<figure><img width="3700" height="1900" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114101116/637208159c7e80680e0b54cajpeg.jpg" alt=""/><figcaption></figcaption></figure>The coronavirus disease is one of the most well-documented health crises of recent times, with its correlation to almost every sector in society -- including the <a href="https://www.nepalitimes.com/here-now/post-pandemic-mental-health-epidemic/" target="_blank" rel="noopener noreferrer">mental cost</a> of prolonged lockdowns and the stress during the pandemic. Studies have linked a higher prevalence of anxiety, depression, post-traumatic stress disorder (PTSD), hypochondria, obsessive disorders and psychotic symptoms among the general population in the last two years.But for the first time, <a href="https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0262958&amp;fbclid=IwAR3GhEvU6qnCjQuwR-HEye8Jk3foYOofrmAgpLCgHZEhjm9r_2PWAOpZCBE" target="_blank" rel="noopener noreferrer">a new study</a> squarely links the rise in suicide ideation with the pandemic in Nepal. Police records also show a spike in suicides and self-harm cases in the past two years.Suicide cases had been rising even before the pandemic with 5,509 in 2018 and 5,898 in 2019. However, it jumped to 6,968 during the first year of the pandemic in 2020 — putting the <a href="https://www.nepalitimes.com/banner/nepal-sees-spike-in-suicides-during-pandemic/" target="_blank" rel="noopener noreferrer">suicide rate</a> at 23.9 per 100,000 population.‘The yearly increase in the suicide rate from 2019 to 2020 is 16%, which is more than threefold higher than a yearly increase in the suicide rate from 2018 to 2019 (5%),’ states the paper published on PLOS ONE last month.Titled ‘Association between COVID-19 pandemic and the suicide rates in Nepal’ and conducted by Binod Acharya, Keshav Subedi, Pramod Acharya and Shweta Ghimire, research analysed a total of 24,350 suicides in four years from July 2017 to June 2021 based on Nepal Police data.It investigated changing <a href="https://www.nepalitimes.com/latest/the-other-pandemic-mental-health/" target="_blank" rel="noopener noreferrer">suicide rates</a> in Nepal during the Covid-19 pandemic period (April 2020 to June 2021), compared to the pre-pandemic period (July 2017 to March 2020), adjusted for seasonality and long-term trends in the suicide rate.Males had a higher suicide rate (26.9 per 100,000) than females (16.5 per 100,000), but suicide rates went down over the last two years among males, but was sustained for a longer duration among females. <img width="542" height="600" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114101116/637208189c7e80680e0b54cbjpeg.jpg" alt=""><img width="533" height="600" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114101116/6372081b9c7e80680e0b54ccjpeg.jpg" alt="">For example, all the pandemic months except April and May of 2020 and February and March of 2021 had a significantly higher suicide rate compared to the same months in 2019. In comparison to the same month in 2019, July 2020 (just after the first lockdown) had the highest increase in the suicide rate with an increment of 55%.Researchers have pointed out limited or lack of economic resources, public health infrastructure and awareness about mental health as leading factors for the increase in suicides in Nepal during the pandemic.Nepal is one of the countries with highest suicides rates in the world according to the World Health Organization (WHO). The 2021 Nepal Health Research Council (NHRC)’s National Mental Health Survey found the prevalence of suicidality (current suicidal thoughts, lifetime suicidal attempt and future likelihood of suicidal thoughts) at a high of 7.2% among Nepalis. During the study period of this latest survey, the highest proportion of the suicides were observed in Bagmati province (5,709; 23.4%), followed by Province 1 (5,161; 21.2%), Lumbini (4,757; 19.5%), Madhes (3,053; 12.5%), Gandaki (2,369; 9.7%), Sudurpaschim (2,176; 8.9%), and Karnali (1,125, 4.6%).But Sudurpaschim and Karnali provinces, two of the provinces with the lowest Human Development Index (HDI), had the highest increase in suicide rates associated with the Covid-19 pandemic.‘Sudarpaschim and Karnali regions are also known to have a historically high proportion of seasonal <a href="https://www.nepalitimes.com/here-now/in-the-minds-of-nepals-migrant-workers/" target="_blank" rel="noopener noreferrer">migrant workers</a> in India. People in this region could have experienced additional distress as their migrant family members lost their jobs in India because of the business closure and lockdown,’ states the study.Alternatively, Province 1 which has the highest HDI and relatively low poverty rate among seven provinces has had consistently high pre-Covid-19 suicide rates, but had the smallest increase during the pandemic.Official data shows that Nepal registered an early increase in the suicide rate and mental health problems during the pandemic. Many factors come into play: lack of financial stimulus packages in the beginning, irresponsible media reportage about the virus, conflicting messages by authorities and the s<a href="https://www.nepalitimes.com/here-now/nepal-health-workers-battle-covid-19-but-also-stigma/" target="_blank" rel="noopener noreferrer">ocial stigma of being infected</a> all added to the psychological stress in the public.Restrictions during the pandemic also meant that mental health patients were unable to get timely consultation and medication, further aggravating their condition. ‘Public health interventions to the pandemic, especially the severe ones like lockdowns and business closure, should incorporate economic safety nets and mental health service delivery mechanisms catered to geographic, socio-economic differences and needs,’ recommend the researchers. <img width="1500" height="1000" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114101116/6372081d9c7e80680e0b54cdjpeg.jpg" alt="">Suicides are preventable and treatment of mental health disorders can save lives. A comprehensive suicide surveillance system to maintain detailed suicide and attempt statistics within the jurisdiction of public health agencies rather than just the law-enforcement agencies can be a start.Addressing the underlying cause of <a href="https://www.nepalitimes.com/opinion/coping-with-anxiety-in-new-lockdown/" target="_blank" rel="noopener noreferrer">mental health problems</a> is still the most effective way to prevent suicides. This requires increased awareness and education through various platforms including social media, mass communication and school curriculum, which will in turn also help reduce the stigma associated with psychological disorders. Besides consultation and medication, family support plays a crucial role in healing people with trauma, depression or psychosis. Telemedicine, in particular, has been essential in preventing self-harm during the pandemic but these services need to be scaled up to cover the whole country.The paper concludes: ‘The Covid-19 pandemic is associated with an increased suicide rate in Nepal. The findings may inform policymakers in designing appropriate public health responses to the pandemic that are considerate of the potential impact on mental health and suicide.’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: 9840021600Transcultural Psychosocial Organisation-Nepal Crisis Hotline: 1660 0102005Mental Health Helpline Nepal: 1660 0133666Centre for Mental Health and Counselling Nepal Toll-free: 16600185080, Hotline: 1145Koshish Toll-free helpline: 166001-22322 (Bagmati Province)Patan Hospital Helpline: 9813476123National Suicide Prevention helpline operated by Mental Hospital Lagankhel and TPO: 1166

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Suicides: a pandemic within a pandemic

