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With roughly 0.22 psychiatrists and 0.06 psychologists for every 100,000 people, Nepal is woefully underprepared to meet its growing mental health challenges. The state’s investment in mental health is dis­mal—under a percent of the total health budget. The result: up to 90 percent Nepalis with mental health problems never get professional help. Even the little manpower Nepal has in mental health may not be up to the standard in the absence of a regula­tory body certifying their qualifications and credentials.

“Without a reliable professional body regulating mental health professionals, we cannot ensure the quality of the services they provide,” says Dr. Mita Rana, a clini­cal psychologist and associate professor at IOM’s Department of Psychology and Mental Health. “Baffles me how such an important issue has been taken so lightly!”

How many mental health pro­fessionals are there in Nepal? It is hard to say. What can be said for sure is that there are far few of them. Roughly, there are 0.22 psychiatrists and 0.06 psychologists for every 100,000 peo­ple (see box below), respectively. As a result, around 90 percent peo­ple needing mental health treatment in Nepal don’t get it.Shova Rijal (name changed) of Dhapasi returned to Kathmandu from New York a year ago. Her job as an executive at a stockbroking firm in New York was taxing and she used to book a session with her counselor when­ever she felt stressed out. But she couldn’t do that in Nepal. When she heard of a meditation retreat in a mon­astery next to Swayambhu, she readily joined.

“You know it’s not easy to find a professional counselor here,” says Rijal. “I did a little research, and found nothing convincing.” In the US, she paid $400 for an hour-long session. She thought that was expensive but worth it nonetheless. The four-day retreat in Kathmandu helped her a lot, as she later shared. But it may not be as helpful to oth­ers. As different people have differ­ent mental health conditions, their needs vary.

Jagannath Lamichhane, a men­tal health expert and chairperson of Juggernaut Mindset, thinks that “the non-stigmatizing and accom­modative nature of our society helps people deal with psychological prob­lems to an extent”. He thinks the cul­ture of going to temples and meeting spiritual teachers provides psycho­logical healing, but there may be situations when people need clinical support. More so when the situation has already gone out of hand.

For Lilu Sharma, an engineer by profession, a six-day Art of Living course and then a 10-day Vipassana meditation retreat in Kathmandu were helpful. But the stress of having to look after her alcoholic father, ailing mother, and estranged broth­er, both in terms of time and mon­ey, required something more. More than that, she looks after 114 young men and women aged 16-26 at four hostels she runs in Kathmandu. She counsels these people on all sorts of topics.

What she is doing is more than an ordinary person can handle, much less a single woman in her 20’s. So she thought it would be wise to visit a counselor. “Sometimes, the pressure of having to do everything requires me to go and seek profes­sional help,” she shares. “This helps with my own stress and also enables me to help others.”

Pros and semi-pros

Dr. Kapil Dev Upadhyaya, a senior psychiatrist and consultant at the Thapathali-based Center for Men­tal Health and Counselling-Nepal, stretches his schedule a little to listen to Sharma, as he knows how import­ant it is. Himself a meditation prac­titioner, Upadhyaya also thinks our social and spiritual systems naturally support mental well-being. Still, there is a need for professional help, just as Sharma sought.

While it’s beyond doubt that more mental health profession­als are needed, ensuring their qual­ity is as important. There are very few academic programs in the coun­try to train professional counsel­ors. And there is no mechanism to look after the quality of training.

Tribhuvan University’s Institute of Medicine (IOM) provides an MPhil degree in clinical psychology that enables one to be a licensed clinical psychologist. Likewise, TU’s Central Department of Psychology (CDP) provides two-year master’s degree in psychology and one-year certifi­cate on counseling. The IOM MPhil program started in 1999, but the total number of graduates is still under three dozens in the highly-compet­itive program. The country of near­ly 30 million as such has just over 30 clinical psychologists offering their expertise.

CDP graduates may choose to be psychosocial or school counselors. But they cannot be a registered counselor due to the absence of a regulatory body. Not being affiliated may also mean lack of accountabili­ty. The IOM graduates, on the other hand, can register at the National Health Professional Council (NHPC).

Medical doctors have a well-estab­lished medical council that accredits them after a comprehensive written test. But sans a standard procedure, anybody with a clinical psychology degree from any university can reg­ister at the NHPC. That worries Dr. Mita Rana, a clinical psychologist and associate professor at IOM’s Department of Psychology and Mental Health.

