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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

Of late there has been no shortage of voices linking higher taxes with the supposed failure of the federal formula. It is true that taxes have been increased (and their scopes widened) across the board, from properties to small businesses. Even cattle and bicycles are now being taxed. Land and property taxes were minimal under the old unitary dispensation, with most people paying no more than Rs 100. But under the new consolidated taxes, the same taxes have jumped to an average of well above Rs 1,000.Kathmandu municipality has introduced a spate of new levies and jacked up old ones. It will charge Rs 500 for a person to prove, on paper, that he is alive. To be liable for a naturalized citizenship, the recommendation forum will set you back by Rs 10,000. In Dhangari sub-municipality of Kailali district, you will have to pay an annual tax of Rs 15 if you own a bicycle; crossing a local river on a boat there will incur you Rs 25 a trip. In Godavari municipality of the same district a chatpate seller will have to fork out Rs 20 and an ice-cream seller Rs 30 a day.

Perhaps one reason for such widespread skepticism of the new tax regimen is that people are just not used to hearing of ironsmiths and fruit sellers paying taxes. In time, they might sound pretty normal. But in the view of political analyst Shyam Shrestha there is another, more important reason for this skepticism. “Neither the central government nor the local level governments have bothered to explain the ratio­nale for these levies,” he says.

He has a point. These taxes will help pay for social security and basic health and education needs of the locals, a duty of the local bodies under the new constitution. “How can the local bodies guarantee these services without raising taxes?” Shrestha asks. But Shrestha says elected representatives have thus far been unable to credibly assure the people that their money will be well spent.

“If you can assure them that all their basic needs will be taken care of, who will oppose higher taxes?” he asks.

Notably, three years after the promulgation of the new constitution, the all-important National Natural Resources and Fiscal Commission it envisioned to work out taxes and division of spoils among different tiers of the government is yet to get a complete shape (See: HERE). Perhaps the political masters of the country were never sold on federalism.

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 owl population in Nepal is in danger. Their smuggling has greatly increased in recent times owing to the belief in parts of Central Asia, China, India and Vietnam that they bring good luck. Experts are worried that owls may completely dis­appear from Nepal. Among 225 species of owls in the world, Nepal has 22. “Nepal government has not paid any attention toward its conser­vation,” says Raju Acharya, who conducts studies about owls in Nepal. By contrast, he points out, South Africa has taken many steps to protect its owls.

According to a study by Friends of Nature Nepal, an NGO, around 2,000 owls are smuggled alive from Nepal every year. They are mostly used for medical purposes. Magicians also use them. In China and Vietnam, owls are even used for making alco­hol. There is a superstitious belief in China that drinking alcohol made with owls kept in a bottle for 10 years cures arthritis. “In India, religious priests purportedly use it to cure various illnesses, which is also why smuggling of owls out of Nepal has increased in recent times,” says Acharya, who has visited 46 districts to study Nepali owls.

Owls are used to kill rats in Africa and Malaysia, he informs. An owl, in the pro­cess of giving birth and tend­ing to its offspring, can con­sume as many as 3,000 rats. This is one good reason why Nepal should also conserve its owls, Acharya says.

Though exact statistics on owls in Bardiya are missing, locally, owls are mostly found in community forests and the Bardiya National Park, says the park’s Chief Conservation Officer Manoj Shah. “Thieves and smugglers pose a big threat to conservation of owls. They take the offspring away from the nest, raise them and sell them,” he informs. If a person is found killing, raising or harming owls, they can be fined Rs 50,000, be jailed for three months to two years, or get both the punishments.