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141124/636cfc2c9c7e80680e0a0b73jpeg.jpg" alt="" width="1500" height="1000"/><figcaption>Photo: MONIKA DEUPALA</figcaption></figure><ul><li>Two years ago after going through a bad relationship, a 36-year-old Kathmandu-based doctor started getting suicidal thoughts. During the long months of lockdown, he would be on the rooftop and imagine jumping off to end it all. But before long he realised that he was causing self-harm, and sought help. He was diagnosed with depression, eight months into treatment he is rid of suicidal thoughts and is back to his outgoing ways.</li> <li>The bubbly young woman used to be the life of every party, but few of her friends and relatives realised what was going on inside her mind. As the pandemic hit, she started having violent thoughts about harming others and herself. The 22-year-old tried to deal with it herself, but two months ago she sought help from a mental health doctor. She was diagnosed with Obsessive Compulsive Disorder (OCD) and started treatment. Looking back, she advises others to also seek professional help in time.</li> <li>The young woman felt worthless, lacked confidence, avoided crowds and had self-inflicted cuts on her arm. Her inability to come in terms with her sexuality aggravated her sense of insecurity. When the pandemic foiled her plans, she blamed everything on herself, she felt irritated and uncertain, stopped attending virtual classes and her eating habits changed. She finally sought help for her depression and she is now under regular psychiatric counselling and medications. Grounding exercises in particular have helped her overcome self-harm and feelings of inadequacy. “I am okay now,” she says.</li></ul>As the pandemic turns lives upside down, there has also been a global <a href="https://www.nepalitimes.com/here-now/post-pandemic-mental-health-epidemic/" target="_blank" rel="noopener noreferrer">outbreak of mental health disorders</a>, and Nepal has reported a rise in suicides. However, as these cases show, professional counselling and medication can save lives.Recoveries rarely make news, only suicides do.“Most of my patients who attempted suicide have gone on to lead normal lives after they get treatment, and oftentimes they look back to their mental health crisis as nothing more than a lapse of judgment,” says psychiatrist and researcher Rishav Koirala.There has been a sharp rise in <a href="https://www.nepalitimes.com/latest/have-suicides-increased-during-nepal-lockdown/" target="_blank" rel="noopener noreferrer">suicides in Nepal</a> since the Covid-19 pandemic in March 2020 and subsequent lockdowns. Nepal Police data shows that in the last 12 months, there have been 7,141 reported deaths due to suicides nationwide, up from 6,252 the year before.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: 9840021600Transcultural Psychosocial Organisation-Nepal Crisis Hotline: 1660 0102005Mental Health Helpline Nepal: 1660 0133666Centre for Mental Health and Counselling Nepal Toll-free: 16600185080, Hotline: 1145Koshish Toll-free helpline: 166001-22322 (Bagmati Province)Patan Hospital Helpline: 9813476123National Suicide Prevention helpline operated by Mental Hospital Lagankhel and TPO: 1166<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141124/636cfc2e9c7e80680e0a0b74jpeg.jpg" alt="" width="640" height="475"><figcaption> </figcaption></figure>In a survey last year, <a href="http://www.tponepal.org" target="_blank" rel="noopener noreferrer">Transcultural Psychosocial Organisation (TPO) Nepal</a> which works with mental health compared five years of suicide data for March-July to see if there was any change during the lockdowns in 2020 and 2021.The results are revealing: suicides have been increasing steadily at an average rate of 8.5% every year, but it spurted to 19.4% in the first four months of the lockdown. Researchers also conducted key informant interviews across Nepal, who reported witnessing an increase in <a href="https://www.nepalitimes.com/latest/suicide-watch/" target="_blank" rel="noopener noreferrer">suicidal behaviours</a> in the community as well as health facilities.“We now have both quantitative and qualitative evidence that mental health problems have increased following the pandemic,” says TPO Nepal’s executive director Kamal Gautam. “And given that the majority of suicides are caused by psychological problems, we can say that Covid-19 has significantly contributed to its increase.”Mental health professionals have long been warning of an epidemic of psychological disorders following the Covid-19 crisis. They have reported an increase in anxiety, depression, post-traumatic stress disorder (PTSD), hypochondria, obsessive disorders and psychotic symptoms among the general population in the last two years.Economic collapse, job loss and slashed income due to the pandemic as well as <a href="https://www.nepalitimes.com/latest/in-nepal-lockdown-a-domestic-violence-spike/" target="_blank" rel="noopener noreferrer">increased domestic and sexual violence</a> and added workload during the lockdowns have all acted as contributing factors. In addition, those afflicted do not have normal social interactions that used to be a safety valve during more normal times.Moreover, many patients on treatment and medication have relapsed due to the limited access to health services, counselling and psychotropic drugs during the pandemic, and in many cases because of Covid phobia.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141124/636cfc319c7e80680e0a0b75jpeg.jpg" alt="" width="1052" height="690"><figcaption> </figcaption></figure>Up to 80% of suicides have mental health disorders as an underlying cause. A significant portion of cases are also a result of impulsive behaviour.Experts agree that the official <a href="https://www.nepalitimes.com/here-now/nepals-suicide-rate-vastly-underestimated/" target="_blank" rel="noopener noreferrer">numbers on suicides are vastly underestimated</a> due to a lack of suicide registry. Official figures are based solely on police data and post-mortems, and because of stigma associated with mental health, many families also often refrain from revealing the actual cause of death.Official records also do not take into account <a href="https://www.nepalitimes.com/here-now/in-the-minds-of-nepals-migrant-workers/" target="_blank" rel="noopener noreferrer">suicides of Nepali migrant workers overseas</a>, mainly Malaysia and South Korea. Similarly, suicides among those in the LGBTIQ community who have lost their limited sources of livelihood during the pandemic have been largely neglected.“Reported cases alone are not conclusive, but given that we now have a year and a half long trend and data, we have seen a significant increase in mental health disorders, and can assume that pandemic has played a crucial part in the rise in the number of suicides,” adds Rishav Koirala.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.who.int/news-room/fact-sheets/detail/suicide" target="_blank" rel="noopener noreferrer">More than 700,000 people die by suicide</a> every year around the world, that is one in every 100 deaths -- more than HIV, malaria, breast cancer, or war and homicide. And for every suicide, there are many more who make attempts to end their lives.Nepal is among the countries with the highest suicide rates in the world and consistently ranks within the WHO’s top 10 list. The Nepal Health Research Council (NHRC)’s <a href="http://nhrc.gov.np/wp-content/uploads/2020/09/Factsheet-Adults-1.pdf" target="_blank" rel="noopener noreferrer">National Mental Health Survey</a> published earlier this year found the prevalence of suicidality (current suicidal thoughts, lifetime suicidal attempt and future likelihood of suicidal thoughts) to be high at 7.2% among Nepalis.