1) Impart life skills and entrepreneurship-based education targeting both school and out-of-school children and youth.
2) Build a strong public health system inclusive of mental health services.
3) Guarantee easy access to finance to set up new business or enterprise.
The most painful thing for human beings is to be plagued by thoughts of inner darkness. The suffering caused by this darkness is enormous and often hard to express in words. My journey through inner darkness started when I was 10. I had no idea what was going on. I used to feel sad, lonely, and suicidal.
It took me seven years to even know that the cause of the darkness was depression. I recall the day my father took me to his psychiatrist friend. When the doctor diagnosed me with childhood depression, my father looked somber, as though his pride had been pricked, as though he had lost hope in his son.
Though I seemed active, cheerful, and friendly to others, throughout my college and university days, I felt lonely, terrified, humiliated, and defeated. I was dependent on medication for a decade after the diagnosis with no recovery in sight. That’s when I decided to face myself and make a choice between living a double life and making my journey public and, as a result, an agenda of public importance.
In early 2008, when I started to write articles on mental health issues in national dailies, including my accounts of suffering, I slowly began to understand the gravity of mental health problems in the country. I was shocked to learn that 50 percent of mental health problems begin before the age of 14, and 80 percent before 24. On average, individuals suffering from mental health problems take 10 years to seek professional support in countries like Nepal. Imagine how much damage the disease would have done to the individual in that time.
Following my articles, hundreds of people reached out to me with their stories. In a society where social stigma and discrimination towards mental illness is rampant, listening to people with mental health problems became a life-changing experience for me. Those labeled mentally ill are the most vulnerable people in the world, not only because of the complexity of the problem but because of social beliefs and attitudes towards them. I was also shocked to learn that the global recovery rate from mental health problems is just around five percent.
Even before the start of Covid-19, mental health problems were spreading like wildfire in Nepali society. Poverty, unemployment, gender disparity, poor health facilities, myths and misconceptions about mental health problems, chronic physical health problems like cancer, abuse of substances like alcohol and drugs, poor parenting, conflict, and political instability have been the major contributors to mental health problems in Nepal.
But since the onset of Covid-19, it’s as if the above-mentioned triggers have been amplified by over 200 percent at once. There are reports that the mental health of up to 90 percent of the people has been affected by the Covid-19-induced new reality. Of course, the scale and gravity of the situation greatly vary, but almost no one has been spared some impact on their mental health.
Suicide is increasing and racing to become the number one cause of death among the youth. Nearly 70 percent of youths involved in the informal sector are now unemployed. Tourism and transport that provide over two million jobs have been paralyzed for over a year. Despite 400,000 youths entering the job market every year, there is a dearth of employment or economic opportunities inside the country.
This new socio-economic and public health reality is enough to gauge the risk of mental health problems in Nepal. Add to that the anxiety that is caused—overtly and subconsciously—by the relentless political instability and brinkmanship that force the country to teeter on the fringes of state failure.
In my personal and professional experience, mental health is not only a reflection of personal health but of our collective social, educational, cultural, economic, and political reality. A country that ignores mental health cannot grow healthily. It should not only be providing adequate mental health services but also promoting mental health by ensuring citizens can meet their basic needs.
In particular, in this Covid-19-induced reality, Nepal should prioritize three areas to meet the ‘happy Nepali prosperous Nepal’ mantra our prime minister likes to harp on: Life skills- and entrepreneurship-based education targeting both in-school and out of school children and youth; strong public health system inclusive of mental health services; and, easy access to finance to set up new business or enterprise inside the country.
In working with people with mental health problems in Nepal, I have realized that most of them have developed various conditions as a result of their immediate socio-economic environment. Only the state can make this socio-economic environment more mental-health friendly. The importance of creating an enabling environment for everyone to grow and flourish cannot be stressed enough.
To prevent over 80 percent of all future mental health problems, it’s important to give our children and youth life skills and entrepreneurship-based education, which our education system has failed to do thus far. Covid-19 has taught us the importance of building a strong public health system inclusive of mental health.
Strong health and education systems are the pillars for an enabling environment for every citizen. When skilled and healthy citizens are supported with easy access to finance to undertake skills-based entrepreneurship and businesses in diverse areas like agriculture, technology, innovation, public service, we can transform this country in a generation. Not only will the collective mental health of the country improve, that will in turn also drive the economic prosperity we so fervently desire. This is my vision for Nepal.
What is the biggest lesson you learned while working in the field of mental health in Nepal?
Earlier, I used to feel alone and think I have the biggest problems in this world. But when I started working in this field, I got to know that others had much bigger problems. It was a revelation.
How would you rate Nepal’s mental health facilities in the South Asian context?
I can’t give it more than two or three out of 10.
Any book you would recommend to help us tide over these tough times? Siddhartha by Hermann Hesse.