Mental Health in Nepal: A Call to Action to shrink suicide rates

Mental health is a crucial part of our overall well-being. It affects how we think, feel, and act every day. It plays a big role in how we handle stress, face challenges, and perform at work, and it impacts our personal, professional, and social lives.

Mental health includes our emotional, psychological, and social health. It’s about our thoughts, feelings, and actions as we go through life. It shapes how we deal with stress, connect with others, and make decisions. The concept of Mental Health can be best understood as a spectrum, ranging from being mentally well to being mentally ill. This spectrum acknowledges the dynamic nature of our mental well-being, indicating that our mental health can vary greatly over time and influenced by a multitude of factors involving biological factors like genetics, life experiences that are traumatic and stressful, psychological factors such as low self-esteem, and environmental factors like poverty or violence.

Mental Health Spectrum

While developed nations like Australia and the US have recognized the importance of mental health, providing extensive services and resources, the scenario in underdeveloped countries like Nepal starkly contrasts. Despite its natural beauty and rich culture, Nepal grapples with challenges such as corruption, political instability, inadequate education, healthcare services, and a lack of opportunities, all of which invariably affect the mental well-being of its citizens. The concept of mental health remains young in Nepalese society, backed by stigma and misinformation. Discussions on mental health are taboo, and those experiencing mental health issues are often viewed as weak.

The significant misunderstanding and lack of awareness about mental health create obstacles for those suffering from mental illness to seek help or get the right care. There are primarily two kinds of barriers: stigma-related barriers, where individuals with a mental disorder hesitate to speak up due to fear of judgment or negative reactions from their family or society. The other is non-stigma-related barriers, where individuals prefer to deal with their issues alone, hoping problems will resolve by themselves. In both situations, individuals tend to keep their struggles private and avoid seeking help, which can lead to worsening conditions like anxiety and severe depression, and tragically, may lead some to consider taking their own lives. Unfortunately, in Nepal, the issue is so prevalent that almost everyone knows someone who has taken their own life.

The National Mental Health Survey of 2020 reveals a concerning statistic: nearly 80% of people in need of mental health care do not receive it. Further distressing information comes from the Nepal Police, indicating that the annual increase in suicide rates over five years (2015–2020) in Nepal was 7.2%, which then doubled to 14% in 2021.

Data taken from WHO’s report on Suicide Prevention in Nepal

The data visualization clearly indicates that the trend of suicides in Nepal has been consistently rising. Nepal holds the 17th position globally for male suicide rates and the 3rd for female suicide rates, making it the leading cause of death for women aged 15–49. Women in Nepal are estimated to attempt suicide three times more often than men, with reasons largely tied to sociocultural factors and gender inequality, including interpersonal conflicts, marital disputes, relationship issues, and social exclusion. Furthermore, studies reveal a chilling fact: 60% of women who died by suicide had experienced physical abuse in the three months leading up to their death.

So, what leads to these troubling statistics? Several factors contribute, each as critical as the next. Here are some of the major reasons for the collective mental health challenges facing the entire country:

1. Policy Framework and Infrastructure: Although Nepal’s government established a National Mental Health Policy in 1997, its implementation has been lacking. While mental health legislation exists, there’s a void in long-term strategies and programs for mental health. Insufficient funding has been allocated to address mental health issues effectively. In partnership with the WHO, the Nepalese government launched the Suicide Helpline number ‘1166’ in September 2020, which became fully operational in May 2021. However, there’s still a need to raise awareness about this helpline and to build trust among the population.

2. Mental Health Services: The majority of mental health services are institution-based, lacking a holistic treatment approach that includes community care and specialized care. Various NGOs offer community-based mental health services, yet there’s a shortage of training and engagement of community volunteers. Traditional healers and religious leaders often serve as the primary source of mental health treatment due to a lack of awareness and the non-integration of mental health knowledge in sectors outside of health, such as education, social services, welfare, and sports. There’s a significant gap in the availability of mental health services, including a lack of hospitals specifically for children and the elderly. Only 450 mental health beds are available nationwide, equating to 1.5 beds per 100,000 people. Additionally, essential psychotropic medications are missing from the free drug list, and there’s an absence of a mental health supervision mechanism within the existing system.

