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As a part of our campaign to bring mental health awareness and help improve the country’s mental health institutional setup, ApEx on May 8 organized a roundtable of mental health professionals. Held on the eve of the May 13 local elections, this time, we wanted to understand the kind of steps that are necessary at the policy-making level in order to boost the mental wellbeing of Nepal’s nearly 30 million citizens—especially its youth population in the 16-40 age bracket.    

Local governments poorly informed on mental health

Dr Basu Dev Karki
Lead Consultant Psychiatrist, Patan Mental Hospital

The big problem now is that people are still unaware of their needs and basic rights when it comes to accessing mental health services. Local governments are supposed to provide mental health services to their citizens, but they themselves are poorly informed.

At the policy-making level, mental health is still not our priority. We as a country are yet to accept that mental health is directly connected to our quality of life. 

The Sustainable Development Goals, which also includes mental health, have been stuck in the ‘implementation phase’ for the past seven years. In the meantime, our suicide rate is increasing. 

If mental health is not a priority at the policy level, how can we expect the general people to prioritize it? In business, whoever brands themselves the best wins in the market. But unlike the case with physical health, we have been unable to brand mental health awareness. 

There are mental health-related policies in place, so much so that municipalities are provided with the necessary budget, human resources, and training for mental health awareness and services. These municipalities also have the responsibility of training health workers and program managers on mental health. Yet they still don’t realize that this is an important and urgent issue. There is also no mechanism to monitor their work in this area. 

Awareness should not be an event, it should rather be a movement.

Most mental health professionals don’t have adequate training 

Kapil Sharma
Counseling Psychologist and Psycho-social Counselor at HUDEC Nepal

We need to look at mental health through the psychosocial lens as well. No doubt, sensitization and awareness on this topic is growing among the youths. But we still don’t talk about mental health in general. 

In the majority of the cases, individuals, even if they realize that they are in need of first-hand mental health support, don’t know where to go, and they can’t even talk about it with their families. How can we expect the topic of mental wellbeing to be normalized when there is no social support for it? 

From the perspective of service providers, there are many training programs. But as these mental health trainings are not as prioritized as physical health training, our mental health service providers aren’t equipped to tackle the scale of the current mental health crisis.

One needs social motivation to seek support, which is lacking at the community level. It's a two-way challenge: Are service providers competent enough to provide the needed services? And are the service seekers aware enough of the services they should seek? 

Today’s youths live online. While there is an overload of information they can simply google, there is no way to guide them to understand their own mental issues or that of others. I’ve had clients who google their symptoms and self-diagnose—rather than look for one-to-one support before jumping to conclusions. 

There are many aspects to mental health awareness, and we need to look into all of them to better understand our own mental health. 

About time the country implemented a referral system

Shreeya Giri
Mental Health Advocate, Founder of Happy Minds

As an online mental health service provider, our operation exists on a digital platform. That is, we are cent percent dependent on gadgets, electricity, Wi-Fi, and mobile data to ensure that the needed support is being given to those who can’t access in-person services. 

Yet there is no guarantee of when the power will be cut and when the network will be interrupted. These faults in the infrastructure make such mental health services hard to access. If there are no digital infrastructures in certain parts of Nepal, people cannot access our services at all. So how do we help people in those areas who are in dire need of support? 

Unawareness and unavailability of these services lead to one common issue: we normalize mental health problems. Psychological abuse at the workplace and in the household is considered normal. Many people who are being emotionally abused don’t come forward and don’t get the right guidance. Even if people are aware that they need help, they don’t recognize what exactly it is that they need or that they can find the right person to talk to. 

To spread mental health awareness, Nepal needs a referral structure. How long will we keep saying that people don’t seek mental health support because they don’t feel the need? Every day in hospitals people are going through traumatic experiences. If the doctors can refer them to a counselor or a psychologist, they will get the necessary support to overcome their mental trauma. This can prevent future mental illnesses. 

In 2021, the government had set aside a budget of 1 percent for mental health services. But even this amount hasn't been properly utilized. The Health Ministry hasn't been able to mobilize experts to make the most out of it. 

