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The two cases cited above are in many ways emblematic of mental health patients in Nepal, where one in three people will develop some kind of psychi­atric problem in their lifetime. But according to Health Research and Social Development Forum, over 90 percent of those who need mental health services in Nepal don’t get it. “Most of my patients are either scared of being judged when people find out about their problems. They typically come for help only when the problem gets out of their hands,” says Dr Krishangi Basnet, a practicing psychiatrist in Kathmandu. “Even though the situ­ation has improved of late, it is still far from satisfactory.”

Acceptance, understanding and support of family and friends are crucial in dealing with mental health problems. But these can be hard to get with mental illness stigmatized.

According to psychiatrists, they mostly see cases of anxiety and mood disorders in Nepal. In anxi­ety disorders, an individual comes to associate fear or anxiety with certain objects or situations. Most people with anxiety disorder will try to avoid exposure to whatever trig­gers their anxiety. Likewise, mood disorders are known as affective disorders or depressive disorders, where patients undergo significant mood changes, generally involving mania or depression.

Missing beds

The multi-sectoral action plan for the prevention and control of non-communicable diseases (2014-2020) estimates that 18 percent NCDs in Nepal are related to mental health. The World Health Organi­zation’s 2012 global suicide survey ranked Nepal seventh, with depres­sion being the major suicide trigger. Yet Nepal is far from fulfilling the needs of its mental illness sufferers.

Even though the costs to individ­uals, families and the society due to mental disorders are staggering, less than one percent of our annual health budget goes to mental health and only two percent medical and nursing training is dedicated to it. At present, there are only 50 psychiat­ric clinics and 12 counseling centers in Nepal and most psychiatric wards are staffed and run by nursing staff without specialized training in men­tal health (See first box). Moreover, there is no mental health division in Ministry of Health (although one is planned) and there are only a handful professional organizations working on mental health.

“Since mental health problems are often intangible, it is a little dif­ficult to allocate budget for it,” says Bir Bhadra Joshi, assistant executive at the Department of Health and Population. “But with many NGOs working on it, we believe we are better placed to deal with it now than we were even a decade ago.”

But it is hard to do away with entrenched prejudice. The civ­il code of Nepal (which is in the process of being amended) still uses derogatory words like ‘mad’, ‘insane’, ‘person with broken mind’ to describe those with mental health problems.

Constitutionally challenged

The constitution of Nepal (Arti­cle 25 of fundamental rights) guarantees the right to health and healthcare to all Nepali citizens. The World Health Organization too clearly states that health is a state of complete physical, mental and social well-being. But Nepal has been slow to act, as the focus is still predominantly on physical health, even though evidence continues to mount that mental problems also lead to many physical health com­plications. So awareness is vital. But it is not enough.

“Public education about men­tal health problems and treat­ment options need to go hand-in-hand with improvements in mental health services,” says Kamal Gautam, the deputy execu­tive manager of the Transcultural Psychosocial Organization, an NGO that works with the government. “We need many more trained psy­chiatrists and treatment centers.”

But how do you first diagnose you have a problem?

It is impossible to make a cer­tain diagnosis. But if certain signs (See second box) appear within a short span of time, they may offer tell-tale clues. If you or someone you know has been showing these signs for more than two weeks, con­sider consulting a therapist as soon as possible.

Two tales

I was 20 and studying medicine at the time. I had severe anxiety due to family issues, which in turn led to depression. I had to temporarily drop out of medical school in the final year. But in spite of being a medical student, I couldn’t seek the help that I needed. It took me over three years to overcome the dis­ease. I dealt with it on my own because I was in denial and didn’t want people to know. I fought alone and won. I am now 40 and work as a neurosur­geon because the brain fas­cinates me. I had to waste three years of my life because I could not get help. Again, I was able to overcome depression on my own but I also realize there might be others who may not be as lucky.

—A 40-year-old male neurosurgeon

I grew up seeing my dad scream at my mom all the time. I could sense dad’s withdraw­al from reality and his sinking into fantasy and delusion even though I was only 10 at the time. My dad, a teacher, was someone everyone looked up to. This slow fragmentation in his thinking made our lives difficult. It took us around two years to figure out he was men­tally ill and another year to diag­nose him with schizo­phrenia, which is a chronic mental disorder involv­ing abnormal social behavior and delusions. After years of parental dis­putes, I too started having mental health problems. But I was in denial. After numer­ous failed suicide attempts, at the age of 17, I acknowledged the severity of my depression and anxiety, and sought medical help.

