A recent infographic published by Kantipur showed that there were 192 suicides in the first 16 days of the coronavirus lockdown in Nepal. This is by far the highest cause of death during this period, while natural death is second with 88. These alarming numbers indicate the severity of mental health issues and suicide rates in Nepal. While most of the world believes in addressing mental health issues and has appropriate measures for their citizens who suffer from this, the situation in Nepal is just the opposite. Mental illness is a taboo here, and the victims are pushed to silently suffer by themselves. According to a report by the World Health Organization (WHO), Nepal sees 6,840 suicides annually, but insiders know the underlying issue is far greater than just the officially announced numbers.
This hidden pandemic is an unfortunate last result of a progressive worsening of a person’s mental wellbeing. It starts with signals anyone can relate to such as mental fatigue due to unfulfilled expectations or ambitions, anxiety, and chronic emotional and physical stress. It also all starts with the victim as well as their family. Neither do the victims talk about their mental health issues nor are those around them adequately engaged with them either because of lack of understanding or for fear of societal stigmatization. They are often anxious about opening up due to the fear of being misjudged. They don’t feel comfortable opening up and sink deeper into despair and seclusion. Furthermore, their families might not be aware of the potential implications or consequences of living with a person with mental health issues. Even if they know this, they might not be able to take measures to help the victim because of public stigma, societal taboo, or simply lack of knowing how to respond. This dearth of communication and absence of support is the primary reason behind the worsening mental health of these individuals. This may build up to such an extent where they may commit suicide.
Seeking professional medical help is certainly a sensible decision to take for someone who is suffering mentally. This usually means visiting a psychiatrist in a country like Nepal that lacks a strong system for mental health and has shortage of counselors and psychologists. At the clinic, they have a conversation where the patient tries to present the problems they are facing mentally, emotionally, and even physically (e.g. headache). The psychiatrist tries to make the best judgment on how to help the patient, which primarily means medications. Most of the patients that visit a psychiatrist, even in their first visit, just end up walking out with a prescription.
If clinically approved medications were enough to help people get over mental illnesses, then why are there still so many suicide victims? The underlying reason is the lack of understanding, support and empathy that they are missing in their lives. Many of these people don’t have the intimate support of someone who could understand and empathize with what they are going through. That is why empathetic peer-to-peer communication is absolutely necessary to help people who are suffering mentally. We must develop an ecosystem of peer-to-peer communication, creating a supportive environment and community where people are comfortable to open up and talk with one another, sharing what they go through every day. It is paramount to give support and encouragement to people who are showing the initial symptoms of mental health distress and to those who are already experiencing more severe stages of mental health deterioration. Such effort should be complementary, on case-by-case basis, to the need of more advanced, professional help either in the form of psychologist or for more serious cases, the clinical support of a psychiatric.
To address this underlying issue, an online support group called Paaila was recently started to provide an easy-to-reach platform for anyone in need of mental health support. The mission of Paaila is to help people overcome their fears and encourage them to open up and seek help, and make people aware of the fact that feeling mentally unless, anxious, depressed or suicidal is not their fault at all. It is just an uncontrollable mental state that they are temporarily in. Platforms like Paaila give them compassionate and empathetic support, which many of them feel like they do not genuinely have.
In order to win the mental health battle, it is going to be essential to break traditional taboos embedded in our society, by educating the families and the loved ones of those experiencing all the forms of mental disorder, from the mildest to the most severe forms of it. Effective use of social media and any other digital platforms can help create a much needed new understanding of what it means to live with a mental health problem. Having peers helping and supporting each other can be an effective way to start addressing a different pandemic, one that often goes unnoticed until you read a gloomy headline about a mentally ill or suicide victim.Obviously a country like Nepal needs to put in place a strong system that detects and not ostracizes, that counsels and not judges, a system that can heal and not just “cure” all those citizens with mental health related conditions. Ultimately, it is okay not to be okay because, as Paaila believes, we can all replace 'I' with 'We' and even 'Illness' can become 'Wellness.’
(Galimberti is the Co-Founder of ENGAGE, an NGO partnering with youths to promote social inclusion in Nepal. He can be reached at [email protected] . Shantanu Sharma is a mental health advocate, who has dealt with severe depression, suicide survivor, and is the Co-Founder of Paaila. He can be reached at [email protected] and [email protected] )