TW: Mention of suicide

Nepal Mental Hospital: 1166

TU Teaching Hospital Suicide prevention line: 16600121600

Patan Hospital suicide helpline: 9813476123

According to the WHO, mental health is determined by a complex interplay of individual, social, and structural stresses and vulnerabilities (World Health Organization: WHO. “Mental Health.” www.who.int, June 2022). It is impossible for us to truly understand this interplay if we, as a society, do not bring up the conversation of mental health as individuals. WHO also states that 1 in 8 people live with a mental health disorder and most people do not have access to effective care when treatment and prevention options exist.

This article aims to uncover more about mental health in Nepal. This includes the current status of help available for mental health management, challenges that arise in accessing help for mental health, societal attitudes towards it, etc. through research and interviews from individuals working in the mental health field.

Data showed that during the 2019 – 2020 period, 6252 Nepalese committed suicide. The number then increased to 7141 in the year 2021 (which is around 19 people per day). A lot of this was due to financial stress during the pandemic where families felt they had no option but to end their lives as they could not sustain themselves much longer. An unfortunate instance of this in the year 2022, was the attempted suicide by a family of five in the Dandapauwa, Nagarjun district. The family had attempted suicide by drinking poison. When discovered, the family was taken to the hospital for treatment. All members of the family survived except for a 33-year-old member who died during treatment.

In many cases, suicide is associated with mental illnesses such as bipolar disorder, depression, schizophrenia, etc. But there are other social factors like unemployment, conflict, labor migration, and displacement that are a growing problem and cause stress to people which can cause feelings of hopelessness and suicidal thoughts.

In an interview with the Himalayan News Service, Ritesh Thapa, the director and consultant at Rhythm Neuropsychiatry Hospital and Research Centre stated “Growing frustration due to political instability, unemployment, failure in exams, financial problems, extramarital affairs, and complex modern lifestyle are also pushing youths to commit suicide. There are multiple factors for one to commit suicide. However, it is preventable if proper counseling, treatment, and care are given.”

Approaching the topic of treatment, there are many reasons Nepali people cannot access or opt not to seek mental help treatment. A nationwide prevalence survey of suicidality was conducted between January 2019 and January 2020. The highest prevalence of a lifetime mental disorder among adults was found in province – 1 at 13.9%. There were other regions such as province 2 where mental health issues were reported to be rare. However, Megnath Dhimal, the senior research officer at the National Health Research Council stated that it is unlikely that people do not have mental health issues but the majority of them are unaware of the concept of mental health and do not believe in sharing their issues as they believe in stigma associated with mental health disorders.

Furthermore, only 40% of people with admitted mental health issues confided in their spouse or close family member about them. According to the survey, only 6.5% of individuals visited a psychiatrist, 0.2% consulted psychologists and 0.3% consulted counselors for help. The majority i.e 8.8%, and 6.7% of individuals reached out to non-specialist medical practitioners and faith healers respectively.

Aawaaj News reached out to Dr. Nidhi Thapa, who is a lecturer in the Department of Psychiatry in Nepal Medical College and a consultant psychiatrist at Chhetrapati Hospital. In the interview, she discussed the attitudes people hold towards mental health treatment and disorders currently. She mentions that the stigma surrounding mental health has reduced a lot and people are changing their mentality towards mental disorders, viewing them as legitimate and valid. However, as discussed along with the statistics above, most people are still unwilling to reach out for help. Doctor Thapa revealed that people struggling mentally choose to ignore symptoms of mental disorders and prefer to simply “deal with it” alone. People are quick to view mental struggles as a “weakness” and patients or families of patients are often in denial of their deteriorating mental conditions. Dr. Thapa mentions that people in their early 20s to 30s are the most frequent visitors in the hospital at the moment. She added that migrant workers who are showing signs of stress and mental illness have also increased during the recent Dashain season.

Moving on to the affordability of mental health care in Nepal, the National Mental Health Survey’s Fact Sheet in 2020 suggests that the yearly average expenditure on the treatment of mental disorders was Rs 23,659 (with associated costs). The GDP per capita is around 1208 USD as of 2021 so citizens would be expected to pay a sizable 15% of their yearly income towards mental healthcare. In the context of Kathmandu, a 45 to 60-minute session can cost around Rs 1000 or above. Cognitive behavioral therapy or psychological counseling is a long-term treatment process meaning a client has to make several appointments to make progress and prevent relapse. Counseling sessions can often be uncomfortable and sharing problems with a stranger, (medical professional or not) can make one feel vulnerable. Finding the right counselor as an individual can also be a taxing mission. As you can imagine, with money and time being such important resources, mental health care may not end up a priority in most of our lives.

So what is the future of mental healthcare for Nepalese looking like? In terms of laws, the Constitution states that citizens are guaranteed the right to remain mentally sound and live a dignified life. The aim of this was to ensure accessible basic mental health services for all; train a sufficient workforce to provide mental health care and psychological services; protect the human rights of people with psychological disabilities and mental illness; promote public awareness of mental health and combat stigma against mental illness; and develop information systems and research. In the year 2018, a new policy for mental health was proposed which was drafted in line with the constitution. The five-part policy had the same objectives and an additional statement issued by the Ministry of Health to separate the budget to provide on a federal and provincial level based on the burden of mental illness and for promotional, preventive, remedial and rehabilitation measures.

However, this remains a far future for us Nepalese as in larger cities, statistically, there are around 0.22 psychiatrists and 0.06 psychologists per 100,000 people. Even with policies to create a mental healthcare plan at a district and local level, there is a lack of supervision for the existing plans. This is evident through the high costs of mental health care, the lack of psychotropic medicines available in the country, and a huge lack of manpower in the mental health field as well as the overburden and exhaustion our existing mental health workers carry.

Some strategies discussed to implement the Mental Health care plan is increasing access to a wider variety of psychotropic medicines and appointing a senior-level officer to facilitate projects, execute policies, and collaborate with national health training centers to recruit and educate mental health workers.

When Dr. Thapa was asked how necessary it is for people to know more about their mental health, she stated that “mental health is associated with how you think, which is associated with how you feel and ultimately, how you behave”. She stated that mental health was overlooked in the past but it is time for us, Nepalese, to realize that it is just as important as physical health. Besides this, having mental illness can make one more prone to physical illness and vice versa so it is important to take care of both aspects. She commented on how our once, collectivist community is changing rapidly to our new lifestyle choices. For example, the culture of a joint family is now rivaled by the creation of nuclear families.

In such moments, it becomes more important to take care of our mental health and manage emotions. Dr. Thapa suspects that there will be a great need for mental health help in the near future and warns of a mental health crisis if people do not opt to seek mental health care and the number of mental healthcare workers and institutions does not increase. She states that compromising on mental health is a compromise in the overall quality of life for us citizens. Besides this, the country is also at risk of losing confident, healthy, and motivated citizens who can help the country prosper and head towards development.

In conclusion, here are some steps Dr. Nidhi Thapa suggests you can take as an individual to take care of your mental health:

Try to maintain a good diet and get 8 hours of sleep

Try yoga stretches and working out 4 days a week (or more)

Practice meditation and mindfulness

Try to take out at least 10 – 15 minutes a day doing an activity that brings you joy

Practice gratitude by journaling and listing things you are grateful for

Spend time with family, friends, or loved ones and reduce screen time

Minimize alcohol intake

Educate yourself on mental health terms

Offer help to friends/ family if you see signs that they are struggling with maintaining their mental health

If you can afford it, seek professional or medical help if you are struggling