ApEx Roundtable: Talking mental health on election eve

As a part of our campaign to bring mental health awareness and help improve the country’s mental health institutional setup, ApEx on May 8 organized a roundtable of mental health professionals. Held on the eve of the May 13 local elections, this time, we wanted to understand the kind of steps that are necessary at the policy-making level in order to boost the mental wellbeing of Nepal’s nearly 30 million citizens—especially its youth population in the 16-40 age bracket.    

Local governments poorly informed on mental health

Dr Basu Dev Karki
Lead Consultant Psychiatrist, Patan Mental Hospital

The big problem now is that people are still unaware of their needs and basic rights when it comes to accessing mental health services. Local governments are supposed to provide mental health services to their citizens, but they themselves are poorly informed.

At the policy-making level, mental health is still not our priority. We as a country are yet to accept that mental health is directly connected to our quality of life. 

The Sustainable Development Goals, which also includes mental health, have been stuck in the ‘implementation phase’ for the past seven years. In the meantime, our suicide rate is increasing. 

If mental health is not a priority at the policy level, how can we expect the general people to prioritize it? In business, whoever brands themselves the best wins in the market. But unlike the case with physical health, we have been unable to brand mental health awareness. 

There are mental health-related policies in place, so much so that municipalities are provided with the necessary budget, human resources, and training for mental health awareness and services. These municipalities also have the responsibility of training health workers and program managers on mental health. Yet they still don’t realize that this is an important and urgent issue. There is also no mechanism to monitor their work in this area. 

Awareness should not be an event, it should rather be a movement.

Most mental health professionals don’t have adequate training 

Kapil Sharma
Counseling Psychologist and Psycho-social Counselor at HUDEC Nepal

We need to look at mental health through the psychosocial lens as well. No doubt, sensitization and awareness on this topic is growing among the youths. But we still don’t talk about mental health in general. 

In the majority of the cases, individuals, even if they realize that they are in need of first-hand mental health support, don’t know where to go, and they can’t even talk about it with their families. How can we expect the topic of mental wellbeing to be normalized when there is no social support for it? 

From the perspective of service providers, there are many training programs. But as these mental health trainings are not as prioritized as physical health training, our mental health service providers aren’t equipped to tackle the scale of the current mental health crisis.

One needs social motivation to seek support, which is lacking at the community level. It's a two-way challenge: Are service providers competent enough to provide the needed services? And are the service seekers aware enough of the services they should seek? 

Today’s youths live online. While there is an overload of information they can simply google, there is no way to guide them to understand their own mental issues or that of others. I’ve had clients who google their symptoms and self-diagnose—rather than look for one-to-one support before jumping to conclusions. 

There are many aspects to mental health awareness, and we need to look into all of them to better understand our own mental health. 

About time the country implemented a referral system

Shreeya Giri
Mental Health Advocate, Founder of Happy Minds

As an online mental health service provider, our operation exists on a digital platform. That is, we are cent percent dependent on gadgets, electricity, Wi-Fi, and mobile data to ensure that the needed support is being given to those who can’t access in-person services. 

Yet there is no guarantee of when the power will be cut and when the network will be interrupted. These faults in the infrastructure make such mental health services hard to access. If there are no digital infrastructures in certain parts of Nepal, people cannot access our services at all. So how do we help people in those areas who are in dire need of support? 

Unawareness and unavailability of these services lead to one common issue: we normalize mental health problems. Psychological abuse at the workplace and in the household is considered normal. Many people who are being emotionally abused don’t come forward and don’t get the right guidance. Even if people are aware that they need help, they don’t recognize what exactly it is that they need or that they can find the right person to talk to. 

To spread mental health awareness, Nepal needs a referral structure. How long will we keep saying that people don’t seek mental health support because they don’t feel the need? Every day in hospitals people are going through traumatic experiences. If the doctors can refer them to a counselor or a psychologist, they will get the necessary support to overcome their mental trauma. This can prevent future mental illnesses. 

In 2021, the government had set aside a budget of 1 percent for mental health services. But even this amount hasn't been properly utilized. The Health Ministry hasn't been able to mobilize experts to make the most out of it. 

We need to better utilize existing platforms

Dr Rishav Koirala
Psychiatrist, Grande Hospital and Executive Director at Brain and Neuroscience Center, Nepal

The most important part of awareness is amplifying conversations on the promotion of positive mental health and prevention of possible mental illnesses. Normally, we have a habit of seeking help at the last moment. If we can take action now instead of tomorrow, the situation of mental health in Nepal will significantly improve. 

Youths are the most aware of mental health, yet they can’t separate between right and wrong emotions, normal and abnormal suffering. 

Moreover, the large population of working-class people in our country is aware of the support infrastructure as well as support via digital platforms. What they lack is the knowledge of where these infrastructures are and how they can be accessed.

We need to find better ways to utilize these existing platforms and create awareness in such a way that every individual is aware of where they can find these spaces, how they can communicate, and what signs and symptoms they should be aware of to seek professional help. 

We can blame the stigma on mental illness for the current crisis. But it is also important to analyze how this stigma came to be and how we can eliminate it. Seventy years ago, there wasn’t a well-equipped mental health service-provider in Nepal. People weren’t aware of mental illnesses. Only when a person had reached a terminal stage, at the peak of their illness, were they considered mentally ill. Psychosis is a terminal mental illness, and this was what people labeled a mental health problem, and so the stigma of mental health began.

Times are changing, and Nepal has come a long way in terms of awareness and mental health services. Yet many people still believe in that stigma and the thought of mental illness scares them. It all comes down to awareness and changing the perspective on mental health.