We need to better utilize existing platforms

Dr Rishav Koirala
Psychiatrist, Grande Hospital and Executive Director at Brain and Neuroscience Center, Nepal

The most important part of awareness is amplifying conversations on the promotion of positive mental health and prevention of possible mental illnesses. Normally, we have a habit of seeking help at the last moment. If we can take action now instead of tomorrow, the situation of mental health in Nepal will significantly improve. 

Youths are the most aware of mental health, yet they can’t separate between right and wrong emotions, normal and abnormal suffering. 

Moreover, the large population of working-class people in our country is aware of the support infrastructure as well as support via digital platforms. What they lack is the knowledge of where these infrastructures are and how they can be accessed.

We need to find better ways to utilize these existing platforms and create awareness in such a way that every individual is aware of where they can find these spaces, how they can communicate, and what signs and symptoms they should be aware of to seek professional help. 

We can blame the stigma on mental illness for the current crisis. But it is also important to analyze how this stigma came to be and how we can eliminate it. Seventy years ago, there wasn’t a well-equipped mental health service-provider in Nepal. People weren’t aware of mental illnesses. Only when a person had reached a terminal stage, at the peak of their illness, were they considered mentally ill. Psychosis is a terminal mental illness, and this was what people labeled a mental health problem, and so the stigma of mental health began.

Times are changing, and Nepal has come a long way in terms of awareness and mental health services. Yet many people still believe in that stigma and the thought of mental illness scares them. It all comes down to awareness and changing the perspective on mental health.

Nepal-China relations have been rather choppy of late, particularly after the Nepali parliament’s ratification of the MCC compact. China believes the current (election-bound) Sher Bahadur Deuba government does not prioritize ties with the northern neighbor. Members of the government, meanwhile, seem wary of recent Chinese assertiveness in Kathmandu. 

When Chinese Foreign Minister Wang Yi visited Nepal in the third week of March, Beijing and Kathmandu were expected to mend fences and sign something concrete under the BRI. It was not meant to be. 

This week ApEx held a roundtable with some China experts on the current state of Nepal-China relations. Excerpts: 

(Note: Indira Adhikari and Sharada Ghimire, the two other invitees to the roundtable, had to pull out last-minute due to personal emergencies.) 

China has become a bargaining tool for power 

Pramod Jaiswal

(Research Director at Nepal Institute for International Cooperation and Engagement, with specialization in China and South Asia) 

To understand China’s Nepal policy, it is imperative to delve into its larger South Asia policy. Beijing has prioritized South Asia with the view to developing its southern and western regions, particularly Tibet, which is comparatively less developed than other parts of China.  

Xi Jinping is the first Chinese president to visit all South Asian countries, except Bhutan with which China does not have diplomatic relations. With Nepal, China is developing relations in trade, defense, and security. It is also engaging with Nepal at the political level. 

Scores of countries seem eager to enhance ties with China for their economic development, but we have been unable to do so. Even the countries that have hostile relations with Beijing are benefiting from China’s growth. But even as a neighbor, we haven’t been able to strengthen ties with China. 

Whenever our politicians feel that their positions are under threat, they try to use China as a tool to stay in power. This happened during the Panchayat regime, and this is happening today. Even when the communist government led by KP Sharma Oli was in power, there wasn’t much progress in Nepal-China relations. 

China will not engage with Nepal to the extent of offending India. What China rather wants in Nepal is a trustworthy and long-term partner to address its security and economic concerns. Before 2008, China was completely reliant on Nepali monarchy to pursue its interests here. Now, China is engaging with all political parties. 

There has been much rhetoric about MCC and BRI, but what is our official stand on these issues? We never delve into the economic aspects of these issues, only seeing them through the narrow lens of nationalism. We lack the vision and willpower to benefit from China’s rise. It’s high time that our political leadership mended its ways. 