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141124/636cfc339c7e80680e0a0b76jpeg.jpg" alt="" width="1464" height="752"><figcaption> </figcaption></figure>The first of its kind survey in Nepal interviewed 15,088 participants and was carried out before <a href="https://www.nepalitimes.com/opinion/coping-with-anxiety-in-new-lockdown/" target="_blank" rel="noopener noreferrer">the pandemic</a> from January 2019 to January 2020. The study revealed that 10% of Nepal’s adult population had mental health problems in their lifetime with 4.3% experiencing some disorders at present.Mood disorders and neurotic and stress-related disorders were among the most common <a href="https://www.nepalitimes.com/latest/tackling-nepals-mental-health-pandemic/" target="_blank" rel="noopener noreferrer">psychological problems among Nepalis</a>. The prevalence of lifetime disorders was found the highest in Province 1 (13.9%), in the age group 40-49 years (13.3%) and among males (12.4%). As for current disorders, Bagmati scored the highest (5.9%) as well as those in the age group 40-49 years (6.3%) and females (5.1%).These figures correlate with Nepal’s suicide data of the past five years. Despite fewer attempts, men accounted for 57% of total suicides, against 43% of women. Among minors, however, more girls died by suicide, which experts ascribe to possible victimisation and a higher prevalence of borderline personality disorder among younger females.Suicide deaths are also disproportionately distributed across Nepal with Province 1 recording 65 deaths per 100,000 populations. Lumbini and Gandaki follow closely with 58 and 52 per 100,000 respectively. Traditionally neglected by the state and economically disadvantaged Karnali, Far West and Province 2 regions have lower suicide rates.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141124/636cfc369c7e80680e0a0b77jpeg.jpg" alt="" width="2287" height="1816"><figcaption> </figcaption></figure>More people are dying of suicides in urban centres such as Kathmandu Valley and Ilam district, which reported 32 and 38 suicide deaths respectively per 100,000 populations last year against Rautahat’s 18 and Humla’s 6.This is in direct contrast with the global trends where 77% of suicides occur in low and middle-income countries. Unemployment and poor economic condition have long been associated with a high risk of suicides, but only up to a certain point, as proven by recent data. Japan, <a href="https://www.nepalitimes.com/here-now/dead-end-of-the-korean-dream/" target="_blank" rel="noopener noreferrer">South Korea</a> and Hungary with their higher per capita GDPs have some of the highest suicide rates in the world.“Poorer nations have weaker education and health systems, which translates into delayed or even lack of diagnosis but poverty is not a sole factor for suicides,” says Kamal Gautam. “Suicide is complex and there are multiple factors at play which means a linear approach to prevention would be incomplete, it needs an integrated approach.”Addressing underlying mental health disorders is the most effective way to prevent suicides. This means increased awareness and education about psychological disorders, which in turn can help <a href="https://www.nepalitimes.com/here-now/all-in-the-family/" target="_blank" rel="noopener noreferrer">reduce societal stigma</a>. An introduction to and discussion on mental health in the school curriculum can further sensitise the public.In addition to medication and counselling, societal structure and family dynamics is an important support system for individuals suffering from psychosis, trauma and depression. Telemedicine in particular has been essential in preventing self-harm during the pandemic-induced restrictions but mental health services need to be scaled up across the country.On the other hand, a strict regulation must be implemented on the <a href="https://www.nepalitimes.com/here-now/suicide-by-pesticide-in-nepal/" target="_blank" rel="noopener noreferrer">availability of pesticides</a>, an easy means of suicide for many. Access to alcoholic products must also be supervised with Nepalis known to self-medicate to cope with stress and trauma, in turn increasing the risk of self-harm and suicide.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141124/636cfc399c7e80680e0a0b78jpeg.jpg" alt="" width="1280" height="853"><figcaption> </figcaption></figure>But most of all, analysing suicide attempts can be a powerful tool for prevention. On average, there are six attempts behind every suicide. Up to 80% of people with suicidal ideation reveal their intention to either a family member, friends or their doctors within a month before their attempt.“We forget that even before the pandemic suicide rates were very high in Nepal and while the pandemic might have added to the problem, the figures alone don’t mean anything if we fail to also study suicide attempts to find a stronger link between the prevalence and the contributing factors,” says Rabi Shakya, psychiatrist and director of Patan Academy of Health Sciences.He adds: “Historically, there have been more suicides after than during the crisis due to the long-term socioeconomic impacts. So we must start preparing for the pandemic of mental health problems including suicides post-Covid. Our health care workers must be trained and fanned out across the country.”Nepalis are not new to mental health problems induced by a crisis. The 10-year-long Maoist insurgency killed 17,000 people but many more continue to suffer from <a href="https://www.nepalitimes.com/here-now/the-mental-scars-of-violence/" target="_blank" rel="noopener noreferrer">PTSD, depression, anxiety and distress</a>. A 2017 report published in the journal Lancet found as high as <a href="https://archive.nepalitimes.com/article/nation/stigma-and-silence-mental-health-nepal,3486" target="_blank" rel="noopener noreferrer">37.5% of the general public</a> had some form of psychological disorder.The <a href="https://www.nepalitimes.com/here-now/its-all-in-the-mind/" target="_blank" rel="noopener noreferrer">2015 earthquake</a> further added to Nepal’s epidemic of mental disorders. Survivors who had narrow escapes or lost family members reported increased panic attacks, anxiety and trauma.But <a href="https://archive.nepalitimes.com/article/editorial/the-republic-of-insomnia,3311" target="_blank" rel="noopener noreferrer">conflicts, disasters</a> and pandemics have shined a light on mental health with an increased national and foreign investment in prevention and management. With larger chunks of the population impacted, there is now more acceptance and the field is starting to get the priority it warrants.Says Rishav Koirala, WHO focal person for mental health post-2015 earthquake: “The best way to prevent suicides is to address underlying psychological disorders and crises, despite adding to the burden has helped normalise them because many more people can now relate and understand that they are treatable.”

