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Mental health is recognized by the World Health Organization (WHO) as a vital element of overall well-being, encompassing emotional, psychological, and social aspects that determine how individuals think, feel, and act throughout their lives. According to the Center for Disease Control, it is not just about the absence of a mental health condition, but it is also about the presence of well-being and the ability to thrive. 

WHO warns that globally, mental health issues are emerging as leading causes of disability and poor quality of life, with approximately one in seven people living with mental disorders each year. Mental health has increasingly emerged as a critical public health challenge in Nepal. A combination of high prevalence of mental disorders, limited access to services, and persistent social determinants has created a significant treatment gap that undermines individual well-being, productivity, and overall national development.

According to a 2023 analysis, approximately 3.9m Nepalis were estimated to be living with at least one mental disorder in 2019. This translates into a marked rise in the burden of mental disorders over the past three decades: the proportion of disability-adjusted life-years (DALYs) attributable to mental disorders in Nepal has nearly tripled from 1990 to 2019. 

A nationally representative study published in 2016 shows that among Nepali adults (aged 18–65), both anxiety and depression are “very highly prevalent” and often comorbid. Per a 2024–2025 study of over 12,000 individuals found gender disparities, women had significantly higher point-prevalence of anxiety (21.9 percent vs 11.3 percent) and depression (5.4 percent vs 1.7 percent) than men in Nepal.

Social dimension

A study found that social determinants significantly influence mental health outcomes in Nepal. Poverty, unemployment, early marriage, gender-based violence, and caste-based discrimination contribute to chronic stress and reduced well-being, especially among women and marginalized communities. Labor migration, involving nearly four million Nepalis working abroad, often leads to family separation, loneliness, and emotional strain among both migrants and those left behind. 

Women are particularly vulnerable due to restrictive social norms, financial dependency, limited autonomy, and the stigma associated with disclosing emotional distress or seeking care. Youth populations face rising mental health issues driven by academic pressure, unemployment, and social media-related stress, yet few youth-centered services exist.

Kohrt & Harper (2008) argue that stigma continues to be one of the most pervasive barriers to mental health care in Nepal. Strong cultural norms that attribute mental illness to “karma,” spirit possession, or personal weakness reinforce labeling, shame, and social exclusion. Those experiencing mental health problems are often called “paagal” (mad), a term that carries deep social stigma and undermines one’s dignity, identity, and social value. Such stigma not only discourages individuals from seeking care but also results in discrimination within families, workplaces, and communities. 

A study by Luitel et. al (2017) demonstrates that stigma is among the top structural barriers preventing individuals from accessing mental health services in Nepal. Conversely, upholding human dignity requires dismantling mental health stigma, recognizing individuals with mental health conditions as possessing equal inherent worth, protecting their agency in health decision-making, and creating the material and social conditions in which they can exercise substantive freedoms and participate fully in community and family life.

Cultural beliefs, stigma, and social silence

Cultural beliefs and social norms play a decisive role in shaping how mental health is understood, discussed, and responded to in many societies. Across the world, stigma often arises when mental illness is interpreted through moral, spiritual, or supernatural lenses rather than as a legitimate health condition. Such interpretations can influence whether individuals seek treatment, how communities treat people experiencing psychological distress, and whether families disclose mental-health problems or hide them due to fear of judgment. In contexts where collective identity and social harmony are highly valued, stigma can deepen because mental illness is seen not only as an individual issue but as something that threatens family reputation or social standing.

Cultural beliefs and social norms in Nepal play a powerful role in shaping how mental health is understood, interpreted, and treated. These beliefs influence not only how individuals experience psychological distress but also how families and communities respond to such conditions. It is evident that in many parts of Nepal, mental illnesses are not viewed primarily as biomedical conditions but are instead interpreted through religious, spiritual, and moral frameworks. These culturally embedded interpretations often reinforce stigma and undermine human dignity.

Traditional beliefs such as spirit possession, witchcraft, and the influence of supernatural forces remain common explanations for mental distress. Kohrt & Harper (2008) see many communities attribute symptoms of psychosis, depression, or schizophrenia to spirits being displeased. Such interpretations often lead families to seek help first from traditional healers including dhami-jhankri, lama, or tantric practitioners rather than mental health professionals and sharing to peers. While these healers provide culturally meaningful support, delays in receiving clinical care can worsen individuals’ conditions and reinforce the idea that mental illness is anomalous or spiritually polluted. 