—A 19-year-old female student

No. of medical personnel in mental health in Nepal (per 100,000 people)
-0.22 psychiatrists
-0.06 psychologists
-1.5 psychiatric beds
-0.04 counseling centers

To consult one, please contact:

- TUTH Suicide Hotline: 9840021600

- Transcultural Psychosocial Organization-Nepal Crisis Hotline: 1660 0102005

- Mental Health Helpline Nepal: 1660 0133666

Nearly one in three Nepalis will have a mental health problem at some point in their life. But on current trends most of them will silently suffer rather than seek help. There is still a lot of stigma attached to having a mental illness and coming out can be tough on the sufferers. But at least those in Kath­mandu, where nearly all the mental health facilities in Nepal are concen­trated, will have somewhere to go should they decide to get themselves treated. Those in other parts of the country may not be as fortunate. Untreated mental illnesses are a big burden on the sufferers and their families but they also weigh heavy on the economy. According to WHO, mental illnesses typically cost a country between 3-4 percent of its Gross National Product. Yet Nepal currently allocates under one percent of national health budget for mental health. The priority is still on physical illness whose symptoms are clearly visible rather than mental illness whose symptoms may not be as apparent. Moreover, the govern­ment seems to have almost given up on mental health, in the erroneous belief that there are enough NGOs around to deal with it. There are not.

APEX heard harrowing tales of people living with various mental health disorders, most of them suf­fering silently. We clearly need a more open debate on mainstream­ing of mental health disorders, which should ideally be treated no differently than other physical ailments. In fact, debilitating mental health problems, which often lead to suicides and destroy lives and fami­lies, are potentially lethal.

Full story HERE

The renowned Indian dairy par­lor known for its milkshakes now has yet another outlet, this time in Durbarmarg. The new branch is part of Keventers’ rapid expansion in the Indian subcontinent. The brand had previously opened its franchised shops at Labim Mall, Civil Mall, and Thamel.The new shop is located in a generally deserted alley of the otherwise bustling Durbarmarg. “Opening a shop in Durbarmarg was more than a business oppor­tunity. We were trusted with rees­tablishing this relinquished alley, and that is what we have tried,” says Bhaskar Koirala, who owns the franchise for Nepal along with one of his cousins. “Kev­enters is known for its quality and healthiness,” he adds. “But we also focus on style and ambi­ence of our outlets. We want to make Keventers a destination for all our valued clients to unwind and chill.”

The new outlet is not only aesthetically beautiful, its cool air also makes you feel like you have just escaped the bustling city. With prices for the milk­shakes ranging from Rs 200 to Rs 540, just about anyone can enjoy a bottle (yes, these shakes come in beautiful bottles that you can take home.)

Keventers was established by Edward Keventers in 1925 with outlets in Darjeeling, Delhi, Cal­cutta, and Aligarh. When India got its independence in 1947, ownership was transferred to Ram Krishna Dalmia, whose grandson Agastya Dalmia resuscitated and reinstated the brand in 2015.

Soon after the Koiralas bagged the rights to open Keventers’ first fran­chise abroad, in Nepal. Today, Kev­enters has in excess of 250 outlets and is experiencing quick expansion in India. More outlets are planned right around Nepal as well.

Recent addition to the menu is the Keventers’ Ice-cream Soda that is served in recyclable cups with bio-degradable straws. The soda in the drink is made on the spot to ensure freshness.

“We imported the machine from India so that we could deliver fresh­ness right up to individual tables,” says Koirala. The 20- ounce drink costs Rs 230. “We have other bev­erages as well. The dry fruit shake is one. We are looking to include more alternatives as well,” says Koirala.

Even after the introduc­tion of the Plastic Bag Directive (2016) and declaration of a nationwide ban on import, export, distribution, use, and sale of polythene bags below 30 microns in thickness, the use of plastic bags in the country continues. Excess use of plastic bags is a big source of urban pollution and it harms the health of cattle that inadvertently ingest these bags. Prem Sunwar wanted to do something about it. He thus established Deep Paper Bag Industries Pvt. Ltd, whose main remit became to import photo-degradable bags from India. These plastic bags decay when they come in contact with soil and sun­light. This bag is made of corn flour and cellulosic fiber and goes by the name of “Nature Cure Bio Bags”. The entire decay process takes about 15 days. It has already been successfully tested by the government of India as well as Nepal Academy of Science and Technology.

Initially, Deep Paper imported 1,000 kilos of the photo-degradable bags from G.R. Virindera Industries in India which manufactures and prints these bags. The price ranges from Rs 350-400 per kilo depending on the purchase amount. The bags imported by Nepal has a print of Lord Bud­dha with the statement “Buddha was born in Nepal” along with another statement “We Make Nepal Beautiful”.