Sonia Awale

Nepal sees spike in suicides during pandemic

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131116/636cebb69c7e80680e09ad21jpeg.jpg" alt="" width="1280" height="853"/><figcaption></figcaption></figure>2020 was a blur and I was hoping 2021 would bring an end to the pandemic, so we could start moving on with our lives. But the surge in Covid-19 cases in India is causing <a href="https://www.nepalitimes.com/editorial/the-covid-tsunami/" target="_blank" rel="noopener noreferrer">a second wave in Nepal</a>, too.With millions losing their jobs and struggling to make ends meet in a country where many survive on daily wages, the concept of lockdown may seem helpful. However, the fear of death from hunger seems to pose <a href="https://www.nepalitimes.com/editorial/reduce-harm/" target="_blank" rel="noopener noreferrer">a bigger threat than Covid</a>.I talk to my parents every day, and get updates on family members to see how everyone is doing and making it through the day. My father tells me daily how many people tested positive and how Nepal continues to struggle with finding enough hospital beds for those whose oxygen levels dropped suddenly.One of his friends who had to be suddenly hospitalised, was discharged. “You never know, who will catch it next,” he told me.As I make a list of pros and cons of which vaccine I should get, I continue to hear about how my mother and aunt in Nepal have been trying to get vaccinated. Vaccines should be available for those who are above 60, but they cannot locate where to get it. Now, vaccinations have stopped because vaccine lines themselves became spreaders.It is hard for me to be far away and try to offer support when we are physically apart. It is usually the same conversation with my parents every day, and while we try to stay hopeful that the vaccine will help, we wonder when things will get better.My friends here constantly ask me how my parents are doing as they read about the emergency in India and Nepal, and all I can say is: “Yes, they are okay, but the country is not.” I try to stay strong, while feeling completely helpless from halfway around the world.Nepal banned all domestic and international flights this week, after going into mandated quarantine from 29 April. Nearly half the districts in Nepal are in lockdown for two weeks, and Kathmandu, Lalitpur and Bhaktapur are the most affected by the pandemic with half the <a href="https://www.nepalitimes.com/latest/nepal-designates-more-hospitals-for-covid-19-treatment/" target="_blank" rel="noopener noreferrer">7,448 new cases nationwide on Monday</a>.I had no doubt that by the time of my <a href="https://www.nepalitimes.com/opinion/flying-home-in-a-pandemic/" target="_blank" rel="noopener noreferrer">planned visit to Nepal in September</a>, Covid would have been a distant memory. But with the way things are progressing, that glimmer of hope feels fainter and fainter.When even rich countries continue to struggle with the pandemic despite all their resources, I worry how a developing country like Nepal will overcome this. What is the government of Nepal doing about vaccines? Will the second lockdown really help? What plans are in place to help people bearing the economic impact of the lockdown?My father and mother say they try to stay positive and stay strong during this difficult time because there is nothing else they can do. We have grown so used to the lack of social interactions that the only way to stay connected has been limited to talking on the phone, or video chatting.Last week, I had my first anxiety attack of the year after many people here in the United States asked me how my family was doing in Nepal. I felt helpless and overwhelmed with the concern and in telling others “everything is okay (for now)”, when I knew clearly that I was not okay.We are all exhausted from the never-ending stress. As I sat up in bed, holding myself, rocking back and forth telling myself to focus on my breathing and repeating, “I am okay, I am okay” I was not sure if I believed myself. I felt consumed by the overwhelming feeling of helplessness, guilt and regret.We have seen many lose their lives, and it is the fear of how many more people we will lose again. What are we going to do when we do not know how to control the spread?The only thing that I know that is under our control is our own emotions, and it is hard when lives of so many loved ones are at stake. Living in <a href="https://www.nepalitimes.com/latest/tackling-nepals-mental-health-pandemic/" target="_blank" rel="noopener noreferrer">fear and anxiety</a> of the worst that might happen makes it extremely hard for many to go on with their day-to-day lives.There is <a href="https://archive.nepalitimes.com/article/nation/stigma-and-silence-mental-health-nepal,3486" target="_blank" rel="noopener noreferrer">social stigma</a> attached to mental health, plus the lack of resources in Nepal has made this time more difficult for Nepalis. It is recommended you speak to a therapist, but many do not know about this and face difficulty finding one.A daily habit of meditation is one technique we can use at home to practice mindfulness and strengthen our mental state. It is challenging to attempt meditation when the world around you is in chaos, but it seems to be the only thing that can help many right now when we need it the most.Speaking to your loved ones and checking in on them regularly has proven to be extremely helpful, so I would recommend we continue staying connected with family members and friends whether we live in the same city or different continents.Also, try keeping your minds busy by reading or watching television to reduce some stress. Adopting new hobbies or taking this time to learn something new will also keep your mind preoccupied because overthinking about the situation without a helpful solution will only bring you down more.It is not easy to focus on our overall health when the country is in shambles, but taking care of our physical health is also very important during this time. Making sure to eat well and <a href="https://www.nepalitimes.com/opinion/yoga-in-the-time-of-covid-19/" target="_blank" rel="noopener noreferrer">incorporating physical activity</a> may seem minor, but will improve our sense of overall wellbeing. Some have found that getting a pet or raising plants in the garden can help with the low mood.As I try to stay strong for myself and my family from across the world, I hope we take the time to stay connected with loved ones and prioritise our physical health. I hope the daily meditation, healthy diet and physical exercise can ease the stress of the second lockdown. This is a time for us to stay strong for ourselves and others, while we hope the dark clouds pass over us quickly.Anjana Rajbhandary lives and works in Chicago. She writes this fortnightly Nepali Times column Life Time about mental health, physical health and socio-cultural issues.

Anjana Rajbhandary

Coping with anxiety in new lockdown

<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110111128/636cd24a9c7e80680e08f901jpeg.jpg" alt="" width="3264" height="2448"/>When Covid-19 hit, the hardest thing to do was staying home. I was like a prisoner in my own apartment, an experience shared by so many. Suddenly, everything that gave me energy had been taken away, and it left me feeling irritable.I ran out of patience and began to vent my frustration on people close to me. I knew it was unfair. I was being selfish in focusing concerns solely on myself, on how Covid-19 was affecting me. It took some time to realise how much it impacted the whole world. Switching the focus from myself to the broader picture helped me have a more mature view.When millions were losing jobs, some were busy posting on social media about how they were not able to get a decent haircut or a manicure. I was more concerned with my limited freedom, rather than the deteriorating health of millions of people. I was not putting things in perspective.An article in <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/keep-healthy-relationship-during-pandemic" data-saferedirecturl="https://www.google.com/url?q=https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/keep-healthy-relationship-during-pandemic&amp;source=gmail&amp;ust=1610708220289000&amp;usg=AFQjCNFVrNotr3_ajuI-qH_FTzJGEjhJDQ">John Hopkins Medicine</a> stresses on broadening your support system instead of heavily depending on your partner for all emotional needs because everyone has their own threshold. We all come with individual needs. Speaking to my parents and friends helped immensely during the most difficult times. Never have I been so grateful to the internet for keeping people connected.It had always been easier for me to complain and find faults in everything, but Covid-19 taught me to introspect. Instead of focusing on the negative, I started working on myself through yoga and healthier habits, and better communication.Humans tend to show their worst side to the ones who love them the most because we know they will always be there for us despite our unacceptable behaviour. Chartered Counselling Psychologist Krista Rajkarnikar says the pandemic has actually given newfound hope to relationships.“It is fairly early to have a more specific response to this question, however studies have suggested it is not all bad for relationships. Despite higher divorce rates and various lockdown-related interpersonal difficulties, people have also shown higher rates of care, empathy, concern, and love for family and friends during these pressing times,” she said.What stands out is the support people received from their families as Covid-19 took a toll on many aspects of people’s lives. A recent Monmouth University poll showed that  most people were still satisfied with their relationships despite the stress of the pandemic.The poll showed that 51% of the respondents expected their relationship to emerge stronger from the tests the lockdown had put them through, and 1% said their relationships would get worse. Although the findings are reassuring, people are not  numbers.It is important to focus on individual needs, because we all suffer differently. Even if the majority of people are doing better, it does not matter on an individual level for those who are doing worse. For them, statistics do not mean anything.https://www.youtube.com/watch?v=ZrhguBwPmCA&amp;t=18sIn the end, it all comes down to choice. That is what the pandemic has taught us—do we want to hold on, or let go? It is up to us to shape relationships, because they demand they be nurtured. From my reading of people in my life, I have seen that the pandemic is helping people appreciate what they have instead of run after what could be, and take responsibility for their actions.I know couples who postponed their weddings, and they have all said that despite the stress and anxiety of having to replan the wedding, their relationships have got stronger. Before the pandemic, people with jobs could hardly make time for their loved one, but being together also helped many couples re-bond.Despite vaccines being rolled out, uncertainties abound. It helps to be more patient and understanding of others as well as of ourselves. This is not an easy time, and relationships take work.We spend so much time paying attention to other people’s lives, celebrity scandals on our phones that we must remind ourselves to be fully present when we are with the people we love. We have a desire to be heard but we also need time to listen. It is also important to realise when it is an unhealthy relationship, and when it is time to walk away instead of trying to keep fixing it.I learned the value of nurturing my relationship by listening to people who knew its healthy definition. In most relationships, it is easy to find faults when you go looking, and in the same way it is also easy to find solutions if that is what you want.A healthy and happy relationship gives people the emotional strength to handle life’s various stressors much better. Always remind yourself that you are choosing to stay in a relationship because it makes you happy and because it makes you a better person. The companionship and emotional support are helpful for your mental well-being.Anjana Rajbhandary writes this fortnightly Nepali Times column Life Time about socio-cultural issues, mental health and physical health.