Beliefs in karma that a person’s suffering results from past sins or moral failings further moralize mental health conditions and contribute to blaming the individual.

Stigma is deeply intertwined with the cultural lexicon. Individuals experiencing mental health issues are often labeled as “paagal” (mad), “sano dimag” (small-minded), “nasamjhine” (irrational), or “kamjor” (weak). These labels carry strong social judgment, implying unpredictability, incompetence, or danger. The use of such derogatory terms reflects a social narrative that reduces a person’s identity to their mental condition, directly undermining their autonomy, agency, and dignity. Such labeling results in “structural violence,” where individuals are excluded from education, employment, and social participation due to perceived inferiority.

The fear of shame (lajjā) and the desire to preserve family reputation (ijjat) further intensify stigma. Family honor remains central within Nepali society, and mental illness is often viewed as a threat to the household’s social standing. This leads many families to hide symptoms, avoid seeking help, or restrict the affected individual’s mobility. Women are disproportionately affected: because they are commonly blamed for causing disharmony, family problems, or “inviting” misfortune, their distress is seen as a personal failure rather than a health condition. In some cases, women are subjected to verbal abuse, restriction of autonomy, or even abandonment due to mental illness, reflecting highly gendered forms of stigma.

Shawon et al. (2024) studied mental health through gender aspects and found that women who express emotional suffering may be labeled as ‘overly sensitive’ or ‘weak’, while men may face stigma for failing to embody cultural expectations of strength and emotional control. In patriarchal households, women’s suffering is often minimized or dismissed as normal emotional fluctuation, linked to menstruation, pregnancy, or household stress. This silencing hinders early identification and reinforces unequal power dynamics. Because of these cultural pressures, many individuals opt for alternative healers before turning to biomedical services.

For countries like Nepal, where social stigma, poverty, foreign migration, gender inequity, and weak health systems intersect, the mental health challenge is even more urgent. The evidence reviewed in this article shows that mental health struggles in Nepal are deeply tied to vulnerability: individuals who are socially excluded, economically fragile, or culturally marginalized face disproportionate risks of distress and also bear the heaviest weight of stigma. These vulnerabilities do not exist in isolation but accumulate across family life, livelihoods, social belonging, and access to care. Understanding these dynamics is essential for promoting dignity-centered mental health interventions that respect cultural contexts while challenging harmful stereotypes.

The author is a graduate student of Global Affairs at the University of Notre Dame, USA

A young man injured in a road accident in Kathmandu struggles to enter a government office because there’s no ramp. A woman who lost her leg during the 2015 earthquake waits outside a clinic with no accessible toilet. A child with cerebral palsy sits at home because her school lacks a wheelchair-friendly classroom. These are not isolated experiences; they reflect how our infrastructure and social attitudes continue to fail people who live with injuries or disabilities.

In the case of people with disabilities, the Universal Declaration of Human Rights reframed the global understanding of dignity. Article 1 declares that “all human beings are born free and equal in dignity and rights.” Article 16 of the Constitution of Nepal (2015) explicitly affirms that “every person shall have the right to live with dignity.” Yet, for many individuals with disabilities, dignity is frequently compromised through discrimination, exclusion and social stigma. Such violations not only undermine fundamental rights but also contribute to poor mental health outcomes, creating a cycle of suffering that affects individuals, families and communities. From a developmental perspective, Amartya Sen’s capabilities approach broadens the notion of dignity by emphasizing substantive freedoms and the real opportunities people have to pursue lives they value. When dignity is eroded through neglect, discrimination or violence, individuals experience profound personal harm, and the consequences extend further: social systems lose cohesion, legitimacy and overall effectiveness. This underscores the necessity of fostering environments where people with disabilities can fully exercise their rights, capabilities and inherent dignity.

Nepal’s position

There are lots of areas that we are behind in addressing the dignity of differently-abled people. The barriers begin with our built environment. Most public buildings in Nepal remain inaccessible to those with physical limitations. Sidewalks are uneven, roads often lack crossings or tactile paving for the visually impaired, and many schools do not have ramps or adapted toilets. Even newly-built structures often lack accessibility standards mandated under the Act Relating to Rights of Persons with Disabilities, 2074  and the UN Convention on the Rights of Persons with Disabilities (UNCRPD), to which Nepal is a signatory. 

These physical barriers are more than design flaws but they are reflections of our social priorities. Our public spaces silently communicate who belongs and who doesn’t. When a person on crutches cannot cross the road safely or a wheelchair user is carried up stairs because there is no ramp, it reveals a failure of imagination and empathy.