Deuba has chosen one neighbor over another 

Gopal Khanal

(Foreign affairs advisor to KP Oli during his first term as prime minister) 

We have to understand that China is an emerging superpower. The world is becoming multipolar, and China’s foreign policy has vastly changed from the one adopted by Deng Xiaoping. Beijing is now more assertive in the international arena than ever before. 

China shares borders with 14 countries. But it wants to engage not just with its neighbors, but also with the world at large. Thus its greater presence in Nepal is to be expected. But it is crucial that Nepal adopts a balanced foreign policy with India and China. Both the neighbors are equally important to us. 

But it seems the current five-party ruling alliance undervalues China. There is a perception that this government favors Western countries. China should be Nepal’s highest foreign policy priority. There have been some departures in our bilateral engagement with China under PM Deuba. First, you see a clear anti-China prejudice. For instance, soon after its formation, the incumbent government formed a panel to look after alleged Chinese encroachments of Nepali territories, even though the two previous governments had already concluded that there was no border dispute. Second, when Chinese Foreign Minister Wang Yi visited Nepal, there were no talks on BRI projects. 

I see the current government choosing one neighbor over another. Due to serious lapses in judgment of our political leadership, we find ourselves in a difficult geopolitical spot. When Chinese President Xi Jinping visited Nepal in October 2019, he talked about turning Nepal from a landlocked country to a ‘land-linked’ country. This was a momentous announcement but there was then no follow-up from our side. We have never seen our relations with China through the lens of larger national interest. 

There have been some mistakes from the Chinese side as well. For instance, Chinese Ambassador to Nepal Hou Yanqi’s running-around to save the Nepal Communist Party from imploding did not send a good message. Likewise, China could have resolved the problems at border points to smoothen the supply of goods. On the MCC compact, too, it would have been better had Beijing refrained from making any statement. 

Indo-Pacific’s prominence has affected Nepal-China ties 

Rupak Sapkota

(Former Deputy Executive Director at the Institute of Foreign Affairs under foreign ministry) 

There are three ways of viewing Nepal-China relations. First is the larger geopolitical context. There has been extreme pressure on international power-balance of late due to growing rivalry among big powers. Strategic convergence between India and the US is increasing, and China and the US are headed towards confrontation. So the geopolitical center of gravity is gradually shifting to the Indo-Pacific. Such developments are likely to have some implications on Nepal’s national security and sovereignty as well—and which is also why we are seeing some stress in our relations with China. 

Our economic ties with China are stagnant. This did not happen even when there was a supposedly China-friendly government of left parties at the helm. We signed the transit and transport agreement with China, but it didn’t move ahead. Similarly, we signed several vital agreements when Xi Jinping was in Nepal, and they too remain unimplemented. 

I think there is a structural problem. Trade and connectivity with China should run parallel to our relations with other countries. We often make the mistake of seeing China as an alternative when our relationship with the other neighbor sours. Carefully balancing our neighbors should be the utmost priority of any government. 

China now sees Nepal not only from the security viewpoint but also as a strong economic partner. In recent years, Chinese investments in Nepal have increased but are still to benefit from the latest Chinese technology and knowhow. At the same time, there is growing interest among the Chinese about Nepal, which can be seen in Chinese social media platforms. 

In order to close the loopholes in the conduct of our foreign policy, including with China, we must have a sound mechanism to provide timely inputs to the government. But what we see is our policy-related institutions are not functioning well due to lack of resources, politicization and other issues.

No institutional framework to settle Nepal-China issues

Upendra Gautam

(General Secretary at China Study Center-Nepal) 

Frankly speaking, geopolitically, we are not in a comfort zone. Nepal should have a long-term view on our relations with China, which is lacking. We have policy inconsistency with China. We should stop viewing our ties with any country from the perspective of one party or government. Whenever there is a government change in Kathmandu, a new foreign policy is drafted. But why? The basic framework of foreign policy should remain unchanged. 

The problem is not just with the present government. For instance, time and again Nepal has failed to take up its issues with China in a frank and assertive manner. Our individual leaders take up important issues with China without understanding that China will not heed them until such proposals come via official channels. 