Relationships in the time of corona

<figure><img width="747" height="600" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109141112/636ba78a9c7e80680e07378cjpeg.jpg" alt=""/><figcaption></figcaption></figure>In the past week, two photojournalists and several reporters at a digital news portal have tested positive for SARS-CoV-2. The group Photo Journalists Nepal is organising PCR tests for all its members in the coming weeks.    Being on-site on the frontlines is also exerting a mental strain on journalists across the country as they have the constant fear of exposure and transmitting to elderly family members at home. They are also worried about losing their jobs, as media companies start laying off staff.This in turn is affecting the quality and quantity of news delivered by agencies. On the other hand, the financial fragility of media companies also affects their independence as they come to depend more on government support or advertising revenue.  A nation-wide survey carried out by the Nepal Press Institute and the University of Bournemouth found a rise in mental strain complaints among Nepali journalists. The poll was conducted between 10-24 July, and involved 1,134 journalists from all seven provinces. Of those surveyed, 83% said they worried about increased risk of infection, 75% said they feared the situation would get worse – as it did in the subsequent weeks after the survey was conducted. And 62% reported personal discomfort, and 28% were even losing sleep.https://www.youtube.com/watch?v=L7-w7_jXD1EAside from worry about their health, reporters also said the uncertainty about their jobs and not getting salary on time was also causing mental stress. As many as 74% of the journalists polled said they had already suffered financially from the crisis, while 6.3% lost their jobs altogether, while 38% had salary cuts. These numbers are now higher because several more publications have shut down in the past month.  Even in July, the survey already showed that mental health was becoming a problem among frontline media practitioners. A quarter of those polled reported experiencing bouts of depression or frustration, and 60% constantly worried about their ability to support their families.   Finance Minister Yubaraj Khatiwada has proposed an aid package for cash-strapped journalists through the Coronavirus Relief Fund, and discussions with media support organisations are said to be underway.   <a href="https://www.nepalitimes.com/latest/in-locked-down-nepal-print-is-still-king/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/in-locked-down-nepal-print-is-still-king/&amp;source=gmail&amp;ust=1598416952991000&amp;usg=AFQjCNEm4pi2b_c74e39buscgy9bCs1qCQ">Print publications</a> have been particularly affected by the pandemic, with 55% journalists reporting a drop in the number of pages in their outlets, while 48% said there was a reduction in frequency of their editions. Many news agencies have also been forced to go online only, even as readership migrates from print to <a href="https://www.nepalitimes.com/here-now/nepalis-are-drifting-to-digital-media/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/nepalis-are-drifting-to-digital-media/&amp;source=gmail&amp;ust=1598416952991000&amp;usg=AFQjCNFr3phi8yhoDHvT49nzYXRb3561DQ">online sites and internet coverage grows. </a>The survey reported a drop in the quality of audio and visual news broadcasts, as 20% of journalists felt they were spending less time doing their reporting or editing work.UPDATE 28 August: The Federation of Nepalese Journalists revealed that 71 media persons across Nepal have tested positive. Of them,  the most (27) are in Province 2.

Nepal’s journalists are also on the frontlines

<figure><img width="1500" height="1010" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101116/636b704d9c7e80680e06006fjpeg.jpg" alt=""/><figcaption>Photo: MONIKA DEUPALA</figcaption></figure>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.Read also: <a href="https://www.nepalitimes.com/here-now/suicide-by-pesticide-in-nepal/" target="_blank" rel="noopener">Suicide by pesticide in Nepal</a>, Sonia AwaleMost 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: 9840021600Transcultural Psychosocial Organization-Nepal Crisis Hotline: 1660 0102005Mental 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.”Read also: <a href="https://www.nepalitimes.com/latest/suicide-watch/" target="_blank" rel="noopener">Suicide watch</a><a href="https://archive.nepalitimes.com/article/nation/down-and-out,3158">Down and Out</a>, Smriti Basnet <figure><img width="1500" height="947" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101116/636b704f9c7e80680e060070jpeg.jpg" alt=""><figcaption> </figcaption></figure>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.Read also: <a href="https://archive.nepalitimes.com/page/suicide-in-nepal">End pain, not lives</a>, Anjana Rajbhandary“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.”  Read also: <a href="http://archive.nepalitimes.com/news.php?id=16792#.XhbkgFUzbIU">Self-destruct</a>, Indu Nepal <a href="https://www.nepalitimes.com/here-now/dead-end-of-the-korean-dream/">Dead end of the Korean Dream</a>, Ki Mindo in Seoul <h2>A note on suicide notes</h2> 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.Read also: <a href="https://www.nepalitimes.com/here-now/dead-end-of-the-korean-dream/" target="_blank" rel="noopener">Dead end of the Korean Dream</a>, Ki Mindo in Seoul

