Although mental health issues in Nepal are becoming alarming, the government has not given high priority to their treatment.

Before her marriage, Suvarna (name changed) from Sindhupalchok had a single dream, to study, land a job and stand on her own feet. However, traditional societal and family constraints placed a barrier in front of her dream.

While studying for her Bachelor’s degree, an arranged marriage was set for her. Her dream of studying and working was confined within the four walls of her home after marriage. Her studies were cut short and she ended up becoming an ordinary homemaker. Up to this point, she had no complaints.

However, the tragedy began when domestic violence reared its head before even the first year of marriage had passed. “Even when my sister-in-law, who married after me, became a mother to a daughter, I couldn’t have children,” Suvarna recalls. “My mother-in-law would even call me a ‘barren woman’ and instigate her son to marry another woman.”

Despite his mother’s insistence, her husband did not marry a second time but his behavior toward Suvarna grew harsher by the day. Occasional physical assaults and abuse began to occur. This violence, which never made it past the threshold of her home, turned into a deep emotional knot inside her mind.

Sixty-five-year-old Sita (name changed) is another example of just how deeply these emotional knots can affect a person. Otherwise in normal health, her face suddenly became twisted. Fearing that she had suffered a stroke or a severe brain issue, her relatives panicked. To seek treatment, they knocked on the doors of renowned hospitals, neurologists, physiotherapists and medical specialists. Numerous health tests were conducted but the reports revealed no major physiological defect.

With a twisted face, Sita stopped stepping outside her house. Once all avenues for physical treatment were exhausted, the family decided to try a different approach and reached out to counselor Sudipa Dhungana for her treatment.

“Sita’s case was complex for me,” Sudipa says. “Initially, I was confused about whether to take this case or not.” However, as their conversations progressed, Sudipa decided to take on Sita’s case.

“The first few sessions were spent in general conversation,” Sudipa recalls of her counseling sessions with Sita. “It was only by the sixth session that the root cause of her ailment was uncovered.”

Thirty-five years ago, Sita’s son had drowned to death. Such an unimaginable tragedy is overwhelming for any mother. However, back then, she was not allowed the space to pour out her grief. In the name of comforting her, her family and society prevented her from weeping, repeatedly telling her ‘you shouldn’t cry’, ‘you must accept it’ and ‘you must be patient’. She was forced to suppress the volcano of grief boiling inside her own chest.

“She was never allowed to weep in grief over her son’s death. For a long time, the pain of loss, agony and suppressed tears remained suffocatingly bottled up in a corner of her mind,” says Sudipa. “In psychology, there is an established principle, the emotions, fears and severe mental trauma that we suppress inside us never die. When they find no outlet to escape, they begin to manifest as physical symptoms. In medical terminology, this is known as ‘somatization’ or ‘conversion disorder’.”

Sudipa determined that this unexpressed grief ultimately tied itself into knots within the nerves and muscles of Sita’s face, manifesting as facial twisting. She then decided to pursue emotional rather than physical treatment for Sita, allowing her to freely shed the tears she had held back for so long. The weeping that had been restrained 35 years ago when she lost her son flowed like a flood during counseling. As she engaged in mantra chanting, meditation and specialized expressive therapies, the knot of grief embedded deep within Sita’s mind gradually began to untangle.

As her emotional pain subsided, the twist in Sita’s face also gradually disappeared. The condition that strong medications and physical treatments could not cure was fully resolved simply by lightening her mental burden and pouring out her suppressed tears.

“This experience with Sita is not merely an isolated case. It is a profound lesson for society as a whole,” says counselor Sudipa. “Crying when in pain, grieving and expressing one’s emotions are not signs of weakness. They are natural processes for staying healthy.”

Suvarna and Sita, both cured after receiving treatment, are not just two examples of people who faced mental health issues for different reasons. They are a mirror reflecting the escalating mental health crisis in Nepal. Having received timely treatment, they are now living happily with the support of their families. However, not everyone suffering from mental health issues receives care like theirs. For lack of treatment, many have even resorted to taking their own lives.

According to the latest five-fiscal-year data from the Nepal Police, 35,048 people in Nepal have lost their lives to suicide. This statistic reveals that, on average, 7,000 individuals commit suicide every year. Yet, amidst this alarming reality, flipping through the Red Book of the Ministry of Health and Food Safety reveals no separate budget line for mental health.

For the current fiscal year 2026/27, the budget for the Ministry of Health and Food Safety, including projects and programs implemented by provincial and local levels, stands at a little over Rs. 96.37 billion. This represents just 4.54% of the country’s total budget.