Pradeep Kumar Dhakal, the spokesperson of Deep Paper, says the response to the prod­uct is good and the bags are in high demand. Since they initially imported only 1,000 kilos, they are already out of stock. “Gro­cery stores and organic houses bought many bags,” he says. “We are looking to import more.

Hopefully, we will be able to meet the demand pretty soon.” As previous unsuccessful attempts suggest, putting a full-stop to the use of plastic bags is almost impossible. Promoting the use of photo-degradable bags seems like a more viable option. They aren’t that expensive either. If Nepal can establish a photo-degradable bag industry and import the know-how, then we can imag­ine a future when all non-biodegradable plastic bags will be gone.

DJ ZENNY

Soon after debuting in 2013 with the Naughty Naughty Pool Party, Jenny Tamang started getting popular and doing various gigs. She has since established herself as one of the most popu­lar female DJs in the coun­try. Having taken part in various national and interna­tional events, Zenny is now selective. “After reaching a certain height, it’s not pos­sible for me to accept every offer I get. I have been in this industry long enough and I think it’s time for me to con­sider other opportunities. DJ-ing is my passion and I’m never leaving it but I need to think about my future as well,” she says.

Currently living in Mu m b a i , Jenny says being a female DJ has its own positives and neg­atives. “It’s a glam­orous job but at one point you get tired of being sexualized. We’re generally appointed as attractions rather than as DJs.” She says she wants to be appreciated for her work rather than her face or her body. To all the newcomers in the field, DJ Zenny suggests that they should just go for it. “What you think about yourself is more important than what other people think about you,” she says.

DJ NANI

One of the new and emerg­ing names is DJ Nani. Shy and rather introvert Sushmita Maharjan generally prefers to keep to herself but when it comes to her work, she turns into a whole new person: rather extrovert, energetic and driven. Sushmita, a high-school graduate, has been in this field for three years. Asked why she chose this as her career, she replies it was because “I’ve always been passionate about music.”

Starting out at 19, DJ Nani had to initially face a lot of criticism. “People didn’t sup­port me initially, not even my family, but but I didn’t give up. I continued and now they are now more supportive,” she says. Like DJ Zenny, DJ Nani wants to take up some other job besides DJ-ing. “I plan to go abroad for my stud­ies but right now I am happy with how things are working out here.” DJ Nani performs at Victory Lounge throughout the week and does freelanc­ing as well. “I like the glamor and the glitz of the profession. It’s fascinating,” she says. “You have to struggle a lot as a female DJ but ultimately it’s worth it. That is what I say to all the upcoming artists: don’t give up.”

DJ ARLIN

Anju Gurung, 19, was born and brought up in Gorkha. She later shifted to the valley to pursue her career. In the field for about a year and half now, she initially took three months of training. “My brother is a DJ and he inspired me. When I attended his show, I felt the music that he played, and that is what inspired me,” says DJ Arlin. Gurung says she had to fight her way to get to where she is now. One of the aspiring and emerging female DJs of the country, Gurung is a strong advocate of wom­en’s empowerment. “Our society always finds a way to undermine women, and the same happened to me as well,” she continues.

“My friends, my family, they criticized my choice and my work but I didn’t give up. This is what I wanted to do and I had to prove them wrong,” says Gurung, adding she is determined to make her name in this field. “I fought my way up when everyone was pulling me down and there is no way that I’m going back,” she says. Being a female DJ you need to fight for yourself, against the people sexualiz­ing the profession and take a stand. For all the newcomers, she says “know your worth and strength, you’re strong enough to remove all obsta­cles in the way” o

Before the country became a republic in 2006, cross-dress­ing was considered illegal under various laws against ‘public immorality’. But the practice was legalized in 2007 and a ‘third gen­der’ besides ‘male’ and ‘female’ option given to those applying for Nepali citizenship. Yet transgenders still face hurdles to fully embrace their identity. Many Nepali trans-women (male-to-female transsexuals) dream of having enough money to travel to Thailand to undergo complicated and costly surgery to fully transform into women; a few of them have been successful. But, technically, there are no trans-men (female-to-male transsexuals) in Nepal, even though some like to identify them­selves as such.

Elyn Bhandari

Elyn Bhandari, 27, was born and raised in Kathmandu. He always knew that he was different but lived as a male till he graduated from high school. “I then met a friend who interned with the Blue Diamond Society. She brought me here for counseling and orientation.” Bhandari was 21 when he found that he identified as a trans-man, and not a lesbian. Just like Bhandarai, lots of trans-men initially misidentify them­selves as lesbians.