Nepal’s suicide rate vastly underestimated

<figure><img width="1400" height="934" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108111152/636a359a9c7e80680e0482bcjpeg.jpg" alt=""/><figcaption>PIc: MONIKA DEUPALA</figcaption></figure>A couple in Kathmandu, tired of their daughter playing with her mobile all the time, cut off the home internet and hid her phone. The 23-year-old got severe withdrawal symptoms, became agitated, was weeping and yelling, and even slashed her wrist. Her parents had to take her to a psychologist.A woman in Baneswor disabled the home wifi because her 17-year-old son was always on his mobile. The teen then started going to his aunt’s home just to use the net. He told his psychiatrist: “If I don’t have my phones, I get anxious. I don’t even want to eat or talk.” Read also<a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/?p=24696&amp;preview=true" target="_blank" rel="noopener">Facebook nation</a>, Madhu Acharya<a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/?p=24697&amp;preview=true" target="_blank" rel="noopener">New news</a>, EditorialA father was concerned that his daughter studying the A-levels appeared lethargic every day, and wondered if she was on drugs. He peeked into her room one night and found her watching pornography on her phone. Psychologist Ganga Pathak who treated all three patients, says Internet addiction has become an epidemic in Nepal in the last five years. A psychological counselor for over 20 years, she says this phenomenon is similar to drug addiction or alcoholism.Read also:<a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/?p=24646&amp;preview=true" target="_blank" rel="noopener">Nepalis are drifting to digital media</a>, Madhu Acharya and Bhumiraj ChapagainInstead of linking people, she believes that as elsewhere in the world the Internet is making Nepali users lonelier, unhappy, insensitive and unproductive.A 12-year boy in Dhumbarahi had pasted a notice on his door forbidding anyone from entering because he was on his mobile all the time. When his parents tried to get him to talk to people, he would cry. They took him to Pathak, who diagnosed digital addiction.Children’s minds and bodies grow rapidly before the age of five, so they should be kept away from mobile phones. However, since most parents are busy, they prefer to distract their children with gadgets, which is the beginning of children’s addiction, says Pathak.Sabrina Thapa, who teaches at a school in Balaju, says her students are mostly up all night playing games on their mobiles, so they are drowsy in class. A study of 136 students three years ago by the Manmohan Memorial Institute of Health Sciences showed that 92.8% were affected by digital addiction or Gaming Disorder. In 2018, WHO listed Gaming Disorder among international diseases. Facebook, YouTube, Instagram and more recently TikTok are the most popular sites. Read also:<a href="https://www.nepalitimes.com/banner/addicted-to-the-joystick/" target="_blank" rel="noopener">Addicted to joystick</a>, Suprasanna Aryal<a href="https://www.nepalitimes.com/editorial/face-to-face-with-facebook/" target="_blank" rel="noopener">Face-to-fact with Facebook</a>While last year’s Sharecast survey showed that 86% of youth aged 16-24 used Facebook regularly, the proportion has grown to over 90% this year.Digital addiction among the youth seems to be a result not of the need to communicate through the Net, but of habit formation. Tirsana Sharma, 18, of Kalanki says: “I alone use almost a dozen communication apps like Facebook, Messenger, Instagram, Snapchat, Twitter, Tiktok, Viber and WhatsApp. If I do not use them all, I might miss what my friends are up to.” Socioloigist Janak Rai believes digital addiction is changing the communication culture and socialisation within Nepali socitety. “Due to digital addiction, the new generation is becoming self-centered. We cannot stop the use of these technologies, but it is time we began a public debate on how and for how long we should be using them every day.”Digital addiction also leads to insomnia, which invites further health problems like migraines, anxiety, and depression. According to Sirjana Adhikari, eye specialist at Tilganga hospital, constant exposure to the blue light from smartphones and laptops directly affects the eyes, and leads to problems like itchiness, dry eyes, headache and blurred vision. Constant bending to use the devices leads to chronic neck ache called ‘text syndrome’ or ‘text neck’.Digital addiction also makes users more aggressive, and the Police believe that it is contributing to crime. SP Narendra Upreti of the Crime Investigation Division says: “There is a trend of shooting pornographic videos, exchanging them, blackmailing people and attempts at character assassination. Up to 90% of the digital crimes that we investigate are related to sex.”

Nepal is becoming a nation of net addicts

<figure><img width="1400" height="932" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110714114/636902db9c7e80680e037c8bjpeg.jpg" alt=""/><figcaption>Source: The Lancet</figcaption></figure>The debilitating effects of mental health diseases and the <a href="http://archive.nepalitimes.com/news.php?id=14138#.W2MFj9Uza70" target="_blank" rel="noopener">social stigma associated with them</a> are not limited to patients: the lives of family members also change irrevocably. Family support can also be an important source of strength and even help in the healing process, say psychiatrists, patients and their relatives.Reshma Magar from Sindhuli, brought her 35-year-old son to a mental health clinic in Kathmandu after he displayed symptoms like severe headaches, mouth fizzing, and haphazard running around. As a mother, she was constantly worried he might hurt himself.“We have the Sun Kosi River nearby and I would think: what if he jumped?” says Magar, who has to tie him up in the hospital bed to contain his violent behavior. “I would be crying and the nurses here would console me.”Read also: <a href="https://www.nepalitimes.com/?p=10647&amp;preview=true" target="_blank" rel="noopener">Raising children can be therapy</a>, Ketan DulalNabina and Samira Pradhan shared similar hardships. Their brother, 40, started showing erratic behaviour after his wife left him, taking their daughter with her. He throws things around, does not eat, and their 71—year-old mother has to look after him.“It is very hard,” Nabina says, “mother herself has health issues and because of our brother’s state, violence in the home remains a constant danger.”Sufferers of psychotic mental illnesses are generally unaware they have a problem. In <a href="http://archive.nepalitimes.com/article/nation/stigma-and-silence-mental-health-nepal,3486" target="_blank" rel="noopener">schizophrenia</a>, a severe psychotic disease, patients have a distorted sense of reality − hallucinations, extreme paranoia, hearing voices − that their mind infers as truth. They resist help, and family members have a difficult job coaxing them to seek and continue medical treatment.Beyond this, the emotional trauma of having a suffering relative is a constant feature of life for the Magar and Pradhan families, which makes each day frightening and unpredictable.Read also: <a href="https://www.nepalitimes.com/?p=10641&amp;preview=true" target="_blank" rel="noopener">Addicted to the joystick</a> , Suprasanna AryalResearch has shown that patients suffering from psychosis have various structural and functional abnormalities in the brain. Schizophrenia patients have dysfunctions in their neurotransmitter systems, metabolic pathways and certain structures in the brain regulating motor activity.Traditionally Nepali society, which did not have coping mechanisms, regarded mental disorder as a curse, and there is strong social stigma and ostracisation of both the patients and their families. Derogatory labels for <a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/overcoming-depression,2164" target="_blank" rel="noopener">‘crazy’ people like ‘dimag khuskeko’ or ‘pagal’</a> are still widely used.However, now that science has shown that the causes are mostly chemical imbalances, there is treatment says Basudev Karki of Lagankhel Mental Hospital: “Medicine now has treatment for mental diseases, just like for physical ailments. Problems of the mind also need medical care and treatment and there is nothing wrong in that. Instilling this understanding will help address stigma for patients.”Read also: <a href="https://www.nepalitimes.com/?p=10601&amp;preview=true" target="_blank" rel="noopener">Ashna comes out of black</a>, Sewa Bhattarai <img width="670" height="585" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110714114/636902de9c7e80680e037c8cjpeg.jpg" alt="">However, Karki cautions that medical interventions alone sometimes do not suffice because the triggers may be a combination of biological, psychological and social factors. For example, there was a <a href="http://archive.nepalitimes.com/article/editorial/the-republic-of-insomnia,3311" target="_blank" rel="noopener">surge in mental disorders in Nepali society</a> during <a href="http://archive.nepalitimes.com/article/nation/psychological-scars-of-maoist-conflict-on-young-survivors-take-longer-to-heal,1519" target="_blank" rel="noopener">the conflict</a> and after <a href="https://www.nepalitimes.com/here-now/its-all-in-the-mind/" target="_blank" rel="noopener">the earthquake</a> and Blockade. Out-migration and family separation pushes people into another class of mental illness, like neuroses, such as <a href="http://archive.nepalitimes.com/regular-columns/all-in-mind/the-silent-scream-depression-is-common-but-only-few-get-treatment,588" target="_blank" rel="noopener">depression</a> and anxieties in which, unlike psychosis, the patients preserve a sense of reality.Following hospital treatment it is up to family to provide psychological support for patients, to think positively and maintain a healthy lifestyle. They must protect patients from extreme stress due to social factors, such as unemployment or financial trouble.Muna Tamang shows extraordinary determination this week as she sits beside the hospital bed of her 24-year-old daughter who is suffering from psychosis. “As long as she can live and heal, I have decided that we will do anything for her treatment, even if we have to take loans,” Tamang told us.Read also: <a href="https://www.nepalitimes.com/here-now/its-all-in-the-mind/" target="_blank" rel="noopener">It's all in the mind</a>, Sonia AwaleNepal’s mental health facilities are mostly based in cities, but even here there aren’t enough trained specialists to deal with what is a national mental health epidemic. Up to one-third of Nepal’s population suffers from some form of mental illness, according to one study. (See chart)One group, The Transcultural Psychosocial Organistaiton (TPO) is working to remedy the urban-rural mental health gap, by training doctors and health workers at the local level with Female Community Health Workers.“We do not just want to make these services available, but to also ensure people reach out to them, and refer patients to seek help in facilities,” says Kamal Gautam at the TPO.Such efforts have helped remove stigma, and empowered patients and families to receive treatment and care. But Nepal still has a long way to go. With greater state investment, access to mental health services and proper therapy, family members can be even more involved in helping patients and reducing their stigma.Some names have been changed.

