COVID-19 and Suicidal Rates in Nepal: An Urgent Need for Mental Health Interventions

Understanding the Major Causes/Factors

Social distancing induces a lot of anxiety and depression among many persons in Nepal. During the lockdown period, the restrictive measures had tremendous effects on socio-economic life such as; loss of employment, financial hardship, social functions and gathering. Similarly, the lockdown has placed enormous pressure among students awaiting exams and results. Their level of anxiety and stress towards study was raised due to the nation-wide lockdown. Further, persons with existing mental illness like depression and other illnesses, the person going through mental health treatments and older adults were affected most. Meanwhile, the older population with chronic diseases were mostly feared of their low immunity to fight against COVID-19. The vulnerable groups have suicidal ideation and thoughts as they are self-judgmental [10]. The GoN imposed isolation and quarantine which has imposed disrupts normal social lives of the individuals and created psychological fear and anxiety for a considerable period.

The overwhelming number of suicides during lockdown may be attributed to loneliness, lack of freedom, fear of infection, alcohol withdrawal, depleted social safety nets, loan defaults and deprivation of work/job opportunities. However, the complex socio-cultural, political, economic dimensions and their interactions need to be analyzed to be able to understand the various factors that triggered the high risk of suicides in Nepal during the lockdown. Additionally, various other factors such as; gender-based violence, domestic abuses, inequalities, family issues in rigid patriarchal family structure, poverty and deprivation from basic needs, limited access to health care services might have increased the risk of suicides during the period. Currently, the health system is entirely engaged in the prevention and control of COVID-19. As a result, the mental health services delivery system has been hampered and overlooked which ultimately created a barrier to access mental health services throughout the country [11, 12].

Preventing Suicides: Promoting Health

Mental health is still a neglected public health concern in Nepal. In Nepalese society, people with mental health disorders are considered as threats which ultimately lead to refutation for seeking treatment [7]. Social discrimination and stigma associated with it also act as barriers to seek help and treatment. Furthermore, there are cultural dogmas, myths, and religious beliefs around causes and consequences of mental disorders that further discourage people to seek service from the health facilities. In Nepal, most of the time people with mental disorders and their families seek help from traditional healers that does further deteriorate the mental health status.

Mass unemployment is another predictor of suicide. The GoN should immediately make a response plan for those who have recently become jobless. Young people face enormous psychological effects and are anxious about their career prospect because of uncertainties and unable to complete their academic curricula. In such circumstances, educational institutions must plan the best alternative solutions to deliver their curricula. The appropriate interventions should be adopted at local levels to minimize domestic and gender-based violence. The easy access to lethal means has been observed as another risk factor for suicide. During this pandemic, the restriction in the use and sale of highly toxic pesticides and illicit drugs may help reduce suicidal cases.

Since the suicides are preventable, the government efforts to reduce its burden in Nepal are not sufficient. There is a need for comprehensive mental health program at the community level. The government must put effort in creating awareness on mental health and suicide in the community. The suicide prevention and awareness related public service announcement (PSA) message can be aired from radio, telecom. Similarly, looking at the current context the helpline number should be distributed widely to promote health- seeking behaviour for mental health. Every individuals and family should start talking about mental disorders and their consequences. The sense of we-feeling should be promoted in the community so that people get in touch with each other. The principle of social distancing should be advocated as physical distancing in the community level so that there remain social harmony and solidarity among people [13].

The individuals suspected with a history of suicidal thoughts, panic and stress disorder, and low self-esteem should be addressed with appropriate psycho-social interventions. The tele-mental health programs have been initiated in the capital city of Nepal through the support of the Ministry of Health and Population (MoHP) and other relevant stakeholders. However, these initiatives have not reached to the targeted vulnerable population in the rural and remote Nepal. There is an urgent need of 24x7 suicide prevention and response services for emotional, mental and behavioral support in all provinces and local levels of Nepal. The studies from other countries emphasize on health system strengthening for mental health promotion [14]. The adequately and appropriately trained health human resources may need to be deployed to the peripheral areas, and the capacity of healthcare human resources to provide mental health and psychosocial support should be enhanced [2].