“I used social media to open up. Many of my friends were dis­approving,” he says. “Ironically, I had to lose many people in my life when I finally found myself.” Currently employed at the Blue Diamond Society, Bhandari says the place is a family. “My fami­ly was totally against me when I told them I am a man trapped in a woman’s body. But this place gave me the support that I needed. They understood me and helped me understand myself.”

Bhakti Shah

Bhakti Shah, 32, transitioned also into manhood on joining the Blue Diamond Society. Shah knew he was attracted towards females when he was in his early teens. He considers himself considerably luckier than his friends as he didn't have to face much family pressure to embrace the female identity he was born with.

“Before I came out I was scared of what people might think. I felt trapped inside my own body,” he says. “But when I came out I real­ized there are other people like me as well.” When the country has acknowledged the identity of all its citizen, says Shah, there is no need to hide your identity any more.

Shah has had a female partner for 10 years now. “Though god witnessed our bond, we want to our marriage to be legalized and nor­malized," Shah says. “About time the gov­ernment legalized marriage among the LGBTI community.”

Akanshya Timalsina

Born in Morang, Akan­shya Timalsina,25, was very small when she start­ed noticing that she was dif­ferent from other males. But she had to wait till she was 18 before she came across the web­site of the Blue Diamond Society. At long last, the non-profit organization working for LGBTI (Lesbian, gay, bisexual, transgender and intersex) rights would help her identify herself as a transgender.

“Before contacting the society, I had never heard about transgen­ders,” she says. “But that is exactly what I was.” At 24, she underwent a top surgery in Bangkok, followed by a sex change surgery a year later. “It was expensive. I had to spend 5-6 years of my savings for the opera­tion,” she says. “But I regret nothing. I feel like a bird that has just been freed from a cage. I am no longer plagued by the guilt that I am in a body that is not mine.”

Sudeep Gautam

Sudeep Gautam, 27, too always knew. At a tender age of five, when all his friends would play with dolls and wear dresses, he would cry because his parents forced him to do the same. Sudeep never dressed as a female even before he identified himself as a trans-man. He was able to understand his attraction towards females and inclination towards male identity only when entered his teens.

“I had to work like a man in order to look after my family even before I identified as a trans-man,” Gau­tam says. But he had to leave his hometown for the fear that his par­ents would marry him off to a man. His sister then told him about the Blue Diamond Society, and his life changed. He has identified himself as a trans-man since 2011. “Although my biological parents brought me into this world, it was Blue Diamond that made me who I am today. I owe it everything,” he says.

“We fight humiliation everywhere we go. But I’m going to fight nonethe­less, fight for my community till the day I die,” he says. After all, “we’re all different, we are all equals.”

Though Nepal still has a long way to go to be able to play in the foot­ball World Cup, the craze among Nepalis for the biggest sports tourna­ment in the world is unmatched. Busi­nesses were quick to capitalize on it. Be it the cafes, restaurants, pubs or bars, crowds cheering on their favorite teams could be seen everywhere. Places that were relatively quiet prior to the World Cup had come alive as people came in to watch their favorite teams play. Says Ravi Pradhan, the owner of the Sports Hive (Bar) in Jhamsikhel, “During World Cup match-days, business have been up by nearly 50 percent compared to regular days, with almost 300 people coming to every watch.”

Lokraj Joshi of the All-Star Sports Bar in Chakrapath says pretty much the same thing. “Our business had doubled. The place is jam-packed every time there is a match,” he says. Even the sale of electronic appliances such as television sets and speakers rose drastically during the World Cup. “There was around 70 percent increase in business when the World Cup started. But it is back to nor­mal now,” says Animesh Chitrakar of the New Superstar Enterprises at New Road.

The World Cup had a positive impact on liquor, sportswear and merchandise businesses as well. Cheers, an online liquor store, claims 70 percent increase in sales since the start of the World Cup, whereas Arun Sigdel, the owner of Sanepa Madira Store reported around 25 percent increment.

However, Kritika Sapkota from Bhadrakali Sports Pvt. Ltd says that the business of selling official jerseys and other World Cup-related merchan­dise was not as robust as it used to be during the previous World Cups. “Since all the hyped up teams lost in early stages this year, the excitement went down. Thus there was only around 20 percent increment in business, half the level seen during previous World Cups,” says Sapkota.

Sagar Chanda from the Sports Uni­verse in New Baneshwor concurs. “Though sales in merchandise such as footballs is decent, the rate at which the business increased was not satisfactory. Since the major teams were out of the tournament early people were not as excited, which drastically affected our business.”