KATHMANDU, NEPAL — Kaili was diagnosed with depression two years ago. Her symptoms had started to worsen during the coronavirus pandemic. When it first broke out, Kaili, now 32, was forced to live alone in Victoria, Australia, while her husband was stranded in Nepal for over a year, unable to return home due to lockdown. Her marriage suffered, even after her return, and Kaili found herself contemplating suicide.
“I told a friend. I asked for help, ”she says in an interview through Viber, a calling application. She requested that they only refer to her by her nickname due to the stigma surrounding her mental illness. She also confided in her mother-in-law, who lives in Nepal.
Mental health is often swept under the rug in Nepal, but Kaili’s mother-in-law (who also chose to withhold her name to preserve Kaili’s anonymity) did not react this way: an avid social media user, she had been evangelized about its importance. through videos on Facebook and TikTok. Instead, she urged Kaili to seek professional help. “I am far from her; I can’t be there to help, but I can give suggestions,” says the older woman. “So I suggested that she see a counselor.”
More than 10% of adults in Nepal experience some form of mental distress, according to the most recent national mental health survey. A decade-long civil war that ended in 2006 and an earthquake that rocked the country in 2015 partly explain these high rates; The coronavirus pandemic has also made matters worse, with police data indicating an increase in suicides during 2020. However, awareness is also rising. More and more people are sharing their struggles online, removing the long-standing stigma, and psychologists offering services online are reporting an increase in clients, both within the country and from Nepalis residing abroad, like Kaili.
Kaili first sought help from a non-Nepali psychologist in Australia. “I cried many times during counseling because I didn’t understand what they were saying to me,” she says. Culture, more than language, was the barrier. “They used to say that if you’re not happy, give up the marriage instead of trying. … They had no idea what the consequences of giving up would be.” With the support and assistance of her mother-in-law, Kaili started receiving online counseling with a psychologist in Kathmandu. After ten sessions, she says her symptoms are improving.
Politician and activist Ranju Darshana, who rose to national fame in 2017 when she contested the Kathmandu mayoral election, is an example of someone using her platform to destigmatize mental illness in Nepal. The 27-year-old is open about her own struggles with depression and how much she has benefited from counseling it. “My life is fantastic now,” she says. When she contested the 2022 parliamentary elections, mental health was at the top of her electoral agenda. She hosts a mental health podcast and has also produced six YouTube shows, featuring conversations with other well-known figures, such as a former Miss Nepal International who revealed her own struggles with mental health.
Darshana would like to make more videos, she says, but not enough people are willing to talk about their mental health on camera. Since 2020, she has also spearheaded an online meeting on Zoom, “Mental Health Mondays,” where young people can vent, commiserate, and share their experiences.
Niru Khadka, a well-known Nepali comedian, has similarly spoken about her mental health, particularly her depressive tendencies, which emerged in the aftermath of the 2015 earthquake. “Through meditation,” she says, “I not only found a foundation to live, but I also learned the art of living. Last year, she shared her experience of depression through poetry on TikTok; the reel received over half a million views. She also often conducts meditation sessions for the students.
Such efforts have helped foster a better understanding of mental health, says psychologist Sita Lama, who works at Mankaa Kura, which provides online therapy to Nepali clients.
Prerana Dahal, a Kathmandu-based psychologist who works with young clients in Finland, Germany, Australia and the United States, says cultural and linguistic familiarity compels Nepalis abroad to seek therapists at home. “Adjustment problems, relationship problems, an inferiority complex about not having fair skin, and financial difficulties have created mental problems for young Nepalis studying abroad,” says Dahal.
Therapy in Nepal is relatively cheaper, adds Bharat Gautam, who works with the Nepal Transcultural Psychosocial Organization, a mental health non-governmental organization, which has also seen an increase in demand for counseling since the start of the pandemic. Gautam, who sees 40 clients each month and has counseled 200 Nepalis abroad since 2020, also highlights another trend: counseling for Nepali couples where one spouse lives outside the country.
“I cried many times during counseling because I didn’t understand what was being said.”
Young people seeking employment abroad often face extraordinary pressures, which can contribute to poor mental health. Sometimes this manifests as paranoia and suspicion directed towards their wives back home, Gautam says, adding that he is often approached by women who are depressed because their husbands living outside of Nepal suspect they are cheating on them. “In such cases, we counsel both the doubting husband and wife,” she says. Few Nepali men residing abroad seek help on their own.
However, as awareness and demand for mental health services increase, the healthcare infrastructure is struggling to keep up. The government is trying to close the gap, says Phanindra Prasad Baral, head of the mental health section of the Department of Health Services. “Our health workers have not been able to diagnose mental illness and bring it into our system,” he says. “So we are providing five-day training to the paramedics, doctors and medical officers at the health posts on the diagnosis and treatment of mental health services.”
Data from the Nepal Medical Council lists 244 people with a bachelor’s degree or higher in psychiatry; according to another estimate, the country has fewer than 200 psychiatrists and about 230 psychologists. Increasingly, they must care not only for the millions of Nepalis in the country, but also for those seeking treatment in the farthest corners of the world.
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