Mental health-related programs and funding allocations are subsumed under epidemic disease control, non-communicable disease (NCD) control, health promotion and general hospital budget heads. For instance, the Mental Hospital in Lagankhel has been allocated Rs. 100.5 million for recurrent expenditure.

Dr. Samir Kumar Adhikari, spokesperson for the Ministry of Health and Food Safety, insists that the government has not neglected mental health. “We have categorized non-communicable diseases and mental health under the same umbrella,” he says. “The situation regarding non-communicable diseases is critical, and the status of mental health is equally alarming.”

Children, despite their young age, are also falling victim to mental health issues. According to data from the Nepal Police, a total of 4,187 minors under the age of 18, comprising 1,328 boys and 2,859 girls, have committed suicide over the past five years. This clearly highlights the growing mental stress and lack of psychosocial support among school-aged adolescents. Police investigations indicate that mental illness and psychosocial distress are the primary drivers behind these suicides.

Sudipa, who has been providing counseling since 2020 with a focus on adolescent challenges, views Nepal’s current mental health landscape as deeply challenging.

In the Red Book, allocated funds cover programs such as the procurement of medicines for non-communicable diseases (NCDs) and mental health, capacity building and monitoring for health workers in three districts where the NCD-related HCCI program is implemented, PEN training for NCDs, mhGAP 2A and 2B training for mental health, and district-level mental health review and planning initiatives.

However, these measures fall far short. As demand for mental health services continues to surge nationwide, Sudipa points out that the sector remains policy-wise neglected. “Nepal lacks proper policies, clear guidelines and adequate budget allocation,” she laments.

On the other hand, ministry spokesperson Dr. Samir Kumar maintains that mental health is given significant priority, asserting that funds are specifically earmarked under designated mental health budget heads within local-level programs.

Severe shortage of expert workforce

Noting that mental health issues have increased by nearly 100% worldwide over the past two decades, psychiatrist Dr. Rishabh Koirala states, “Fortunately, compared to the past, societal awareness and vigilance regarding mental health have grown. People are shedding their shame and hesitation to visit hospitals for treatment.”

However, Dr. Rishabh acknowledges that the path to reaching a hospital for someone suffering from mental illness is still not as smooth as it is for other ailments. According to him, symptoms of mental illness extend beyond sadness and loneliness. They also include palpitations, headaches and insomnia. When such symptoms appear, people initially seek care from doctors in other medical disciplines.

Explaining that patients in rural areas often wander to faith healers, traditional spiritual practitioners or astrologers first and only consult a psychiatrist after the condition turns complex, he adds, “When other medical professionals fail to identify the symptoms early on and refer patients to psychiatrists, individuals are forced to wander in distress for extended periods.”

According to Dr. Rishabh, there are currently around 250 practicing psychiatrists in Nepal. He sees only 25 patients daily at his private clinic. However, while working at government or charitable institutions, Koirala recalls treating up to 35 patients in just three hours.

The primary challenge facing mental health services in Nepal is the severe shortage of specialized human resources. Dr. Rishabh shares that although around 40 new psychiatrists graduate annually, most migrate abroad because they do not receive financial or intellectual returns proportional to their investment and hard work. “Out of the five people who studied alongside me, I am the only one remaining in Nepal,” he says, offering his own academic cohort as an example. “This has a direct bearing on the quality of care provided.”

Treating mental illness requires sufficient time to understand the patient’s emotions, provide counseling and offer guidance on lifestyle modifications, something Dr. Rishabh argues is virtually impossible given the current doctor-to-patient ratio. Unless the brain drain of psychiatrists is halted, Dr. Rishabh contends, it will remain impossible to achieve an adequate number of psychiatrists in Nepal even over the next 20 years.

Proper counseling can prevent mental health problems. However, surprisingly, there are no established standards for becoming a counselor. “There are those of us who hold Master’s degrees, yet local levels are appointing individuals who have completed just 10 to 20 days of training as counselors, which is playing with patients’ health,” Sudipa shares.

She explains that while clinical psychologists are registered with the Nepal Medical Council, there is no licensing system in place for general counselors.

Dr. Samir, spokesperson for the ministry, states that allocating a budget, opening hospitals and assembling specialists alone will not provide a permanent solution to mental health issues. “No matter how many psychiatric hospitals you open, how many mental health specialists you gather, or how much medication you arrange, that alone will not solve this problem,” he says. “Budget alone cannot accomplish everything, nor does a lack of budget mean nothing can be done.”

He believes that improving the educational environment, ensuring employment, guaranteeing job security and enhancing the social atmosphere will reduce mental health issues. “Moving beyond hospitals and treatment to emphasize prevention and health promotion is the primary necessity, and we are working on that,” says spokesperson Dr. Samir.