All in the family

https://youtu.be/3q459iYj9HAAshna Lama flips a black folio. Each page has a stark female figure in white. Some standing up, others sitting, some lying down or meditating.The flowy edges enclose shards and squiggles, as if hiding a deep hurt within. The drawings seem to signify how women try to keep their pain inside, while keeping a bubbly facade.Ashna Lama herself is a chirpy 21-year-old who laughs a lot, makes self-deprecating jokes in her singsong voice. Few can tell that this cheery face masks a difficult struggle with anxiety attacks and depression.Lama grew up in an artistic family with the smell of acrylic and turpentine. She sketched from a young age, expressing her sadness in art. The current series ‘The Fragility of Anxiety’ was drawn in <a href="https://www.nepalitimes.com/here-now/its-all-in-the-mind/" target="_blank" rel="noopener">2015 after the earthquake when she had panic attacks</a>, and was put on medication.Read also: <a href="https://www.nepalitimes.com/here-now/its-all-in-the-mind/" target="_blank" rel="noopener">It's all in the mind</a>, Sonia Awale“I was traumatised, I didn’t speak to anyone for four days. There were a lot of thoughts running through my mind,” recalls Lama. “Then I turned to my sketchbook and started drawing, and these figures just flowed. When I concentrated on sketching I didn’t think of anything else, and the focus calmed me down.”<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110714114/636902b49c7e80680e037c7cjpeg.jpg" alt="" width="572" height="1024"/><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110714114/636902b69c7e80680e037c7djpeg.jpg" alt="" width="575" height="1024">Three years later, Ashna is ready to exhibit the sketches alongside her own poetry at the one-day exhibition at Hotel Annapurna on August 12. Lama says the black pages of the notebook spoke to her, and resonated with her art. She describes her <a href="http://archive.nepalitimes.com/regular-columns/all-in-mind/the-silent-scream-depression-is-common-but-only-few-get-treatment,588" target="_blank" rel="noopener">bouts of depression</a> as “spiraling into blackness”.Read also: <a href="https://www.nepalitimes.com/?p=10636&amp;preview=true" target="_blank" rel="noopener">All in the family</a> , Prakriti Kandel<a href="https://www.nepalitimes.com/banner/the-art-of-healing/" target="_blank" rel="noopener">Art has historical association with mental health</a>. Frieda Kahlo painted self portraits to deal with debilitating injuries, Monet was highly anxious, Picasso was said to be schizophrenic, and Van Gogh depressed and bi-polar. Lama says her art is also a reflection of her inner turmoil.“When the pressure cooker is about to burst and the whistle goes off, the steam is art. If it is too much to handle, I draw," says Lama, adding it was not easy to decide to share her work and open up about her deepest emotions. But she decided to go for it to spread awareness of mental health in Nepal, and break the taboos.Lama found out she was getting too dependent on medication. Once, having lost her pills she started banging her head on walls, hoping she would pass out. The drawings have helped her get off medication, and she says many others with mental health issues may also need an outlet for expression.Read also: <a href="https://www.nepalitimes.com/?p=10647&amp;preview=true" target="_blank" rel="noopener">Raising children can be a therapy</a>, Ketan Dulal<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110714114/636902b99c7e80680e037c7ejpeg.jpg" alt="" width="1500" height="1381"><figcaption> </figcaption></figure>After she came out to talk publicly about her affliction, Lama found many opened up too. They were lonely, and felt as if they were the only ones suffering. It helped to share.“Mental health is so little understood in Nepal. There is so much stigma, and I want to generate some discussion through this exhibition. It is for people who appreciate the effort it takes to bare your innermost soul to an outsider,” says Lama.Once a science student and a part-time model, she decided to take a clean break and enrolled in an art school in Florence. She says formally studying art in the city of Michelangelo, Botticelli, Raphael, and Dante gave more definition to her form of expression. She also paints commissioned work where she digresses from signature black to dabble in rainbow hues.The future? Lama wants to return to Nepal and learn thangka painting: “I want to sweat it out, grinding gemstones to make colours, using the techniques to make my own kind of art.”It would be a homecoming for Ashna Lama, shedding black for the vividness of life in her own country.Read also: <a href="https://www.nepalitimes.com/?p=10641&amp;preview=true" target="_blank" rel="noopener"> Addicted to the joystick</a>, Suprasanna AryalThe Fragility of AnxietyHotel Annapurna 12 August, 4:30-6:30PM<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110714114/636902bc9c7e80680e037c7fjpeg.jpg" alt="" width="640" height="917"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110714114/636902bf9c7e80680e037c80jpeg.jpg" alt="" width="640" height="921">

