Suman is a journalist in his late 30s. He holds a decent job and is often described as sociable. Ram is an engineer who teaches in a reputed college in the capital. He has a steady income and from his appearance, you wouldn´t think there was anything wrong with him. Though they come from diverse fields and different family backgrounds, there is something in common between the two. Both have been seeing a psychiatrist for the last few years. Neither dares speak up. They say they fear going to their psychiatrists: What if an acquaintance spotted them at a shrink´s? This reluctance to admit to mental problems is not limited to Suman and Ram. And in a country where up to a quarter of the population is estimated to be suffering from some form of mental illness, this reluctance to come out in the open can have alarming consequences.
The biggest problem for those living with various mental illnesses right now is their restricted access to those who can help them cope with their problems. As it is, the number of trained manpower in the field is abysmally low: a psychiatrist for a million Nepalis. The situation in the outskirts is even more dismal as the huge majority of trained manpower in the field, most importantly psychiatrists and clinical psychologists, are concentrated in the capital. Thus, it wouldn´t be a stretch to say that the state cares little about the fate of up to five million silently-suffering Nepalis. Just consider the fact that in order to tackle a problem of such magnitude, the government sets aside under a percent of health budget for mental health.
The hush-hush culture that characterizes the field of mental health in Nepal is taking a huge toll on sufferers, their families and the wider society. It is hard to quantify the loss of productive workforce and the effect of poor mental health on the country´s other socio-economic indicators. But it is undoubtedly large. Only a culture of openness can reduce the stigma attached to mental illness and those suffering from it. It will also be important to tailor programs for the concentrated clusters where the incidence of mental health illness is high: for instance, a 2009 government study found that suicide was number one cause of death among women aged 15-50. The limited studies that have been carried out indicate that the incidents of Post Traumatic Stress Disorder (PTSD) are significantly high among those directly affected by conflict. But till date, there appears to be no coherent strategy to take on the scourge of mental health head on.
For there is a clear lack of priority for mental health in government policymaking. This is unlikely to change unless policymakers realize that not acting on this front could have potentially devastating consequences for the Nepali society. So long as Sumans and Rams cannot consult mental-health professionals without having to worry about all the unwanted repercussions of their action, there is unlikely to be a marked improvement in the condition of the millions of Nepalis living with mental illness.
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