“Without a reliable professional body regulating it, we cannot ensure the quality of mental health services being provided,” says Rana. “Baffles me how such an important issue has been taken so lightly!”

Some non-government organi­zations offer short-term counsel­ing training. But these are only seasonal and tailor-made pro­grams ranging from one week to few months in duration. Both Lamichhane and Dr. Rana are skeptical of the quality of these programs. The trainees are either NGO workers or are later employed by them. Their skills may not be of much help to most sufferers of mental health problems.

Hope amid despair

One reason Nepal has few mental health professionals is low pay. Counselling in par­ticular is time-consuming. The medical doctors hardly spend 2-3 minutes on an out-patient in Nepal. In an hour, a busy doctor sees as many as 30 patients: the more patients you see, the more money you make. But clinical psy­chologists do not have that luxury. Sometimes they may have to spend hours with a single patient, limiting their scope of payment.

Dr. Rana, who sees patients at Teaching Hospital, spends an hour with a patient on average. “It’s a delicate process. We have to spend time with the patients, and closely listen to them. Only then can we help them.”

She also does part-time consul­tancy at the Gyaneshwor-based Himal Hospital. In her three hours at Himal, she can see only three patients. A patient pays Rs 800 per session at the hospital, compared to $400 (Rs 45,000) Rijal paid in New York. “Despite the pay, you cannot neglect the need for more profes­sional mental health services,” Dr. Rana asserts.

The need for psychological coun­seling was particularly high after the 2015 earthquakes when many peo­ple suffered mental trauma, accord­ing to Dr. Upadhyaya. Perhaps this realization led to Nepal hosting the first International Conference on Mental Health in February 2018. One of the conference recommendations was to ‘improve the technical capac­ity and skills of health profession­als working at all levels of mental health care’.

But no improvement toward that end is in sight. There is hope though. The Nepal Health Research Council, a body under the Ministry of Health and Population, has started a Nation­al Mental Health Survey project that is expected to give a ‘clear national picture of the prevalence of mental disorder and unmet need for ser­vices’. The report, due in 2021, could potentially be a game-changer for mental health in Nepal

Mental health stats

•Government spending is less than 1 percent of its total healthcare budget on mental health.
• There are 0.22 psychiatrists and 0.06 psychologists per 100,000 people.
• Mental health services are concentrated in the big cities.
• There are approximately only 50 psychiatric clinics and 12 psychological counseling centers.
• An estimated gap between treatment and magnitude of mental health problems is over 85 percent.
• There are estimated 1.5 beds per 100,000 people across the country for mental health patients.
• Suicides among women of reproductive age increased from 22 per 100,000 in 1998 to 28 per 100,000 in 2008.
• Only 2 percent of medical and nursing training is dedicated to mental health.
Source: Health Research and Social Development Forum (HERD), 2016

Where to seek help?

Only a few facilities in Nepal provide psychological support (psychiatrist or clinical psychologist) for those with mental health problems, including the ones mentioned below. The list is not comprehensive; we hope it can be a starting point though.
1. Center for Mental Health and Counselling-Nepal (CMC-Nepal), Thapathali (01-4102037, 4226041)
2. Rhythm Neuropsychiatry Hospital and Research Center Pvt Ltd, Ekantakuna (01-5000700, 5000711)
3. Mental Hospital, Lagankhel (01-5522278, 5522266)
4. Teaching Hospital, Maharajgunj (01-4412303, 4412505, 4412605)
5. Patan Hospital, Lagankhel (01-5522278, 5522266)
6. Kathmandu Medical College, Sinamangal (1-4242121, 4242015)
7. Private hospitals [Himal (01-4415076), Om (9802076225), Norvic (01-4258554), Mediciti (01-4217766), Metro (01-4721514, and others]
8. BPKIHS Dharan (025-525555)
9. Manipal Teaching Hospital, Pokhara (061-526416/17/18/19)