Ashna comes out of the black

<h2>The conflict and earthquake added to Nepal’s hidden epidemic of mental disorder</h2><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110710114/6368ca479c7e80680e02f2fejpeg.jpg" alt="" width="1400" height="1050"/><figcaption>MEMORIES: Nani Maiya Prajapati was serving lunch to her husband, daughter, son-in law and two grandchildren when the earthquake struck three years ago. She survived, but the rest of her family did not. The 2015 tragedy left mental scars on thousands of survivors like her that will take time to heal. ROJITA ADHIKARI</figcaption></figure><a href="http://archive.nepalitimes.com/article/nation/stigma-and-silence-mental-health-nepal,3486">One-third of Nepalis</a> were already suffering some form of psychiatric disorder, but mental health experts say the numbers <a href="http://archive.nepalitimes.com/article/nation/psychological-scars-of-maoist-conflict-on-young-survivors-take-longer-to-heal,1519">went up significantly during the Maoist conflict</a> and rose again after the <a href="http://archive.nepalitimes.com/blogs/kundadixit/2015/05/27/a-month-that-felt-like-a-year/">2015 earthquake</a>.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110710114/6368ca4a9c7e80680e02f2ffjpeg.jpg" alt="" width="130" height="101">Besides existing psychological disorders in the general population, there are now torture victims, child soldiers, combatants with post-traumatic stress disorders (PTSD), <a href="http://archive.nepalitimes.com/article/nation/Mental-cost-of-migration,3159">mistreated migrant workers</a>, and lately earthquake survivors who had narrow escapes or lost family members.Read Also: <a href="https://www.nepalitimes.com/?p=4261&amp;preview=true">Time heals</a>, Prabin DhungelArun Bhattarai was lying down for a nap that Saturday three years ago when a deep underground rumble followed by a big jolt woke him up. His house in Dhading collapsed, and his family became earthquake refugees in Kathmandu. Bhattarai, now 46, suffered from insomnia and anxiety attacks for months afterwards. The trauma drove him to drink, but today after treatment he has beaten his alcoholism.“A lot of people suffered from anxiety, <a href="http://archive.nepalitimes.com/article/editorial/the-republic-of-insomnia,3311">post-traumatic stress disorder</a> and depression following trauma and bereavement during the earthquake, some even attempted suicide,” says mental health specialist Kapil Dev Upadhyay. “The disaster aggravated the psychosocial condition of many patients who were already recovering.”<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110710114/6368ca4b9c7e80680e02f300jpeg.jpg" alt="" width="500" height="715"><figcaption> </figcaption></figure><a href="https://reliefweb.int/sites/reliefweb.int/files/resources/Hidden-Aftershocks_Summary-Report.pdf">A survey</a> of earthquake-affected districts of Rasuwa, Nuwakot and Makwanpur for the Nepal Red Cross Society, conducted by the group Transcultural Psychosocial Organisation (TPO),  showed that nearly 40% of respondents suffered from <a href="http://archive.nepalitimes.com/regular-columns/all-in-mind/the-silent-scream-depression-is-common-but-only-few-get-treatment,588">depression</a> and anxiety for a year-and-half after the earthquake. Another 22% said they had suicidal thoughts, and a quarter had taken to drinking heavily. More women than men were affected by the symptoms (see chart).Sunita KC was out for a Saturday walk with her husband at Kathmandu Darbar Square when nearby <a href="http://archive.nepalitimes.com/article/nation/Monumental-loss,2215">monuments swayed and collapsed</a> in clouds of dust. The 23-year-old was plagued with nightmares and lost the will to live. She got better after medication, but three years later her symptoms have returned. This week KC was in a clinic in Kathmandu with her family for consultation where she was diagnosed with severe depression.At the Psychiatric Department of Teaching Hospital, Rishav Koirala estimates that every family has at least one member afflicted with some form of mental illness after the earthquake.“In a way, the earthquake was a blessing in disguise because it raised public awareness about mental health and partially removed the <a href="http://archive.nepalitimes.com/news.php?id=14138#.WthaP26FPIU">stigma</a>. The government was also forced to address mental healthcare.”Indeed, the government trained MBBS doctors to provide psychiatric help to survivors in the primary health care systems and district hospitals. Nepal’s Mental Health Policy, adopted in 1997 but rarely implemented, is finally being revised.At an <a href="http://mentalhealthconferencenepal.com/programme/">international conference on mental health in Kathmandu</a> in February, the government pledged to prioritise mental health, increase investment for a mental health focal unit in each provincial health ministry, and to recognise alcohol and substance abuse as mental health problems.“School level psychological education can help change societal attitudes towards mental disorders, and since Nepalis are resilient and family-oriented there is a support system,” says psychiatrist Namrata Pradhan at Model Hospital.Nepal has one of the lowest patients to psychiatrists ratios in the world. In addition, society has entrenched stigma about ‘mad’ people who are often ostracised, often by family members. Even before the earthquake, patients were left to fend for themselves.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110710114/6368ca4d9c7e80680e02f301jpeg.jpg" alt="" width="878" height="516"><figcaption> </figcaption></figure>Rabi Shakya, professor of psychiatry at the Patan Academy of Health Sciences agrees that the public is more aware of mental disorders after the earthquake. “There has been a visible change in terms of awareness and general acceptance level regarding mental health, and as a result patients are coming out and seeking treatment,” he told Nepali Times this week.Post-earthquake studies have shown higher rates of psychiatric disorders, but the major limitation is the lack of a baseline study. The Nepal Health Research Council is now preparing a nationwide mental health survey later this year to help develop a longterm plan to upgrade psychiatric care.Says mental health activist and former patient Jagannath Lamichanne: “We need public awareness and acceptance so that people are comfortable with sharing their experiences, and that can be the most powerful tool for prevention.”Name of patients have been changed.Read also:<a href="http://archive.nepalitimes.com/article/nation/stigma-and-silence-mental-health-nepal,3486">Stigma and silence</a>,  Ketan Dulal<a href="http://archive.nepalitimes.com/article/editorial/the-republic-of-insomnia,3311">The republic of insomnia</a>,  Editorial<a href="http://archive.nepalitimes.com/article/nation/psychological-scars-of-maoist-conflict-on-young-survivors-take-longer-to-heal,1519">Post-conflict stress syndrome</a>,  Taylor Caldwell<a href="http://archive.nepalitimes.com/article/nation/down-and-out,3158">Down and Out</a>,  Smriti Basnet

depression