Nepal’s suicide rate vastly underestimated
Nepal’s public health system has no mechanism for recording suicides, and the only statistics about suicides can be found in police records. This data shows that about 5,000 Nepalis kill themselves every year.
But since only police records are counted and attempted suicides are not reported, the official data gives no sense of the incidence of people trying to take their own lives.
Based on police data and projections, the World Health Organisation put Nepal as the country with the 7th highest suicide rate in the world (24.9 per 100,000). Public health experts say that suicide is just the symptom, and that the real disease is poor mental health.
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Most people who commit suicide suffer from depression and other mental illnesses like schizophrenia and substance abuse disorders. The Nepal Health Research Council (NHRC) is for the first time conducting a nationwide survey of mental health by year-end, and already the picture is not looking good.
Do not shy away from seeking help. If you, or anyone you know, would like to speak to a trained mental health professional, please contact:
TUTH Suicide Hotline: 9840021600
Transcultural Psychosocial Organization-Nepal Crisis Hotline: 1660 0102005
Mental Health Helpline Nepal: 1660 0133666
“From our pilot survey, we found depression in 3.4% of people, and suicidal tendencies in one out of every ten Nepalis,” says Kriti Adhikari of NHRC.
Most of these people cannot access the counselling and treatment they need since Nepal has only 0.13 psychiatrists per 100,000 people, and most of them are concentrated in urban areas. Nepal Police is the only entity that deals with suicide, and it is more concerned about the criminality of the act than about mental health.
“Nepal’s law classifies suicide and abetting suicide as crimes, so our priority is figuring out the criminal element of the cases,” explains police spokesperson Shailesh Thapa Chhetri. “There is no punishment for suicide because the person is already dead. But we investigate to find out if the death was a murder or a suicide.”
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The fact that Nepal Police personnel are not trained in mental health, and that the health system does not record suicides or suicide attempts means that there is no entry for suicide in the Health Information Management System, the database of all patients at government health facilities. This keeps suicides hidden.
“The police data on suicide understates the problem of mental health in Nepal,” says Ravi Shakya, a physician at Patan Hospital, which has a mental health department. “We know more men die from suicide than women and they tend to use more violent means. But in fact, many more women attempt suicide and fewer of them succeed. They may come to hospital, recover, and go back home, but that does not mean their mental illness is over.”
Except at Patan Hospital, victims of attempted suicides receive no mental health counselling after their physical health improves. But last year the Ministry of Health and Population appointed a focal person for mental health for the first time. This focal person, Phanindra Baral, acknowledges that Nepal has not done enough to address mental health and suicide prevention.
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“There are not enough psychiatrists in Nepal to serve the whole country. So for now, we are training the current health staff in basic mental health issues and counseling,” says Baral. “We are taking the program to 41 districts this year, and hope to serve all 77 districts in the next two years.”
For the first time, the Ministry has included mental health as a priority in its proposal to the National Planning Commission, hoping to see that reflected in the next five year plan. But till that happens, there are other things to be done.
“Mental health still has a stigma and people are not willing to acknowledge it or seek help. The first step is to raise awareness of mental health and suicide,” says Uden Maharjan, public health researcher and co-author of a paper on suicides in Nepal. “We need suicide helplines and people should be made aware of how to access them so they can open up.”
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A note on suicide notes
With the spread of social media, police have to contend with suicide notes not just on paper but also on the Internet platforms. But the real challenge of dealing with suicide note is still the same: the mental health. Should the declaration of a dead person be believed? And if the dying declaration blames someone else for that death, how credible is the allegation?
Ravi Shakya, a physician at Patan Hospital says that dying declarations are usually held to be credible evidence. “When someone declares that they are want to die and proceed to kill themselves, we have every reason to take such a note seriously,” says Shakya. “However, if they blame another person, we cannot assume guilt based on the allegation. We have to take into consideration that the person who committed suicide could have been mentally ill.”
The police also take such suicide notes seriously, but prioritise criminal investigation over mental health. “A suicide note is evidence, so we treat it with utmost care. We analyse the handwriting to make sure it matches the dead person’s. If the dead person blames other people, we consider them under suspicion until they are proven innocent,” says Shailesh Thapa of Nepal Police. The police do not necessarily question the sanity of the person who wrote the note, therefore sidelining the mental health aspect of the suicide.
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