Infrastructure that is excluded is not only unjust but it is also economically inefficient. By neglecting to accommodate all citizens, we restrict participation in education, employment and governance. Accessibility is not a luxury for a few; it is a fundamental right for all and every person has an equal dignity.

The cultural barrier

The deeper challenge, however, lies in our attitudes. In many communities, people with disabilities are still viewed with pity or dependency, rather than as individuals with agency and potential. Sympathy often replaces justice. Charity programs and donation drives dominate our response, while systems for empowerment, accessibility and inclusion remain weak. Too often, we view injury or disability through a lens of tragedy instead of resilience. When the injured or differently-abled are portrayed as objects of sympathy rather than participants in society, their voices are sidelined from policy debates and community life.

Nepal’s culture of community and compassion can, paradoxically, both comfort and confine. Compassion must evolve into inclusion. Our values from Buddhist teachings on interconnectedness to Hindu values of sewa (service) already hold the moral grounding for inclusion. But it is time we translated those values into systemic change. True dignity is not about receiving kindness; it is about being treated as an equal.

From the lens of IHD

As Nepal builds roads, hospitals and digital systems, it must remember that true development is not just about what we build, but for whom we build. Integral Human Development (IHD), a dignity-centered framework that aims for human flourishing, and sees every person as a whole reminds us that a just and prosperous society must recognize every individual as capable of contribution and worthy of care. It offers a transformative way to rethink how we design societies. It begins from a simple truth: a person is not merely an economic actor or a recipient of aid, but a whole human being physical, emotional, social, and spiritual. Dignity is its core foundation. Dignity is also the key pillar of development, and every person, regardless of special needs, deserves to flourish.

IHD invites policymakers to pause and reflect before drafting any plan or project. If we are building a school, would we feel confident sending a child with special needs from our own family there? If not, then the project is not good enough. This is what IHD demands, merely not perfection, but empathy and coherence between intention and impact. It helps us to transform policies from technical checklists into moral commitments. It challenges us to see the person before the impairment, the capability before the constraint.

From policy to practice

Nepal needs more than laws to advance inclusion, it needs implementation grounded in dignity. First, enforce accessibility standards across all levels of government. Every new school, hospital and municipal building must meet basic mobility, visual and hearing-friendly design requirements, with accessibility audits built into approval processes. Second, invest consistently in rehabilitation and reintegration. Road-accident survivors, earthquake victims and others with long-term injuries need sustained physiotherapy, counseling and employment support. Third, ensure that people with disabilities and injuries are part of decision-making; their lived experience is essential for designing inclusive systems. Fourth, shift cultural practice. How we speak to, treat and create space for differently-abled people determines whether inclusion is real or symbolic. Finally, mainstream inclusion in education and employment through teacher training, workplace adaptations and public awareness. Economic participation allows people not just to survive but to thrive.

Nepal stands at a crossroads. Progress is visible in infrastructure and connectivity, but true development is measured by who can access those advancements. A ramp at a school or tactile paving at a bus stop may seem small, yet they embody respect and equal opportunity. Designing for the most vulnerable ultimately benefits everyone: the elderly, the sick, children and temporary accident survivors, strengthening trust and resilience.

As Nepal reimagines its development path, IHD offers a guiding compass. It urges policymakers to move beyond economic expansion and ask how policies nurture the whole person. Through this lens, these reforms are not technical fixes but parts of a holistic vision that balances efficiency with empathy, participation with policy and growth with justice.

The author is a graduate student of Global Affairs at the University of Notre Dame, USA

Despite numerous acts, strategies, and five-year visions, our policies often overlook the lived realities and inherent dignity of our citizens. A national health insurance program may cover basic health services for mothers in rural Tarai, yet many still face malnutrition. A young graduate in Kathmandu may access education, but the lack of meaningful employment undermines their aspiration. A farmer may receive subsidies for seeds, yet without fair market access, their labor and knowledge are undervalued. These fragmented solutions reveal a deeper issue: policies that lack to honor the capabilities and dignity of the people they are meant to serve. And here, the question is raised: Do our policies see people as whole human beings?

This is where Integral Human Development (IHD) offers a different lens. Rooted in the belief that every person possesses inherent dignity, IHD insists that development must address the whole person – body, mind, spirit, dignity, and relationships. It challenges us to design policies that move beyond numbers and sectors. Unlike frameworks that reduce people to economic indicators or mere recipients of aid, IHD views individuals as agents of change embedded in families and communities.