Although Sudipa alleges that local governments are appointing counselors based on 20-day training programs, local levels are unwilling to accept this claim. Ran Bahadur Pandey, a public health inspector at Belaka Municipality in Udayapur, states that local health workers themselves undergo training and screen individuals with mental health conditions. “A while ago, while working at Triyuga Municipality, I had the opportunity to receive training on mental health,” says Pandey, who has since been transferred to Belaka. “That training proved immensely helpful in identifying patients’ problems.”

Public health inspector Ran Bahadur informed that mental health treatment is provided at the municipal hospital in Belaka Municipality, adding that specialists are also brought in to offer counseling and treatment for mental health issues. “We counsel those cases we can handle ourselves and for complex problems beyond our capacity, we refer them to higher-level hospitals,” he said.

Although mild mental health issues are treated and counseled at the local level, patients with complex conditions are treated at the Mental Hospital in Lagankhel, Lalitpur. However, conditions at these facilities are far from encouraging. Multiple patients are accommodated in a single room here.

Dr. Ishwari Khanal, Information Officer and Senior Consultant Psychiatrist at the Mental Hospital, Lagankhel, acknowledges that the hospital environment appears unkempt due to its aging physical infrastructure. “Because it is an old building, there are even water leakage issues in some areas,” he says. “The 50-bed hospital is constantly at full capacity. While it is true that multiple patients share a single room, it is not foul-smelling.”

The discussion on mental health began late

According to Dr. Basudev Karki, Senior Psychiatrist at the Mental Hospital, Lagankhel, the number of service seekers reaching out for mental health care has risen in recent times. Drawing from nearly 12 to 13 years of extensive experience in the mental health field, he notes that mental health issues have not suddenly emerged overnight.

“This problem existed yesterday, just as it exists today. The only difference is that people previously did not come forward openly, whereas now the number of individuals actively seeking care has increased,” says Dr. Basudev.

Flipping through historical documents reveals that mental health challenges in Nepal have been severe for decades. The National Health Policy of 1997 itself noted that out of the total patients arriving at health institutions, 25% suffered from some form of mental health issue.

Recent national surveys reveal that the situation is growing even more alarming. The First National Mental Health Survey of 2020 indicated that 4.3% of the total population requires immediate mental health treatment and counseling services.

According to the Nepal Demographic and Health Survey 2022, 22% of women and 11% of men in Nepal suffer from issues such as anxiety, worry and depression.

Compared to the past, however, some positive developments have emerged in human resources and policy frameworks. According to Dr. Basudev, while Nepal once produced only two to three psychiatrists per year, around 40 to 50 specialists are now graduating annually, enabling specialized services to reach smaller cities and district levels. Furthermore, Dr. Basudev notes that over 6,000 health workers have received certified training to extend primary mental health care down to the local levels.

In the Nepali context, primary care health professionals, such as Health Assistants, Auxiliary Health Workers (AHWs) and Medical Officers, are provided basic mental health training under the World Health Organization’s Mental Health Gap Action Program (mhGAP). Dr. Rishabh emphasizes that this model represents the most viable solution for Nepal. However, he adds that due to a lack of regular monitoring, supervision and refresher training, the initiative has failed to yield the intended results.

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Noting that debates and policy initiatives surrounding suicide and mental health began globally right after the Second World War, nearly 70 to 80 years ago, Dr. Basudev says, “In Nepal, organized discourse on mental health and suicide started exceedingly late.”

He points out that misinformed beliefs persist among the public, such as the notion that once a person starts taking psychiatric medication, they must remain on it for life or that it impairs brain function. “Modern scientific medications do not weaken a person. On the contrary, they help individuals return to an active and healthy life,” he explains.

The Public Health Services Act of 2018 has incorporated mental health into ‘basic health services’. Furthermore, the ‘Standard Treatment Protocol’, implemented since 2021, ensures that primary mental health medications and care can be managed directly from basic health posts.

Support from loved ones offers a second life

Sita and Suvarna themselves stand as living examples that with the support of loved ones and timely, proper treatment, even individuals whose mental health problems have reached a critical state can find a new lease on life. While Sita recovered once her family found the right place seeking treatment, Suvarna had to endure immense hardship before getting well.

Neglected by her family for being unable to conceive, Suvarna’s lap was finally filled in 2015 when she gave birth to a son. “While others were suffering from the earthquake, my sister was filled with the joy of having a child,” recalls Suvarna’s younger sister. Suvarna had hoped her family’s affection would grow after having a child, but the hearts of her relatives, who had abused her on the pretext of childlessness, did not soften even after her son was born. The cycle of violence continued unabated.

