Tackling Nepal's mental health pandemic

An 18-year-old boy living with relatives in Kathmandu was working to pay his way through college. He lost his job in a restaurant when it closed after the lockdown. The college also shut.

The adolescent boy went back to his district and was living with his parents and siblings for the past six months. He started feeling bored, frustrated, angry and developed negative thoughts.

He started getting flashbacks of his break-up, and the abuse that he faced from relatives in Kathmandu. He started blaming himself and his family for his poor economic condition and all the other problems.

He started smoking, and then moved on to drugs. His depression got worse and he started having suicidal thoughts, and began to behave aggressively towards family members. He avoided communicating with them, he was sleep deprived, lost his appetite, and was constantly restless. He tried to run away from home several times.

The boy’s behaviour stressed his parents, and his father called up the support group Koshish to see if they could help his son. But it was the father who also needed psychosocial counselling.

Techniques such as grounding, PMR (Progressive Muscle Relaxation), mindfulness exercise, thoughts tracking and management were applied during the counselling session to help both the boy and his father. The psychologist also used SET (Somatic Experience Therapy), where the boy’s feelings, body sensations were explored. His interest, resources, support system, strengths, positive ideas and thoughts were also developed, and this helped him be clear about his thoughts.

After the counselling session, the boy was on medication to manage his restlessness, sleep and appetite problems. He has now been able to banish negative thoughts, he does not behave in a violent manner anymore, and has given up smoking. Seeing the change in him, the boy’s father is also emotionally stabilised. He is still working on his problem, but has his family support.

“This tele-counseling has been helpful and effective,” the boy says. “I can feel my confidence level increase. I am sure that I can go back to my studies and lift the economic status of my family.”

The boy’s case is one of many in which the group Koshish has been involved with helping adolescents and others suffering from stress and psychosocial issues caused by the Covid-19 crisis.

To be sure, mental health was a serious problem in Nepal even before the pandemic, but Covid-19 has made it more acute.  Because of the stigma associated with mental health, very few seek counselling and treatment, and organisations like Koshish are trying to break that taboo.

Koshish (which means ‘try’ in Nepali) has a toll-free counselling service for people all over Nepal. This has proved to be effective in connecting patients with counsellors when there are restrictions on travel.

A 26-year-old woman who was living with her in-laws, daughter and husband in Bardibas, started suffering bouts of depression with the loss of family income after the lockdowns. She heard about the tele-counselling service, and described how her husband had returned from work overseas, and the family was suffering extreme poverty.

The stress caused by this, and worries about supporting the family was giving the woman sleepless nights, severe headaches, stress and memory loss. She called up Koshish, and the tele-counsellor was able to pinpointed her mental state as being aggravated by family and neighbours making noise, quarrelling and shouting. These were triggers for her headaches. But the underlying issue was lack of money, and after talking to her about her skills, counsellors were able to convince her to take up tailoring classes.

This reduced her headaches as she regained confidence and hope for the future to be able to take care of her family with income from tailoring. With breathing exercises and mindfulness sessions she learnt from counsellors, her worries lessened, and the woman gained self-esteem.

"After joining the tailoring class, I feel like I am busy and also capable of supporting my family economically in future., It made me feel hopeful and the headaches were gone,” she said. “My stress is managed and I now have a skill to increase my income.”

She credits Koshish counsellors for helping her regain confidence. She felt heard, got a safe space to express her feelings and move on with her life. She adds, “My husband has now started working in a store, and is planning to find work abroad again after everything gets normal. I am buying a tailoring machine, and will open a shop to support my family.”

These are just two case studies to prove that although there has been an increase in mental health problems among Nepalis after Covid-19, many of them can be managed with proper counselling. But the two examples are just the tip of the ice-berg – there are many more who could easily be helped with proper advice and treatment.

What has been crucial is the ease with which those with problems can call up the helpline, and talk about their stress, worries and depression over the phone.

Matrika Devkota was born and raised in Amppipal, Gorkha. He founded the grassroots organisation Koshish which works both in advocacy, awareness and counselling on mental health. 

Koshish National Mental Health and Counselling Organisation: https://www.koshishnepal.org

Toll-free helplines:

Bagmati Province: 16601 22322

Gandaki Province: 166061 52007

Province 2: 166033 52011

Province 7: 166010 56715