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A recent Niti Foundation survey noted an alarming rise in mental health issues among Nepali youths (aged 18-40) during the pandemic.

A whopping 84 percent of participants reported high anxiety levels. Others said they were living with depression and alcoholism and other forms of substance abuse. While a fraction had access to mental healthcare after Covid-19 restrictions were gradually lifted early this year, even they have been deprived of such services due to the latest lockdowns across the country.

Mental healthcare providers have no other option but to go online, run awareness campaigns on social media and 24/7 helplines. This is a big change for those who give and take mental help and one fraught with challenges.  

“Seeking therapy for mental wellbeing is a fairly new concept,” says 27-year-old Rojisha Shahi, a psychologist at Healthy Minds Nepal. “As a society that is still suspicious of anything on the internet, people are now even more skeptical of online counseling and its authenticity.”

Therapy stands on the foundation of trust and confidentiality. In-person sessions usually familiarize clients with the psychologist and the space they’ll be speaking in. Shahi says she decorates her office with plants and a lot of natural light to help her clients relax.

However, in an online setting, people seeking help are confined to their own space, often the very place they wish to escape. “Many can’t speak freely in an environment where their family can hear them,” Shahi continues. “In the absence of a private space, they have a hard time opening up.”

Saluja Chand, a counselor at St. Xavier’s College, also highlights this issue. “Teenagers are at the receiving end of both academic and familial pressure. So to make themselves vulnerable under these settings takes a lot of courage on their part.”

Where therapy sessions are new, the clients get suspicious about the psychologists and whether someone is listening in on their interaction.

On the other end of the spectrum, there are also instances of severe attachment to the counselor. Kripa Sigdel, psychologist at Psychbigyan Network Nepal, brings up a recent incident of a client who was constantly texting her for comfort. “During in-person therapy, there is a limited time and place on how much the two of you can speak,” she says. “But when that relationship goes online, counselors are easier to reach. The boundaries blur and the client expects you to be there for them 24/7, which isn’t possible for us.”

The relationship between a counselor and a client plays a key role in therapy. And while first introductions and conversation flow usually depend on the individuals and the therapist’s skill, online counseling hasn’t made it any simpler.

“It’s easier to form personal connections with clients when they’re physically present,” Shahi confesses. “Making a person comfortable online completely depends on your verbal skills. It feels more impersonal as there are distractions on both sides.”

Chand seconds this idea, adding that it completely depends on the individuals. “Some find it much easier to open up because of the detachment when you don’t have to show your face or look at the other person.” But for psychologists who also take note of body language and gestures, this is a downside as it blocks one of their main factors of observation.

For instance, Sigdel, who uses holistic activity-based observation methods, finds the sudden shift to online counseling challenging. “Getting quieter clients to open up solely based on conversations is quite difficult,” she says. “And interactive activities are harder to execute online.”

The lack of technological support isn’t helping either. Even during one of the worst crises in history, many parts of Nepal are still facing regular and unpredictable power cuts that don’t just interrupt counseling sessions but also take away the biggest communication channel between the help-seeker and the help-giver.

Similarly, many people from Kathmandu have gone to their villages during the lockdown. Says Pratima Tamrakar, counselor at Helping and Smiling, “Those without Wi-Fi access are solely dependent on mobile data for the internet. For them, help isn’t just far away, but also expensive.”

The expenses aren’t limited to the internet as most psychologists charge for their sessions. Because of the rise of mental health issues during the pandemic and the shift to online counseling, many have slashed their regular fees.

While the charges vary depending on the case’s severity and client demand, average fees for most online counselors ApEx spoke to ranges from Rs 1,000 to Rs 2,500 a session.  

The situation is tough for many. Shahi shares that she has clients who have lost multiple family members to the virus and are now completely lost.

While online counseling has its limitations, it’s also the only alternative right now for people with mental health problems--and it has its benefits. 

A 20-year-old ApEx spoke to had been taking online counseling for the past seven months. Since the lockdown, she’d been having a hard time getting out of her room, her anxiety levels reaching the highest they have ever been. But after receiving help online, she has grown out of her shell and learned to deal with life in a healthier way. When asked if she’d shift to in-person therapy after the second lockdown ends, she admitted that she’d received the help she wanted and wouldn’t be meeting her therapist physically.

Psychologist Sigdel confirms the effectiveness of online counseling, reporting that she herself had taken on newer clients during the first lockdown and finished their sessions before the country reopened.

Karuna Kunwar, psychologist at CMC Nepal, shares that during the beginning of the first lockdown many people were overrun with paranoia and spam-called medical institutes, convinced that they had caught the virus. This occurred so often that hospitals had to provide individual hotlines just to calm and comfort people on their symptoms, with experts speaking on the other end.

According to Sigdel, it was during the very first lockdown in Nepal that Man Ka Kura, an online platform connecting Nepalis all over the world to Nepali psychologists, was established.  

Despite these developments, almost all psychologists ApEx spoke to agreed that they would hesitate to see clients with severe mental illness for online counseling. Because critical psychological disorders can’t be treated with just therapy and online therapy is still in its infancy in Nepal, psychologists are irresolute about taking on severe and violent cases. Instead, for this purpose, they recommend emergency hotlines or seeing a psychiatrist.