3. Human Resource: Mental health services coordination involves various institutions, including the Ministry, government, and NGOs. However, there’s a notable shortage of mental health professionals, with an estimated 25% working abroad. There’s no specific strategy for developing mental health human resources, and mental health education is missing from curriculums at all levels, leading to a lack of properly trained personnel. Moreover, the available mental health workforce is primarily concentrated in major cities.

4. Public Education and Other Sectors: Minimal mental health education has been conducted, resulting in low public awareness and high stigma within the community. Mental illness is often misunderstood and categorized under disability, complicating the public’s perception and willingness to seek help. There’s also a lack of coordination with non-health sectors such as education and insufficient involvement of key community figures like teachers, youth representatives, and clubs in identifying and referring those in need.

5. Monitoring and Supervision: The involvement of mental health specialists in supervising primary healthcare workers is inadequate. Furthermore, there’s a lack of comprehensive national epidemiological data on mental health, and no distinct monitoring and supervision system exists for mental health care.
   

The issues highlighted above represent just a few of the significant gaps in Nepal’s mental health system. Addressing these complex challenges will not be straightforward. Nepal needs a multi-faceted and comprehensive approach to make a meaningful impact.

The following strategies could be essential in mitigating these problems:

a. Fully implement the National Mental Health Policy with adequate budget allocation

b. Develop a long-term mental health strategy with clear goals and measurable outcomes.

c. Prioritise the integration of mental health services across primary healthcare levels.

d. Establish specialized mental health response units within local police stations.

e. Enhance the National Helpline’s visibility and trustworthiness at the community level, ensuring widespread awareness.

f. Transition to a holistic treatment approach that includes community care and specialised care.

g. Enhance training and involvement of community volunteers in mental health service delivery.

h. Collaborate with NGOs to extend mental health services’ reach and impact.

i. Integrate traditional healers and religious leaders into the mental health strategy through training and awareness programs.

j. Invest in specialised mental health facilities for children and the elderly.

k. Update the free drug list to include essential psychotropic medicines, ensuring their accessibility.

l. Integrate mental health components into medical and nursing curricula and community health worker training.

m. Develop strategies to decentralise mental health services to ensure availability in rural and underserved areas.

n. Implement mental health education and awareness campaigns to reduce stigma.

o. Foster collaboration with non-health sectors (education, social, welfare, sports) for integrated mental health awareness.

p. Engage community figures in mental health education and referral processes.

q. Involve mental health specialists in the training and supervision of primary healthcare workers.

r. Establish a national system for epidemiological data collection on mental health to inform resource allocation and intervention effectiveness.

The strategies mentioned will undoubtedly boost mental health awareness and contribute to reducing suicide rates. However, it’s essential to recognize that these strategies will take time to implement, but it’s critical to start as soon as possible.

Meanwhile, it’s important for everyone to speak up. Regardless of your authority or position, begin openly discussing mental health within your family, workplace, classroom, and community. Small, collective steps can lead to significant outcomes. Our previous generation struggled with this issue, our generation is currently facing it, and it’s our utmost responsibility to ensure future generations don’t encounter the same challenges. By the time they begin their journey through life, there should be ample resources and a proper understanding of mental health in the country, treating it as normal as physical health. So, we must take action now.

Let’s not allow our friends, relatives, or anyone to feel they have no other choice but to give up on life. There are countless reasons to find joy and many beautiful reasons to live. Let’s ask, “Are You Okay?” to anyone who seems to be struggling. Listen to them, offer a hug, and reassure them that it’s okay to feel this way sometimes. Let’s normalize conversations about mental health and work towards a world where mental well-being is valued. As we talk about making Nepal great and focusing on its development, let’s start by saving lives and nurturing the future architects of our society. Let’s save our people.