A few months ago, a 29-year-old man from Kathmandu reached the Department of Psychiatry at the Tribhuvan University Teaching Hospital, seeking treatment. Doctors at the hospital noticed a serious mental health problem in the man, who worked at a reputed company.

“His work performance had declined,” said Dr Mita Rana, a professor of psychiatry. “He started to talk less and preferred to stay alone. The man was worried about losing his job, as his company had started a layoff.”

Unlike many people having mental health problems, this man did not take the help of drugs nor did he resort to alcohol to cope. Those who noticed a change in his behaviour and problems in performance advised him to seek a doctor’s help by.

“During counselling, the patient told us that he had a family issue, which disturbed him all the time,” Rana said. “He was worried about losing his job, as he himself knew that his performance had declined and he could be the next to be fired.”

Mental health experts say that even if drugs and alcohol provide some relief from stress, they are no solution and can adversely affect mental health and well-being in the long run. They say that in Nepal, there is a tendency among people to conceal their mental health issues, largely due to the stigma attached to it.

“Compared to the past, more people having mental health problems have started to express their problems with friends and health workers,” said Dr Basudev Karki, a mental health expert. “Stigma related to mental health have somehow lessened due to awareness, but the fact is many mental health patients still conceal their problems due to the fear of getting stigmatised.”

Many of those dealing with mental health problems try to manage stress and other serious mental problems by using drugs and alcohol. Due to the entrenched social stigma, fear of discrimination and others, a lot of patients do not talk about their mental health issues in Nepal.

Many patients conceal their problems and do not seek treatment, and thus continue to live with the issues, said Karki. “A lot of people only approach doctors when drugs and alcohol do not help with their mental health problems. In some cases, problems get worsened instead due to the use of drugs and alcohol.”

Experts ask patients not to hesitate to disclose their issues and seek treatment. They say that early treatment or treatment in the initial stage of mental illness helps patients to have better results. For that, early diagnosis is crucial.

However, Nepal does not have enough experts to deal with mental health problems. According to estimates, there are around 200 psychiatrists in the country and most are working in big cities.

Since most specialists are concentrated in urban centres, people from rural areas cannot access mental health services.

Officials at the Ministry of Health and Population said they have imparted mental health training to hundreds of health workers. The government also plans to seek the support of female community health volunteers (FCHVs) to identify people with mental health problems.

The health ministry has allocated Rs1 million each to 55 districts to train health workers on mental health treatment and FCHVs on awareness in the current fiscal year.

Officials said that some case studies will be provided to FCHVs for the identification of mental health problems such as anxiety, depression, alcohol use, psychosis, and suicidal tendencies. FCHVs will then encourage the patients to go to health facilities for treatment. They will also encourage patients to continue their medications.

Nepal is among the countries with the highest rate of suicide, which is an extreme manifestation of a mental health problem.

According to data provided by the Nepal Police, 6,993 people took their own lives in the fiscal year 2022-2023. This accounts for more than 19 deaths on average daily. Fifty-six percent of those who die by suicide are men.

Doctors say that people do not attempt suicide for a single reason, but due to a complex situation arising from multiple problems.

An increasing number of people are tackling mental problems owing to the rising cost of living and the struggle to manage even their most basic needs, such as food, housing, healthcare and jobs, experts say.

Whatever the cause, suicides and suicide attempts have a ripple effect, impacting families, friends, colleagues, communities and societies, doctors say.

A study carried out by the Nepal Health Research Council in the past shows that about 13 percent of Nepalis suffer from some form of mental disorder. This means around one in eight Nepalis have mental health issues. Moreover, the country simply does not have enough experts to treat mental health problems, it added.

Studies show the magnitude of suffering, the burden and costs for individuals, families and societies arising from mental health disorders are alarming in Nepal.

The World Health Organisation says that one in four people in the world have been affected by mental or neurological disorders at some point of their lives and around 450 million people currently suffer from such conditions, placing mental disorders among the leading causes of ill health and disability worldwide.