Under the wider Covid-19 pandemic lurks another equally problematic pandemic: domestic violence.

According to Domestic Violence (Offense and Punishment) Act 2009, “Domestic violence refers to any form of physical, mental, sexual and economic harm perpetrated by a person to a person with whom he/she has a family relationship and this word also includes any acts of reprimand or emotional harm”.

Women and girls have become especially vulnerable to violence due to the measures taken to contain the virus, in what is known as the shadow pandemic. The risks have been amplified due to restriction in movement, confinement with perpetrators, constant surveillance, disconnect from social support systems, inaccessibility of services, and redirection of resources for Covid relief.

The first lockdown in Nepal started on March 24 and was eased on 21 July 2020. Upon analyzing Nepal Monitor's data—an initiative of COCAP that collates reports of violent and non-violent incidents and political contestation in Nepal based on print and online news reports—we found that the number of reported domestic violence cases went down compared to the past few months when the lockdown started. And the post-lockdown months, in general, saw lower numbers of domestic violence media reports than the pre-lockdown months of 2020, with spikes in May and October.

Female deaths resulting from domestic violence in 2020, again as reported in the print and online news reports, on the other hand, increased post-lockdown compared to pre-lockdown in 2020. Compared to pre-lockdown, fatality rates seem to be higher post-lockdown, highlighting the severity of the shadow pandemic.

The low number of domestic violence reports may be due to the print and online news reports choosing not to prioritize domestic violence in times of crisis. There is a dip in the number of reported domestic violence complaints in the first month of the lockdown compared to the month before the lockdown, as per Nepal Police. The decline in registered complaints has been witnessed in all provinces.The number of registered domestic violence applications declined by around 90-95 percent in all provinces apart from Bagmati province, where it went down by around 82 percent.

Even in Kathmandu Valley, registered domestic violence applications declined by around 93 percent in the first month of the first nationwide lockdown as compared to the same period prior to the lockdown. The degree of the decline is alarming and it indicates the inadequacy of the formal reporting mechanisms.

But did cases of domestic violence really decrease during the lockdown? The answer is a resounding no. The reporting of domestic violence through alternative media was found to have surged.

While the complaints registered with Nepal Police plummeted, as per the blog report by the World Bank, “A 24-hour toll-free helpline run by National Women Commission (NWC) received 885 calls related to domestic violence from April to June 2020. This is over twice the number of calls received within the same period prior to the lockdown (Dec 2019-Feb 2020)”.

“The call numbers after the imposition of the lockdown was very high. Because of lack of mobility and confinement, we would receive cases of physical harm, mental torture, and other forms of domestic violence which women were compelled to endure,” says Kabita Khadka, one of the helpline officers at National Women’s Commission.

The alternative reporting mechanisms were not necessarily prepared to meet the needs of the surge in the number of survivors seeking help, however. “As the lockdown happened all of a sudden and there were only ten of us responding, we did not have proper planning and were hamstrung by limited human resources,” says officer Khadka, adding that the ten officers who had to receive the calls had to bear high levels of stress and mental exhaustion.

This shows that when formal mechanisms of reporting were not accessible, alternative mechanisms such as helpline numbers have been used extensively and proven efficient. But it is important to ensure that formal mechanisms are strengthened while the creation and expansion of informal ones should also be prioritized to provide immediate support to survivors. Khadka also suggests better coordination with formal mechanisms such as Nepal Police to ensure that survivors get timely relief.

A 2020 blog report by World Vision, shows a surge in domestic violence cases during times of disaster and crisis. There has thus been a global rise in such cases during the pandemic. Despite the evidence, our legal instruments addressing domestic violence fail to prioritize the vulnerability of women and girls during times of crisis.

(1145 is a toll-free 24/7 helpline number for anyone facing violence. It provides services including counseling and support in reporting cases of violence. The helpline ensures full confidentiality and respect of individual choice.)

Shrestha is an undergraduate student double-majoring in economics and environmental science at Hollins University, US; Bhetwal is an undergraduate studying social sciences at National College, Kathmandu University; and Khadgi is a feminist legal practitioner. 

Singer, director and journalist Phurba Sherpa has managed to set yet another record. Recently, while accepting the certificate for his previous record, Sherpa made another one: accepting the certificate of his record at a world-record height of 5,364 meters from the sea level. 

Sherpa had made it to the Guinness Book of World Records in 2004 by singing an entire song with only one letter of the Devanagari script “Ma” on the album “Geet Ek Akshar Ko.” Recently, the UK’s World Book of Records had accepted it as a record as well. Phurba got the official certificate of the World Book of Records at the Everest base camp.

Singer, director and journalist Phurba Sherpa has managed to set yet another record. Recently, while accepting the certificate for his previous record, Sherpa made another one: accepting the certificate of his record at a world-record height of 5,364 meters from the sea level. 

Sherpa had made it to the Guinness Book of World Records in 2004 by singing an entire song with only one letter of the Devanagari script “Ma” on the album “Geet Ek Akshar Ko.” Recently, the UK’s World Book of Records had accepted it as a record as well. Phurba got the official certificate of the World Book of Records at the Everest base camp.