A hidden mental health epidemic is leading to an increase in suicides in Nepal
Anita, 44, started withdrawing from the social scene. She started gaining weight. She said she had misplaced the joy in her life. She was depressed, but people thought she would get over it. She did not. She was found dead in her bedroom recently next to an empty bottle of pesticide.
The rate of reported suicides in Nepal is increasing, and although more men kill themselves than women, suicide is still the leading cause of death among women in the 15-49 age group. Even in this cohort, girls and women between 10-24 are at higher risk.
The problem was highlighted by the widely-reported suicide last year of a 15-year-old girl in eastern Nepal ostensibly after Brazil lost in the World Cup semi-finals against Germany. Experts say suicides are just the outer manifestation of a hidden epidemic of mental health illness in Nepali society.
“Mental health is not just a biological or medical issue that can be treated with medication, there is a need for psychosocial support,” says clinical psychologist Mita Rana at the Tribhuvan University Teaching Hospital. Up to 15 per cent of mothers in her hospital experience postpartum depression that could develop into psychosis, which makes them susceptible to suicide and infanticide.
THE LIVING: Gita Pariyar with her five children at their home in Chitwan after Gita’s husband Dhan Bahadur killed himself last year after considering himself a failure for not being able to feed his family. Dhan Bahadur’s two previous wives had died because he couldn’t aff ord their treatment. Gita herself is struggling to cope after her husband’s suicide. She says: “If I don’t earn enough during the day, the children go to bed hungry.”
The tragic suicide of Nepal’s most-renowned and up-and-coming film director Alok Nembang at age 40 last year was said to be caused by depression. His personal diaries and a suicide note revealed Nembang’s deep feelings of hopelessness.
Internationally, 90 per cent of all suicides are attributed to mental health causes and depression is the biggest risk factor. One in every five children and adolescents have mental health problems. The social and psychological effects of growing up in an abusive home can haunt individuals for life. There has been a rise in adolescents engaging in self harm by cutting themselves. It is a clear cry for help, and yet this usually goes unnoticed till it is too late.
In Nepal, the number of patients seeking help has risen dramatically, says Renee Gerritzen, a Dutch psychologist practicing at Anicca in Kathmandu: “Four years ago, 10 per cent of my patients were Nepali, now half of them are Nepali.” Gerritzen takes this as a positive development because people are overcoming the stigma.
Nepal’s conflict and natural disasters also have a strong impact on the mental well being of survivors. Mostly diagnosed with post traumatic stress disorder, they require therapy, support and time. There is a danger of psychiatrists overmedicating patients even though some do need antipsychotics which could be abused or sold.
FEELING SUICIDAL: The number of people killing themeleves per 100,000 population is highest in the Mid-western Development Region, but the districts with the highest suicide rates are Ilam and Chitwan. (Click on map for more information)
In Nepal, men above 35 have the highest rate of suicide, and relatively prosperous districts like Ilam and Chitwan have some of the highest suicide rates in the country. Regionwise, the Mid-Western and Western areas have the highest suicide rates and the lowest in the Central Region (see map). The remote district of Rukum, for example, registered 10 suicides in the past four months, and police said the main cause was family disputes.
“The government has to invest more on mental health as the current budget for treatment and counseling is less than one percent of the total health budget,” said Nir Prakash Giri of the Nepal Mental Health Foundation.
If mental illness is the disease, suicide can be the result. Health experts advise that the problem be addressed at the source. However, mental health has such social stigma that most families don’t want to discuss it and many patients fear being labeled “mad” if they see a counselor.
“Mental health is a relatively young science in Nepal, there is little awareness, people may consult astrologers or shamans as respected counselors, and because of taboos and lack of awareness people do not seek help,” said Lisa A Gautschi, a transpersonal psychologist with the Isha Centre in Patan.
The Nepali word for mental illness “bahulako” can span everything from patients with epilepsy to psychosis. Nepal’s Muluki Ain even bars “mad” people from standing in an election and be a member of the board of any organisation.
“First, the language and definition need to change, “ says Nagendra Luitel, a researcher at Transcultural Psychosocial Organisation that works on mental health and psychosocial issues in Nepal. “Legal policies on suicide need to change as it is considered a crime.”
In an increasingly consumer-driven urban setting, we have to remind ourselves to look beyond ourselves and pay attention to people around us. We all know someone with mental health illness, but what are we doing to help? Do we even acknowledge it, or do we ignore it?
It is important to be empathetic and non-judgmental towards individuals with mental health illness. It takes courage to ask for help, and it is the family and community’s responsibility to provide it. With awareness, knowledge, treatment and support, most people diagnosed with mental health illness are able to live happy and healthy lives.
Some names of patients have been changed.
Anjana Rajbhandary is a Mental Health Rehabilitation Technician and is a sub-editor at Nepali Times.
In the shadow of death, Marty Logan
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