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

 

 

Physical	Feelings	Behavior
Tired all the time	Overwhelmed	Avoiding social contact
Sick and run down	Guilty	Withdrawal from social circle
Headaches and muscle pains	Irritable	Relying on alcohol and sedatives
Churning gut	Disappointed/ Sad	Not doing enjoyable activities
Sleep problems	Unhappy/ miserable	Unable to concentrate
Change in appetite	Lacking confidence	Not getting things done at work/school
Loss/gain in weight	Frustrated	Sudden change in behavior/mood

 

 

 

To consult one, please contact:

- TUTH Suicide Hotline: 9840021600

- Transcultural Psychosocial Organization-Nepal Crisis Hotline: 1660 0102005

- Mental Health Helpline Nepal: 1660 0133666