was a concern regarding telepsychiatry, however, it should not be seen as a substitute for psychiatric consultation and teaching, but as a pragmatic alternative to the absence of service provision in remote areas.

The Kathmandu Valley provided an unforgettable setting. This will be an annual event and information can be obtained from the Mental Health Resource Centre, e-mail: sregmi@health-net.org.np.