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.