15-21 July 2016 #817

Down and Out

Possible correlation between migration, mental health and an increase in suicide rates
Smriti Basnet

Map by Sahina Shrestha and Smriti Basnet

Ram, who was from Gorkha, went to work in Malaysia to support his family. Mistreated by his employers, the father of a six-year-old boy soon returned to Nepal but could not find a job in Kathmandu. He recently hanged himself from the ceiling of his room in Boudha.

Biswas was a 21-year-old Dalit who moved to Kathmandu from Sindhuli to run a small tailoring business. The father of a seven month-old daughter hanged himself in his shop.

The deaths of Ram and Biswas are among a dozen suicides reported to police every month in the Boudha area alone.

Extrapolated nationwide, the statistics of suicides among young men driven to migrate for work are shocking. Neighbourhoods like Boudha and Balaju, which have high migrant populations, have shown a greater incidence of suicides within the Valley.

“One contributing factor may be recent migration and poor living conditions. Such life factors contribute to overall stress and may play an important role in an individual's mental health,” said American Fulbright student of Public Health Ashley K Hagaman at a talk at the United States Education Foundation, Kathmandu in May.

The world over, 90 per cent of all suicides are attributed to mental health problems. While Nepal has no recorded statistics of causes, experts cite migration, displacement and loss of support as leading to depression and driving some to take their own lives. Nepal’s national suicide rate is 24.9 per 100,000, the seventh-highest in the world after countries like Sri Lanka and South Korea. However, Nepal has the third-highest rate of female suicides, and it is the main cause of death among women in the 15-49 age group in Nepal.

“People migrate for better economic opportunities. When they do not find them, they become frustrated, which may lead to depression,” said Ram Sharan Pathak, Professor and Head of Population Studies at Tribhuvan University.

Besides dislocation, exposure to violence during and after the war as well as recent natural disasters could be other factors leading to a rise in mental health problems, believes Khem Karki at the National Health Research Council: “Over the years, the migration and displacement of people have been exacerbated by the ten year-long conflict, floods, landslides and most recently the earthquake. There is a lot of stress related to both internal and external migration.”

Jhapa in the eastern Tarai has seen a sharp increase in its population due to new migration from the hills, and there seems to be a correlation with an increase in the suicide rate there over the last three years.

Hari, 26, moved to Jhapa with his wife from their ancestral village in Khotang. The displacement and new surroundings drove Hari to alcohol while his family struggled with earning enough. In September last year, Hari hanged himself on a tree outside his house. He was among 249 persons who committed suicide between April 2015 and May 2016 in Jhapa alone.

The district’s suicide rate three years ago was 25 per 100,000, and rose to 31 per 100,000 this year. Jhapa has now overtaken the neighbouring district of Ilam, which had the notorious distinction of having the highest rate of suicide in Nepal.

“There is unhealthy competition, low coping skills and wide prevalence of alcohol and drug abuse in the district. People have become more aggressive as well,” said Saligram Bhattarai, a clinical psychologist with Transcultural Psychosocial Organization in Jhapa.

Although there is high out-migration of young men from the Tarai to India and overseas, the plains are seeing more people moving down from the mountains. Plains districts like Jhapa, Morang, Kapilvastu, Nawalparasi, Bardiya and Kanchanpur — which have high rates of in-migration — have witnessed a surge in suicides in the last three years. The suicide rate in other Tarai districts, as well as in Kathmandu and Bhaktapur, have remained constant, while Lalitpur has seen an increase.

Experts say that dislocation, in itself, should not lead people to take their own lives, but the absence of proper diagnosis and treatment of mental health has led to an epidemic of suicides. Societal taboos and stigmatisation of mental health have made it difficult for many to seek help.

“Society is bent on undermining and keeping mental illness a secret, rather than cultivating an environment for people with mental illness to be a part of the society,” says activist Jagannath Lamichhane. With only one government-run hospital called Mental Hospital in the capital region and limited mental health professionals, Nepal lacks the human resource and infrastructure to tackle the problem.

The Ministry of Health’s Health Management Information System still does not list suicide as a category while recording deaths. Most data is from the Nepal Police, which treats suicide as a crime. Saroj Ojha of Tribhuvan University Teaching Hospital says: “There is still a lot of social stigma when it comes to suicide. Therefore, it is important to spread awareness and address it as a mental health issue.”

Some names have been changed

Do not shy away from seeking help. If you, or anyone you know, would like to speak to a trained mental health professional, please contact:

TUTH Suicide Hotline: 9840021600

Transcultural Psychosocial Organization-Nepal Crisis Hotline: 1660 0102005

Mental Health Helpline Nepal: 1660 0133666

Read also

Mental cost of migration, Shreejana Shrestha

Neglect of the neglected, Bibhav Acharya and Soniya Hirachan

End pain, not lives, Anjana Rajbhandary

In the shadow of death, Marty Logan

Overcoming depression, Anjana Rajbhandary