<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161152/636d1e8b9c7e80680e0af416jpeg.jpg" alt="" width="960" height="640"/><figcaption>Photo: SAGLO SAMAJ/HIMALMEDIA</figcaption></figure>The Covid-19 worsened the disparities in young children’s development and learning in Nepal. One out of five Nepali children between the ages of 2-4 years are not developing on track amidst the pandemic with noted impact on their health, <a href="https://www.nepalitimes.com/latest/covid-19-cancels-regions-gains-in-education/">learning</a> and psychological well-being, a new UNICEF study has revealed.The Early Childhood Development Index (ECDI) survey conducted in August among 2,853 households via phone conversation showed that children from lower income families, living in rural areas, with caregivers with no or low levels of education, and not attending early childhood education (ECE) programs were at higher risk.Even among children who attended ECE, those who attended government ECE were at higher risk of being developmentally off track compared to those who attended private programs.Early stimulation activities like <a href="https://www.nepalitimes.com/here-now/the-power-of-reading-aloud/">reading books</a>, telling stories, singing songs, going outside, naming objects, counting, or drawing things were found instrumental for young children’s development and learning. However, the data revealed an alarming plunge in parental engagement compared to pre-pandemic conditions.As the country opened up with the decline in Covid cases in August 2021 and parents pursued livelihood options, only 31% of children received early stimulation at home by family members compared to 73% in 2019.A follow up survey in October found that mothers’ engagement improved over the time after she got over the initial hectic schedule right of the pandemic. The same can’t be said for the fathers, whose parental engagement remained low at 6%, maintaining a social norm of men’s reduced role in raising children.This is just the latest in the series of impacts that young children have been subjected to following the pandemic. Early in the coronavirus crisis, repeated lockdowns and travel restrictions meant that parents were unable to take their children for routine immunisation, also resulting in an outbreak of measles in the Dhading district. Similarly, the dramatic <a href="https://www.nepalitimes.com/banner/children-are-collateral-damage-in-nepal-lockdown/">decline in institutional delivery</a> led to increased infant mortality.Reduced family income due to job losses during the pandemic also added to the problem of childhood malnutrition in Nepal. School closures also deprived many children of getting <a href="https://www.nepalitimes.com/latest/nepals-out-of-school-children-get-food-at-home/">one decent meal a day</a> while they also missed their lessons with over 80% of government school children not having attended classes – online or otherwise in the past two years.Among children in the age group 2-4 years, half of those surveyed were found to have been enrolled in <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/Prepping-for-preschool,253">pre-primary level</a> but 34% of them didn’t participate in learning through alternative learning modalities at all, most of the children only accessed home tuition. While low-tech solutions like educational radio and TV and tele-teaching were almost unused, high-tech solutions like online classes were used almost exclusively among children who attended private ECE.Underused low-tech solutions and unequal access to high-tech solutions might have further contributed to the developmental gap observed between children who attended private ECE and other children and is the proof of the <a href="https://www.nepalitimes.com/here-now/digital-divide-exposes-class-divide-in-nepal-schools/">growing digital divide</a> between private and public institutions.Following the survey results, UNICEF has recommended remedial learning to target children at a higher risk. The government and aid agencies should also develop a system to support teachers and parents to understand their children and figure out their learning levels through user-friendly assessments.In many ways, Covid-19 was a learning lesson for future disasters and being forced to adapt to online educational tools has helped teachers, students and parents prepare for school closures. But the alternative methods of learning remain largely underused, mostly in lack of infrastructure. School across Nepal <a href="https://www.nepalitimes.com/here-now/lessons-not-learned-from-the-pandemic/">has to be trained and well-equipped</a> with Internet facilities and electronic devices.Having said that, parenting education, in particular, involvement of fathers and learning at home is of utmost importance and should be communicated as much in the communities.

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Covid derails child development in Nepal

<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.”

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Nepal sees spike in suicides during pandemic

<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

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

It’s all in the mind

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110710114/6368ca509c7e80680e02f302jpeg.jpg" alt="" width="1500" height="844"/><figcaption>Pic: Gopen Rai</figcaption></figure>Immediately after <a href="http://archive.nepalitimes.com/blogs/kundadixit/2015/05/27/a-month-that-felt-like-a-year/">the earthquake</a>, there was a <a href="http://archive.nepalitimes.com/article/editorial/the-republic-of-insomnia,3311">sudden surge of patients with mental disorders</a> in Kathmandu’s psychiatric clinics.But since 2016, records at the Nepal Mental Hospital and Bir Hospital show a sharp decrease in the number of patients with post-traumatic stress disorders. Doctors say the reason is that most patients with earthquake-related psychosocial issues received medication, counselling and support from families in the last three years.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110710114/6368ca539c7e80680e02f303jpeg.jpg" alt="" width="130" height="101">Even so, some survivors still have anxiety attacks during an aftershock or when they hear loud noises. Pukar Gautam was a college student who found himself in the narrow alleys of Patan when the earthquake struck.Read Also: <a href="https://www.nepalitimes.com/?p=4260&amp;preview=true">All in the mind</a>, Sonia Awale“I was terrified and took cover below a sturdy beam,” Gautam remembers. He was traumatised for months afterwards, and even today feels claustrophobic in narrow, crowded alleys.Many traumatised children had to be counselled when schools reopened two months after the earthquake in 2015. They could not concentrate on their studies, had difficulty sleeping and looked distracted.Niroj Mali is a teacher at Chantal Mauduit Academy in Taukhel, and remembers students were still in shock when they came back to school. Instead of regular classes he had the children sing, dance and watch cartoons. “They are doing well now, the earthquake seems like a bad dream,” Mali says.Sandeep Bista, 32, works for the Red Cross and was trapped in a room in Bhaisepati with a visiting aunt when the earthquake struck. He was treated for persistent anxiety, and feels much better now. But his aunt suffers relapses and has to regularly visit the district hospital in Ramechhap.Chief Psychiatrist Lata Shrestha at the Nepal Mental Hospital confirms that the number of patients with psychological trauma has declined to levels before the earthquake. “I have seen more people now seeking psychological help and counselling for trauma and this is a positive side-effect of the earthquake,” she says.Nawal Jha was posted to hospitals in earthquake affected districts and remembers treating many survivors with <a href="http://archive.nepalitimes.com/article/nation/down-and-out,3158">mental disorders</a>. Younger patients who had seen much death and destruction were even <a href="http://archive.nepalitimes.com/regular-columns/all-in-mind/suicide-after-earthquake,496">suicidal</a>, he remembers.Purnima Lama was in a building in Bungamati and suffered a fracture when the house she was in collapsed. She needed medical treatment, but was reluctant to seek psychological counselling. “I was scared <a href="http://archive.nepalitimes.com/article/nation/stigma-and-silence-mental-health-nepal,3486">others would think I was mad</a>,” she says, recalling how a relative was ostracised from her village in Dhading after she was mentally traumatised after a brother was killed during the conflict.Psychiatrist Basu Dev Karki also says societal attitudes towards mental disorders are changing: “People now look at mental health at par with other medical conditions. That is a positive step in ensuring the mental wellbeing of the people.”Some names have been altered.  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

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