6-12 February 2015 #744

In the shadow of death

The suicide rate in Nepal’s most prosperous and literate districts is rising alarmingly
Marty Logan

When 14-year-old student Sujan Lamgade killed himself in Ilam Bajar two months ago, his death highlighted a disturbing rise in the number of suicides in one of Nepal’s most prosperous districts.

Thirty-seven people killed themselves in this eastern district bordering Darjeeling between June-December 2014, according to an unofficial tally. If the trend continues, the year’s total will eclipse those of the late 1990s and early 2000s, when Ilam gained a reputation as Nepal’s suicide capital. The number of people killing themselves had dropped to 12 three years ago.

“The numbers are going up again,” said Bhupal Khatiwada of the Namsaling Community  Development Centre (NCDC). When the suicide rates went up alarmingly in 2002-2003, the organisation ran a campaign to raise awareness about mental health issues, train health workers, and do a survey.

Like other people interviewed, Khatiwada has his own ideas about why the district is plagued by suicides: young people leave home to study and lack family support, older ones are unable to adapt to the lifestyle changes they see in upcoming generations. The fact that Ilam has one of the highest literacy rates could also be a factor.

“If someone said there was bird flu in Ilam, lots of resources would be available to deal with it, but not for mental illness. The government doesn’t have the data or resources to address it,” Khatiwada told Nepali Times.

Researchers at BP Koirala Institute of Health Sciences in Dharan has been researching the causes of the rise in suicides in eastern Nepal for years. One review of patients brought to the hospital after suicide attempts found that 75 per cent of them had psychiatric disorders: in 37 per cent of cases it was depression.

‘Nepali society puts much emphasis on relational, social, familial coherence. Disharmony appears to be the subject of much distress … far more than any other category of stressor,’ concluded the study, published in the Journal of Traumatic Stress Disorders and Treatment, in June 2014.

A 2011 study of 100 patients who had attempted suicide found that 58 per cent had mood disorders, mostly depression, but the majority of them had no prior psychiatric care. ‘The government should launch awareness programs targeting younger generations,’ suggested the authors.

‘Moreover, early identification of suicide-prone individuals, supportive measures and timely referral is strongly suggested.’

Deepak is a college student in Kathmandu who grew up in Ilam. Two years ago a friend of his killed herself while also studying in the capital. “She was a normal girl,” Deepak recalled in an interview. “I didn’t know she was going to do anything like that, she was happy.”

The student said her family and friends told him afterward that she had been depressed. For him, that word is code for a family dispute over a relationship, usually one between young people of different castes. Unfortunately, most young people remain fearful about seeking counselling and treatment because of the stigma.

Soon after taking over as chief of Ilam’s District Health Office one-and-half years ago, Raj Kumar Pokharel, sent a plan to his superiors in Kathmandu to do a small, but systematic study to learn the exact reasons for suicides so solutions could be found.

Pokharel is trying to shift some money from his budget to partly pay for his plan, but much more money will be needed to train health workers to treat mental illness and deliver psycho-social counselling, and raising awareness among the population.

Beyond Ilam, some work is being done to address the mental health of Nepalis. For example, the government has signed an agreement with Transcultural Psychosocial Organisation (TPO Nepal) to implement a pilot project in two districts: Chitwan and Pyuthan to train health workers, raise awareness in schools and public awareness to combat the stigma associated with mental health.

“We are all very aware that mental health support is needed not just for some districts but for all 75 districts,” says TPO Nepal Executive Director Suraj Koirala. But he says scaling up the program will happen gradually because of the government’s lack of resources.

The network also made suggestions for updating the mental health provisions of the Health Act, which is under review.

Read also:

End pain, not lives, Anjana Rajbhandary

Suicide rates are rising, Aarti Basnyat

Stigma therapy, Mallika Aryal

All in the mind, Jagannath Lamichhane

No peace within, Rubeena Mahato

Self-destruct, Indu Nepal

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