Why More Nepalis Are Seeking Mental Health Help (And How)

KATHMANDU, NEPAL — Kaili was diagnosed with depression two years ago. Her symptoms had begun to worsen during the coronavirus pandemic. When it first broke out, Kaili, now 32, was forced to live alone in Victoria, Australia, while her husband was stranded in Nepal for over a year, unable to return home due to a lockdown. Their marriage suffered, even upon his return, and Kaili found herself contemplating suicide.

“I told a friend about it. I asked for help,” she says in an interview over Viber, a calling app. She requested she only be referred to by her nickname due to stigma surrounding mental illness. She also confided in her mother-in-law, who lives in Nepal.

Mental health is often brushed under the carpet in Nepal, but Kaili’s mother-in-law (who also chose to withhold her name to preserve Kaili’s anonymity) did not react this way: An avid social media user, she had been evangelized on its importance through videos on Facebook and TikTok. Instead, she urged Kaili to seek professional help. “I am far away from her; I cannot be there to help, but I can give suggestions,” the older woman says. “So, I suggested that she consult a counselor.”

More than 10% of adults in Nepal suffer some form of mental distress, according to the most recent national mental health survey. A decade-long civil war that ended in 2006 and an earthquake that jolted the country in 2015 partly explain these high rates; the coronavirus pandemic also worsened matters, with police data indicating rising suicides during 2020. Awareness is also increasing, however. More and more people are sharing their struggles online, chipping away at longstanding stigma, and psychologists who offer online services report an uptick in clients — within the country and from Nepalis based abroad, such as Kaili.

Kaili first sought help from a non-Nepali psychologist in Australia. “I cried many times during counseling because I didn’t understand what was being said,” she says. Culture, rather than language, was the barrier. “They used to say that if you are not happy, just give up on the marriage rather than keep trying. … They had no idea what the consequences of giving up would be.” With her mother-in-law’s support and assistance, Kaili began online counseling with a Kathmandu-based psychologist. Ten sessions in, she says her symptoms are improving.

Politician and activist Ranju Darshana, who rose to national fame in 2017 when she contested Kathmandu mayoral elections, is one example of someone using her platform to destigmatize mental illness in Nepal. The 27-year-old speaks openly about her own struggles with depression and how much she has benefitted from psychological counseling. “My life is fantastic now,” she says. When she contested parliamentary elections in 2022, mental health was at the forefront of her electoral agenda. She hosts a mental health podcast and has also produced six YouTube shows, hosting conversations with other well-known figures, such as a former Miss Nepal International who revealed her own struggles with mental health.

Yam Kumari Kandel, GPJ Nepal

Niru Khadka speaks with students about mental health. A familiar face on Nepal’s comedy circuit, she also organizes meditation sessions and shares videos on social media to raise awareness of mental health.

Darshana would like to make more videos, she says, but not enough people are willing to talk about their mental health on camera. Since 2020, she has also spearheaded an online gathering on Zoom — “Mental Health Mondays” — where young people can vent, commiserate and share their experiences.

Niru Khadka, a well-known Nepali comedian, has been similarly vocal about her mental health‚ particularly her depressive tendencies, which emerged in the wake of the 2015 earthquake. “Through meditation,” she says, “I not only found a foundation for living but also learned the art of living.” Last year, she shared her experience of depression through poetry on TikTok; the reel received over half a million views. She also often conducts meditation sessions for students.

Such efforts have helped foment a better understanding of mental health, says psychologist Sita Lama, who works at Mankaa Kura, which provides online therapy to Nepali clients.

Prerana Dahal, a Kathmandu-based psychologist who works with young clients in Finland, Germany, Australia and the United States, says cultural and linguistic familiarity compels overseas Nepalis to seek therapists back home. “Adjustment issues, relationship issues, an inferiority complex due to not having fair skin, and financial hardship have created mental problems for Nepali youth studying abroad,” says Dahal.

Therapy in Nepal is relatively cheaper, adds Bharat Gautam, who works with Transcultural Psychosocial Organization Nepal, a mental health nongovernmental organization, which also has seen a rise in demand for counseling since the onset of the pandemic. Gautam, who sees 40 clients each month and has counseled 200 overseas Nepalis since 2020, also highlights another trend: counseling for Nepali couples where one spouse is based outside the country.

Young people who seek employment abroad often face extraordinary pressures, which can contribute to mental ill-health. Sometimes this manifests itself as paranoia and suspicion directed toward their wives back home, Gautam says, adding that he is often approached by women who are depressed because their husbands based outside of Nepal suspect them of cheating. “In such cases, we counsel both the doubting husband and the wife,” he says. Few Nepali men based abroad seek help on their own.

As awareness and demand for mental health services increases, however, health care infrastructure is straining to keep up. The government is trying to bridge the gap, says Phanindra Prasad Baral, chief of the mental health section at the Department of Health Services. “Our health workers have not been able to diagnose mental illness and bring it into our system,” he says. “So we are providing five-day training to health post paramedics, doctors and medical officers on the diagnosis and treatment of mental health services.”

Data from the Nepal Medical Council lists 244 people with a bachelor’s degree or higher in psychiatry; according to another estimate, the country has fewer than 200 psychiatrists and about 230 psychologists. Increasingly, they must cater not only to the millions of Nepalis in the country, but also to those seeking treatment from the farther corners of the world.