Exhausted by the abuse, she decided to live separately, and her husband also grew distant. Even after moving out, the harassment from her mother-in-law and sister-in-law did not cease. Carrying her young child on her shoulder, Suvarna would fetch firewood and fodder, storing grass in her shed for her cattle. Yet, her mother-in-law and sister-in-law would steal that grass to feed their own livestock. Unable to stay in the village any longer, Suvarna moved down to the local town center carrying her infant son. She opened a small shop and began earning a living through her own hard work.

Just as her life was finding its rhythm, the COVID-19 pandemic threw up another obstacle. Due to six to seven months of lockdown, her shop remained closed, bringing business to a standstill. The compulsion to keep paying rent made it impossible for her to survive in town. Ultimately, packing up her store’s goods, she returned to the village once again.

Upon returning home, yet another label was slapped on her, that of a ‘failed woman’.

Enduring years of relentless violence, the burden of failure and constant humiliation, Suvarna’s spirit was eventually shattered. Her mind grew ill. “At that time, I was terrified of people. Whenever anyone approached, I felt as though they were coming to beat me up,” Suvarna recalls, looking back at those days. “Even if I saw people talking privately, I developed the delusion that they were talking ill about me.”

Instead of understanding her illness, her husband turned to faith healers. Suvarna’s mental condition deteriorated further. However, Suvarna’s younger sister recognized that her sister’s state was due to a mental health issue. She made numerous attempts to take her sister to the hospital. “At that time, I tried hard to convince my sister that she would get better if she went to the hospital, but I couldn’t get her ready,” Suvarna’s sister shares. “When nothing worked to persuade her, I went to a psychiatrist myself and tearfully explained all of my sister’s symptoms in detail.”

Understanding the situation, the doctor prescribed medication. The sister began secretly giving the medication to Suvarna. As she started taking the medicine, Suvarna’s health began to improve and she gradually returned to normal.

A few months later, Suvarna went to see the doctor herself with her sister. With regular counseling and medication, her mind felt significantly lighter and her mental illness continued to heal. However, due to side effects of the medication, she began to gain weight.

Her family eventually discovered that Suvarna was taking psychiatric medication. Instead of offering support, they began viewing her with even greater disdain, labeling her a ‘mental patient’. Seeing her gain weight from the medication, her husband pressured her to stop taking it. Feeling that she had already recovered, Suvarna abruptly stopped taking the medicine without consulting the doctor.

A year after stopping the medication, the illness returned to grip her once again. She reverted to being fearful, easily startled and suspicious. Once more, her sister stepped in as her support system, counseling and guiding her back to the hospital. Compared to the first time, getting Suvarna to the hospital was much easier.

With the resumption of doctor-led counseling and regular medication, Suvarna’s health improved rapidly. This recovery was further bolstered by a change in her husband’s perspective.

Her husband, who had initially clung to faith healers and resentment, came to accept that mental illness is just like any physical ailment and can be fully cured with timely, proper care, offering his full support. “My brother-in-law, who committed violence out of ignorance in the past, now takes my sister to the hospital himself,” Suvarna’s sister shares happily with a smile. “These days, he listens to the doctor’s advice and treats my sister accordingly. She has fully returned to her former self.”

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Another individual who received timely treatment after her family understood her mental health challenges is 21-year-old Sabitra (name changed) from Dadeldhura. Having suffered a heartbreak, when she shared her distress with friends, they brushed it off dismissively as ‘just a breakup’. Burdened by such comments, her condition was recognized by her younger brother, who stood by her side to ensure she received medical care. She is now on the road to recovery.

Sustained by her brother’s affectionate care and regular prescribed medication, Sabitra’s brother also explained from Kathmandu to their parents back home that depression is a genuine illness. Understanding their daughter’s condition, her parents in the village began providing her with the love and encouragement she needed.

“It has been a year since I started taking mental health medication,” Sabitra says. “At first, I was skeptical even about the medicine but I realized one must trust the doctor and the treatment.” Today, Sabitra is much more composed and in control. Overcoming depression, she has returned to a normal life.

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Anyone experiencing mental stress, depression, or suicidal thoughts can contact the following toll-free helplines for immediate support:

National Mental Health and Suicide Prevention Helpline (Government of Nepal): 1166 (Toll-Free – 24/7)

Mental Hospital, Lagankhel, Mental Health Helpline: 9813476123 / 16600121600

TPO Nepal Psychosocial Counseling: 16600102005 (Toll-Free)

CMC Nepal Helpline: 16600116116

Nepal Police Emergency Service: 100

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