We should keep our relationship with China within a certain institutional framework. Without that, Nepal has been unable to raise its issues with China in a systematic way.  We have signed many agreements with China, but have they been incorporated into our national plans and policies? Obviously not. 

We are witnessing a sort of anarchism in our bilateral relationship with China due to a culture of indiscipline. When we talk to China, we should tell them exactly what about their policies hurt us so that they can go about addressing them. But seldom do we do enough homework to identify our issues or to present them clearly before the Chinese. 

Nepal should pursue an independent foreign policy. Geopolitical pressures and concerns are always there, but we can handle those issues with right vision and leadership.  

We should also deal with China without third-party influence. For instance, on the MCC compact, the Nepali prime minister could have held a phone conversation with the Chinese to assure them that its parliamentary endorsement would not affect Nepal-China relations. 

One thing I want to add concerns Nepal-China railway. Nepalis seem to believe that the railway can be built overnight. But we have no good plans for it. You cannot expect China to build such an expensive project and drop it in our laps. Nor have we been able to convince the Chinese that we have either the resources or the manpower to operate such a tricky rail line. 

To create awareness and sensitize the public on the harmful effects of tobacco, the Annapurna Media Network (AMN) on April 27 launched the ‘No Tobacco Campaign for Healthy Nepal’ in collaboration with Nepal Development Research Institute (NDRI) and other relevant stakeholders. The three-month campaign will also pitch for an increase in tobacco tax in the upcoming fiscal 2022/23.

A panel discussion on ‘Tobacco, an ongoing crisis and taxation as a prominent mitigation’ was held on the occasion of the campaign launch, where speakers emphasized the important role of the media in promoting a healthy lifestyle.

They also recommended various ways, including taxation, to reduce the sale and consumption of tobacco products. As part of the campaign, AMN will host and cover all news and activities of the campaign in coordination with Simrik Foundation.

According to the World Health Organization, tobacco is one of the biggest global public health threats. Every day, tobacco products kill more than eight million people around the world. More than seven million of these deaths are the result of direct tobacco use while around 1.2m are the result of non-smokers being exposed to second-hand smoke. A study by NDRI shows that there were 37,529 tobacco-related deaths in Nepal in 2021. There were four deaths every hour.

The Nepal Teen Leaders (NTL) has organized a graduation and welcome ceremony for its third and fourth batch respectively amid a certificate distribution program at Hotel Royal Singi in Kathmandu on 16 April 2022. The event was inaugurated by former Deputy Prime Minister Bhim Rawal who urged youths to join politics. He added that it is not possible to improve our situation without youth’s participation and efforts on mainstream politics.

Surendra Basnet, vice president of National Youth Council showed his commitment to collaborate with NTL members in various youth-centric programs in the coming days.

Similarly, president of Higher Institutions and Secondary Schools’ Association Nepal (HISSAN) Ramesh Silwal thanked the executive team of NTL for conducting such a year-long program as it helps students to focus on their extracurriculars simultaneously. Chairman of Golyan Group, Pawan Golyan said, “Post teen phase is the time to grow oneself from every direction as this time has the hunger of learning.”

Editor-In-Chief of AP1 HD television Tikaram Yatri suggested students to know their passion and work to achieve expertise in the similar field. “I would not have succeeded if I were in politics as that’s not my expertise,” he added. Similarly, Manoj Gyawali, deputy general manager of Nabil Bank presented the importance of extracurriculars by giving the example of process during hiring a person for a job.

General Manager of Turkish Airlines for Nepal Abdullah Tuncer Kececi said that he is happy with the progress of NTL members and his company is ready to help students whenever in need.

The program was chaired by Shiva Danai, director of NTL. He requested the stakeholders for the collaboration with NTL so that they jointly help the scenario of students. Lastly, Bishal KC, member of the organizing committee and executive director of Career Point Education Services Pvt. Ltd. said, “Nepali academic houses have provided good education to the students but they have not been able to help in their entire development. NTL is hence helping the students to connect the missing dots.”