Mental health in Nepal: A ticking pandemic time bomb

Arun Poudel

Arun Poudel

Mental health in Nepal: A ticking pandemic time bomb

Socio-economic trauma of the pandemic is already being felt across the world, and it’s no different in Nepal. The number of psychological illnesses and suicides is expected to spike over the next few years

On May 1, a man in Kathmandu’s Baneshwor committed suicide by consuming Celphos, a pesticide used to preserve grains. While the police are still investigating, family and neighbors reported he had become bankrupt and did not have a grain left to eat. His small eatery was closed and he was under a huge debt.

Since the start of the lockdown on March 24, a total 1105 people committed suicide across the country (as of May 30) as per Nepal Police. This puts the average daily suicides at 16.25, which used to be about 14 before the lockdown. Sixty-nine people killed themselves in the Kathmandu Valley in this time.

Although it is too early to draw definite conclusions and connect this to the pandemic and lockdown, the link cannot be altogether denied as well. The general stress level of the people—the harbinger of all mental illnesses—has definitely spiked.

Dr Kapil Dev Upadhyaya, senior psychiatrist and consultant at the Center for Mental Health and Counselling-Nepal, says the real picture of pandemic-induced mental health issues is yet to surface.

He and his colleagues get calls from patients who are, among other things, unable to sleep. Lockdown stress has increased the risk of relapse for patients who were showing signs of progress, according to Dr Upadhyaya. The cases of post-traumatic stress disorder (PTSD), suicides, alcohol abuse, depression, and anxiety could further rise after the lockdowns, he reckons.

Stress of stigma

Perhaps the long-term impact of Covid-19 would be more on mental than physical health. Mental health professionals have been raising alarms worldwide. The American Psychological Association reports, “Covid-19 has brought a raft of intense new stressors while removing many of the resources people have traditionally used to cope with stress.” Millions of people have lost their jobs and some even their homes and businesses.

The social stigma attached to the virus may be more dangerous than the virus itself, according to Dr Ritesh Thapa, a consultant psychiatrist and director of Lalitpur-based Rhythm Neuropsychiatry Hospital and Research Center.

“The problem is the way we have made it so big. But it is just a virus! We often get infected with a virus, and we get cured. We have already been through HIV-AIDS, Ebola, and leprosy. But in this case, the social stigma has been too much,” says Dr Thapa. Anybody suspected of having it is stigmatized and treated as an outcast. People in quarantine fare no better; so much so they start feeling guilty, leading to multiple psycho-social problems.

Dr Thapa and his team get several calls every day from patients with complaints related to depression or anxiety. Many of them have suicidal thoughts. One patient whom he suggested to get hospitalized refused to do so and later attempted suicide. He failed.

Dr Thapa too reckons not enough people are reporting psychological problems. “We can tell from previous pandemics and public health crises in other countries that it’s going to explode afterward.”

Worldwide, experts have been warning the governments that the next crisis will be economic, and will directly impact people’s mental health. In Thailand, the number of people committing suicide due to economic hardship is predicted to exceed the number of coronavirus deaths.

Besides many economic factors, unemployment resulting from Covid-19 alone might, in the worst case, result in 9,570 additional annual suicide deaths globally, says the UK-based medical journal The Lancet.

Many names of misery

Dr Thapa gets calls from three types of people who report economic hardship. First, entrepreneurs who are under stress due to monetary loss and pressure to repay bank loans. Second, daily wage earners and small-time employees who live in rented rooms. Under pressure to pay rent and buy food, they often complain of “feeling lowly and lonely, and feeling like crying.” The third type is comprised of the youths from outside Kathmandu who are working students in the city. They complain of being stuck in the Valley without jobs and of having depressive thoughts.

Socio-economic trauma of the pandemic is already being felt across the world, as a result of which the number of psychological illnesses and suicides could spike.

On March 30, the finance minister of Germany's Hesse state, Thomas Schaefer, committed suicide after apparently losing hope over the virus’s economic impact. On April 26, Dr Lorna Breen, a top emergency room doctor at a Manhattan hospital, committed suicide. She was one of the frontline medicos treating coronavirus patients.

In India, a 50-year-old Covid-19 patient committed suicide in Stanley Government Hospital, Chennai, on May 26. The next morning, another 57-year-old patient who was isolated for coronavirus symptoms killed himself in Tamil Nadu Government Multi Super Specialty Hospital.

In Britain, Emily Owen, a 19-year-old waitress from Kings Lynn in Norfolk, died in hospital after a suicide attempt in late March. She was “unable to cope with the isolation.” A few days earlier, she had warned relatives that more people would die from suicide during this time than from the virus itself.

Suicide is likely to become a more pressing concern as the pandemic spreads and leaves behind longer-term effects on the general population, the economy, and vulnerable groups, The Lancet writes.

Suicidal facts

According to a study by the Well Being Trust and researchers affiliated with the American Academy of Family Physicians, suicide and substance abuse-related deaths resulting from coronavirus are likely to increase. In the US, such additional deaths may go as high as 154,000 in the next 10 years depending on the impact on the economy. Suicide cases are already high in the country, with 48,344 people killing themselves in 2018, as per the data of the American Centers for Disease Control and Prevention.

Likewise, a spike in suicides triggered by Covid-19 lockdowns is expected to exceed deaths from the actual virus in Australia, according to researchers from Sydney University’s Brain and Mind Center. In the best-case scenario, suicide rates will increase 25 percent in the country, Professor Ian Hickie of the university said in early May. Suicide rates could increase 50 percent over the next five years if the national economy continues to deteriorate for more than a year. This would add 750 to 1,500 suicides to the annual Australian average of 3,000, the study predicts.

Nepal has not evaluated the impending economic and mental consequences of the Covid-19 crisis. The focus has been on continuing the lockdown, without a plan for addressing the psycho-social issues that will later emerge. Reports from our southern border paint a grim picture of the quarantine facilities. People spending time there, who are already facing social stigma, could also go on to develop debilitating psycho-social problems, warns Dr Thapa.

There have been sporadic reports of people suffering from loneliness, desperation due to loss of jobs and businesses, and domestic violence amid the pandemic lockdown. They are yet to be fully assessed and reported. Waiting for the pandemic to be over and lockdowns to be fully lifted might be fatal. As Dr Thapa suggests, it is wiser to take preventive measures now than allow the problem to grow and later burst—with potentially unimaginable consequences.