A book could be boring if it is not of your field of interest. But not all books. Some can be damn interesting regardless of what they are about. Dambar Krishna Shrestha’s ‘Nepali Pravasan: Niyati ra Rahar’ is one such book. It tells stories of Nepalis who have gone to foreign countries—from Asia to Europe to Australia to America. These are stories of life, aspiration, success, failure, pain, death, labor, entrepreneurship, and hope.The stories take you on a world tour and connect you to Nepalis everywhere. You’ll meet Tulasi Kumar Gurung of Pokhara in Hong Kong who ensures that his boss Li Ka-shing, one of the richest men in the world, is safe and sound. You’ll meet Sabin Sapkota of Dharan in Germany, coaching golfers. There’s Gurkha soldier Indra Bahadur Rai from Dharan, showing his five med­als of bravery from World War II. And Hakim Shrestha from Jhapa who runs a chain of grocery stores in Malaysia. The construction com­pany initiated by Dipak Khadka in Hong Kong employs 360 people from Australia, China, and the Phil­ippines. Lakesh Gurung from Gong­abu (Kathmandu) is an army officer in French Foreign Legion.

Gulf countries may be risky for Nepali women but they are doing pretty well in Hong Kong, Japan, the US, and the UK. Pavin Rai from Dha­ran is an officer with British Armed Forces. People often assume she is a Gurkha soldier or a wife of one. It’s hard for them to believe she has fought hard battles in the bunkers of Kenya, Cyprus, and twice in Afghan­istan. Her most difficult moment was when three of her colleagues were killed in Afghanistan in 2008.

Sushila Rai found it difficult to sustain the family even after work­ing from 4am till 9pm at her shop in Dharan. In Hong Kong, earning a living has never been an issue.

On board Qatar Airways, you may run into the music video model Pragya Panta, who is now an air­hostess with the airlines. There you may also meet ‘hot’ cybernepal.com model Sicilia. Eating Nepali food at Monika Rai’s restaurants in Japan and shopping at her department stores can also be an experience.

In America, you’ll meet many of Nepal’s missing celebrities. If you’re one of the music-loving teens of the 1990’s, you may be interested in knowing that Harish Mathema is ‘found in the US doing something or the other.’ It makes me nostalgic as I still have his songs ‘Aankhako Nani Hau Timi’ and ‘Swapnil Rangma’ in my collection.

Actress Arunima Lamsal smiles in front of the tables in a Maryland restaurant where she works. Singer Yam Baral poses for a photo on a street. Actresses Saranga Shrestha and Puja Chanda stand for a group picture with their families. Premraja Mahat, Yam Baral, Sapanashree, Jagadish Samal, Roshan Gurung, Dipesh Kishor Bhattarai sing Nepali songs somewhere. Yam Baral quips: “There are so many Nepali artistes in the US that one may have to take them from here for a show in Nepal.”

The stories are written in direct and unpretentious tone of newspa­per journalism. The skills of Shrestha as a writer-reporter and of Rajendra Dahal, Kundan Aryal, Shiva Gaunle, and Kiran Nepal as editors at Himal Khabarpatrika com­bine to give reading pleasure.

Had it been an academic thesis or an NGO report on migration, it would be half as fun to read. But written by a journalist who is himself a migrant in Hong Kong, it sounds real and lively.

The book is a collection of stories Shrestha wrote between 2000 and 2015 for Himal Khabarpatrika. The 41 stories are thematically divided into nine sections. There are success stories of Nepalis but also stories of awful deaths abroad. It’s appalling to learn that three dead bodies fly into the country daily. There are people who have committed suicide after failing to repay debts even after working under the hot Qatar sun.

There is the gloomy story of Sudarshan Khadka of Lele, Lalitpur, whose brother Ramesh Khadka was one of the 12 Nepalis killed by terror­ists in Iraq in 2004. The government gave the family a million rupees in compensation. The family spent Rs 100,000 to build a bust of the dead son at the courtyard of their house, and gave Sudarshan Rs 250,000 to go abroad for work. Of all the coun­tries, Sudarshan chose Iraq. The rea­son was better pay. He confides to the author: “It’s no use just remem­bering him [Ramesh]. Though the fear of death looms every moment, there is also the hope of earning well.” But he couldn’t enter Iraq. His agent took him to Jordan via India, Dubai, and Kuwait. After spending three months on the tour and losing the money, he returned.

