News of suicides are always followed by reports on how mental health issues need to be addressed—the insinuation being suicide can be prevented if there is greater awareness about anxiety, depression and other such conditions and efforts are made to normalize afflictions of the mind as any other health issue. While that might be true, it’s also important to acknowledge and work on the stressors—violence, discrimination, societal isolation, financial difficulties et al.—that give rise to mental health problems, eventually driving some people to suicide. 

According to Nepal Police data, 7,141 people committed suicide in the fiscal 2020/21, up from 6,252 the year before. The common rationale behind the spike was that the Covid-19 pandemic and the subsequent lockdowns took a toll on people’s mental wellbeing. But experts say the pandemic only exacerbated what has been a major public health issue for years. Suicide, they say, has been one of the leading causes of death in Nepal, with the number of cases increasing every year. What’s more, they agree that because of under-reporting the actual number of cases is way higher than what the police records show. 

According to Manju Khatiwada, undersecretary, National Human Rights Commission (NHRC), suicide has thus far been a neglected problem in Nepal. Often, families of those who commit suicide don’t want to accept that maybe there was an underlying problem. It’s something our society wants to brush under the carpet. There aren’t any national level plans and policies to make people aware of mental health issues or to tackle the various factors that ultimately lead to them. 

“It’s high time we studied why people commit suicide and address the root cause. So far, it’s been cloaked as a mental health problem and we all know what a taboo that is in our society,” says Khatiwada. Suicide, she adds, often stems from a violation of basic human rights. In an apathetic society like ours with rigid norms, each individual’s right to a dignified life is perhaps the last thing that occurs to most people while passing sweeping judgements and discriminating others on the basis of caste, sex, economic background and such. Society neither realizes nor cares about the implications of its actions on people’s mental health. 

Under the surface

Parbati Shrestha, project coordinator at Transcultural Psychosocial Organization Nepal, says not much has been done to prevent suicides. The cases that we hear of are just the tip of the iceberg, she says. Scratch the surface and you will find many social issues that could potentially be suicide triggers. She, like Khatiwada, sees the need to discuss and investigate every suicide and find out the cause behind it. Only when there are more discussions on the factors behind suicides will we be able to inch our way into solving the massive problem it is. 

“When someone commits suicide, we blame the person and condemn the act. We don’t look into our actions to see if we had, knowingly or unknowingly, created an unfavorable environment for them,” says Shrestha, adding many societal issues need to be fixed in order to provide people healthy coping mechanisms and be in a place to seek help, if needed. 

The problem, experts agree, is also that people can’t openly talk about what’s bothering them like, for instance, money woes, marital discord, abuse, postpartum depression, etc. They fear being blamed and stigmatized—for not doing enough or being strong enough. The problem festers, says Shrestha, and sometimes people see no way out other than ending their lives.

Nepal Police spokesperson Basanta Bahadur Kunwar says suicide cases shot up during the pandemic. Though the pandemic undoubtedly impacted people’s mental health, we can’t also ignore that there were many hidden issues that surfaced and snowballed out of people’s control. 

Blue Diamond Society’s president and rights activist Pinky Gurung agrees. The LGBTIQA+ community has always struggled with multiple issues—from identity crisis to lack of familial and/or partner support. The pandemic only made them glaringly obvious. That coupled with isolation and uncertainty was traumatic. Many people in the community, who already felt lonely and disrespected, couldn’t bear it any more. So far, 24 people of the community have committed suicide and around 15 more have attempted it since the start of the pandemic. 

“People in our community aren’t loved, even by their own families, and this leads to a lot of hurt. You need to understand that the sadness they feel is a reaction to that pain. Talking to someone or seeking medical help is the last thing on their mind. Frankly though, even if they opened up, does anyone even care?” asks Gurung. 

Studies show the LGBTIQA+ community is at higher risk of anxiety, depression, post-traumatic stress disorder, and even suicide. The triggers of these mental health conditions are often lack of family support and dignity as well as the ostracization and humiliation they face on a daily basis. Despite the findings of the studies, Gurung laments that nothing has been done to tackle the issue. There is also zero awareness about mental health in the LGBTIQA+ community, she says. 

Integrated approach

Of late, there have been some positive developments though. This is the first time the United Nations has made recommendations to Nepal to look into the causes of suicide and work on them, says undersecretary Khatiwada. It has recommended that Nepal develop and implement a national strategy and action plan for the prevention of suicide. It has also highlighted the need for reliable data collection and addressing the social stigma associated with suicide.

Psychiatrist Dr Kanchan Dahal says suicide is complex, that there isn’t one particular reason why people get to the point where death seems like the only answer. But, often, the driving force is some sort of trauma and a sense of helplessness that comes with it. Also, for some, it might be an impulsive decision, while for others, it could be something that was planned for a while. The fact remains that behind every decision lies immense stress—be it physical, mental, or emotional—and the inability to see a way out of it. 

“The pandemic affected people in ways we can’t even begin to imagine. Some were locked at home with their violent spouses. People were worried about whether they would be able to feed their families. There was also the stress of not knowing how to cope with this discomfiting experience,” says Dr Dahal. Many in the low- and middle-income groups lost their jobs, and families that relied on remittance were left without any income. There was extreme food scarcity. What was unfortunate here, adds Dr Dahal, is that the government didn’t come to people’s aid. He believes many suicides could have been prevented had the government come up with a proper plan to mitigate the sufferings of daily-wage earners. 

“I’m not negating the fact that people might need help to deal with mental health illnesses and that there should be more awareness and acceptance of these issues. But we also need to focus on the circumstances that lead to mental health problems,” says Dr Dahal. Another thing that’s needed is sensitive reporting of suicide, without divulging details of cases. Otherwise, suicide is glorified, giving people ideas. 

All said and done, a major responsibility also lies on families to be attuned to the changing moods and behavioral patterns of their loved ones. We also have to emphasize the importance of healthy relationships and learning to control our emotions. NHRC’s Khatiwada stresses the need to change our socialization process, which, in its current state, she adds, is the root of all evil.  

“We need to understand the importance of the live-and-let-live principle, whereby no one is subject to unwarranted stress and shame. Suicide prevention needs an integrated approach where many larger factors must be considered but a good place to start is definitely in our homes,” says Khatiwada. The need of the hour, she adds, is a non-hostile environment where people feel accepted and valued. 

The unanimous opinion was that we live in a very stressful environment that isn’t conducive to growth and sound mental state. The conversation around mental health, though crucial, can only help so much when the social ills that lead to them are sidelined.