In the context of Nepal, where federalism is still taking root and governance often struggles to balance economic growth with social justice, adopting an IHD framework could make policy more people-centered, integrated, and sustainable.

Human dignity at the center of policy

In Nepal, poverty is frequently measured in income levels or material deficits. Yet dignity is eroded not just by lack of resources but also by exclusion, inequality, and absence of voice. IHD begins with dignity. Policies built on this foundation treat citizens not merely as beneficiaries but as active participants in shaping their own futures.

For example, the 15th Five-Year Plan (2019/20 to 2023/24) envisions a “Prosperous Nepal, Happy Nepali” and sets ambitious targets across various sectors. However, while the plan emphasizes economic growth, it often overlooks the holistic well-being of individuals. Integrating IHD could ensure that economic policies also promote human dignity and participation. For example, when municipalities engage women’s groups or youth clubs in planning local budgets, they do more than allocate resources; they validate the dignity of participation. When health workers treat patients as partners in care rather than passive recipients, they uphold dignity alongside service delivery. Such shifts in perspective are subtle but transformative: they foster ownership, accountability, and trust between the state and its citizens.

Breaking silos through integrated approaches

Policies in Nepal are often designed in silos: health is separated from education, agriculture from environment, and infrastructure from social protection. Yet, people’s lives are not siloed. A malnourished child cannot perform well in school, and an unemployed youth may face mental health struggles.

IHD calls for integration across sectors. Take maternal health as an example. Beyond free check-ups, safe motherhood depends on nutrition, sanitation, transport, and women’s education. Designing these elements in isolation creates gaps that undermine results. Similarly, climate change policies that prioritize infrastructure without addressing farmers’ livelihoods remain incomplete. An IHD framework would compel policymakers to ask: how do health, education, economy, and environment intersect in people’s daily lives?

Integrated policy-making is admittedly complex, but federalism has opened opportunities for local governments to coordinate across sectors. The question is whether national frameworks will empower them to take such holistic approaches or continue reinforcing silos.

Participation and accompaniment

One of the most powerful aspects of IHD is its emphasis on “accompaniment,” i.e. walking with people rather than delivering services from above. This approach recognizes that development is not simply about providing solutions but about building relationships of trust and solidarity.

Nepal already has successful models that reflect this principle. The role of Female Community Health Volunteers (FCHVs) is a case in point. They do more than disseminate health information; they accompany families, listen to concerns, and build bridges between communities and health systems. Their effectiveness comes not only from technical training but also from trust and presence. Expanding such models across sectors such as agriculture, education, disaster preparedness could make policies far more responsive and grounded in lived experiences. Accompaniment also implies long-term engagement. Too often, donor-driven projects operate on short timelines and exit once targets are met. IHD suggests that policies should commit to being present with communities through both successes and setbacks, ensuring resilience rather than dependency.

A call for action

Skeptics may argue that Integral Human Development (IHD) is too idealistic for a country facing poverty, migration, climate threats, and political instability. However, fragmented, short-term approaches have already proven inadequate. Evidence from community-driven initiatives in Nepal and elsewhere shows that when dignity and participation are prioritized, outcomes improve. Federalism itself is premised on the idea of bringing governance closer to people, an idea that resonates deeply with the IHD vision.

Hugo Flores once said, “It is very simple. If we are drafting a piece of policy or designing a project, and it is good enough to apply it to ourselves or our closest ones, then it is a good project. If not, then it is not good enough.” This principle captures the essence of IHD. Policies must be designed with empathy, care, and dignity. For instance, before opening a clinic, policymakers should ask: “Would I send my own mother here if she were sick?” If the answer is yes, it is a policy grounded in human-centered thinking; if not, it needs rethinking.

As Nepal reimagines its development path amid global and domestic uncertainties, IHD offers a timely and transformative framework. It reminds us that progress cannot be measured only in GDP growth or infrastructure projects, but in how policies nurture the whole person i.e mind, body, spirit, and community. Embracing IHD does not mean discarding economic or technical approaches; it means complementing them with a deeper, dignity-centered vision. It means designing policies that are participatory, integrated, and grounded in human relationships.

If Nepal is to craft policies that truly serve its citizens, it must move beyond fragmented targets and embrace Integral Human Development, a vision that sees every citizen not just as a statistic, but as a whole person with dignity and potential

 (The author is a graduate student of Global Affairs (Governance and Policy) at the University of Notre Dame, USA.)