Why would Nepalis go abroad after all? The book offers some ideas. In his preface to the book, Rajendra Dahal writes: “On read­ing the success stories of Nepalis abroad, a question comes to the mind: Nepalis don’t have work at home, but they have no dearth of it abroad. Why is that?”

Published by Himal Kitab for the Center for the Study of Labor and Mobility, Social Science Baha, the 296-page book is priced at Rs 390

A native of Dolakha who has been living in Kathmandu for a long time, Shrestha was always confused about his identity. After the 2015 earthquake, he went back to his hometown to discover himself. He recalled carrying doko back in his village and was always mesmerized by its weav­ing patterns. He says, “Our identity is like doko’s, slowly disappearing in the mist of modernism. I started this project to revive our old traditions and help people recover from the post-quake trauma.”

In our day to day life, seldom do we stop and look around us to see what’s new. The public space no longer seems so public. Shrestha wants people to start noticing things around them again, and using art to bring these public spaces back to life. “People have the miscon­ception that art is limited to drawings, paintings, and sculptures. But this is a false impression,” he says. “Art can be created from anything and everything. From the clothes we wear to the way food is served.”

Shrestha plans is to initiate street art projects all over Nepal, using the medium to reach out to the communities and give them important socio-political messages. “Art has taught me to live a gratifying life, face challenges, and to endlessly experi­ment,” he says.

Though the artist runs the project sin­gle-handedly, he believes he could pro­duce ‘national assets’ even with a little government help.

Many people made fun of Prakash Raj Pandey when he told them he wanted to be a mountaineer. They did not trust him due to his relatively short stature and a body structure that report­edly didn’t suit climbing. On 26 June 2016, he proved them all wrong, by accent­ing his first peak—Baden Pow­ell Scout Peak—and created history by being the second climber in Nepal Scout to scale Langtang.

Mountains fascinated Pan­dey since his childhood. Growing up in the lap of the Himalayas, it was always his dream to overcome the mighty mountains—all across the world. “The story of Ten­zing Norgey Sherpa and Sir Edmund Hilary always moti­vated me and gave me cour­age to climb,” he says. In 2017, he climbed Mt. Island Peak, which paved the way for the ascent of Mt. Everest. Before trying Everest, Pandey had in 2018 scaled Ama Dablam.

Arguably the most import­ant achievement in any mountaineer’s life is scaling the world’s highest peak, Everest. In this venture, as he was the team leader of 11 climbers, he was entrusted with great responsibility. On reaching base camp, obsta­cles came to him thick and fast. An avalanche hit the team. Were it not for his guide Tshering Bhote Lama, he would have died.

“Mountains are gods and the Sherpas are the worship­pers. These guides are the reason climbers like me safely reach home,” Pandey says. The most important part of mountaineering is to be dis­ciplined and to strictly fol­low the guide, he adds. “I guess I am alive because my guides helped me through all the difficulties.”

Pandey is also an active member of Nepal Scout and is involved in social work. Recently, with the support of V.S. Niketan School and Dynamic Scout Crew coor­dinated by Nepal Scouts, he organized the Free Health Campaign at Manang. He also donated to Chepang Basti and bore expenses for Shanti Che­pang’s Grade X education. “I have been a member of Nepal Scout for 13 years. This may be why I am motivated to helping others in need,” he says.

Pandey was committed to helping people of Chepang community as they lacked even basic facilities. “Our donation program fell under the Scout SDGs,” Pandey says, while promising he would continue to work in moun­taineering and social work simultaneously.

While submitting Everest, he came across dead bodies as well as plastic waste. Everest has comparatively more waste than Manaslu or Ama Dablam. He said the volume of waste would greatly decrease if the climbers themselves become more responsible and disci­plined. He hopes to some­way help with the clean-up of Everest.

Pandey proves no matter how much people try to make fun of you and your passion, self-belief and commitment to your dream pays: “When I asked for help for my climbing expedition with friends and possible sponsors, they didn’t trust me as I didn’t belong to a climbing family.”

Now, besides Everest, Pan­dey has scaled Manaslu (the killer mountain), Amadablam (the most beautiful and the most technical mountain in the world), Island Peak, and Baden Powell Scout Peak, the last of them twice.

This autumn he plans to climb the seven highest moun­tains in the seven continents which, he hopes, will also help with the promotion of Visit Nepal 2020