For most of Nepal’s history, mental health was pushed to the quiet corner. People experienced worry, sadness, fear and confusion, but there were few words to describe these emotions. What we now recognise as anxiety, depression, trauma or psychosis was often spoken of simply as mann ko samasya (an ailment of the heart or mind). Emotional suffering was interpreted through spiritual imbalance, karma or misfortune rather than as a health condition that could be understood and treated. This silence shaped the lives of generations.

Long before psychology entered our classrooms and clinics, communities turned to traditional healers. Families sought help from dhami and jhankris and pinned their hopes on rituals and prayers when a loved one behaved differently or seemed overwhelmed. These practices offered comfort, but they also reinforced a culture of silence. Speaking openly about mental distress carried the risk of judgment or shame. Many people learned to endure their pain quietly to protect family honour, dignity and social acceptance.

A gradual shift began in the 1960s. In 1961, Bir Hospital opened Nepal’s first psychiatric outpatient clinic, marking the country’s first formal recognition of mental illness within its health system. A dedicated mental hospital was established in 1984 in Lagankhel. It remains the only hospital of its kind in the country with just 50 beds. These developments were important milestones, yet the stigma remained deeply rooted. Individuals feared being labelled pagal (lunatic), a word that could shadow them for life. Concerns about marriage, employment and social acceptance continued to shape how people viewed mental health.

In the decades that followed, new pressures made the burden heavier. The years of conflict during the Maoist insurgency left countless psychological wounds. Mass migration separated families and exposed workers to trauma, loneliness and exploitation. Natural disasters repeatedly struck the country and left lasting emotional scars. As these stresses accumulated, symptoms of depression, anxiety and chronic stress quietly spread across households. Yet Nepal lacked the foundation to respond. A little more than 10 years ago, the country had fewer than 40 psychiatrists. According to the Ministry of Health and Population’s mental health workforce data published in 2020, there are only about 200 psychiatrists for more than 30 million people, with the most concentrated in Kathmandu. Many rural areas still do not have a single counsellor.

The human cost is visible in Nepal’s rising suicide rates. Suicide has become one of the leading causes of death among Nepali women of reproductive age. A pilot study by the National Mental Health Survey found that suicide accounts for 16 percent of deaths among women in the age group and that 21 percent of suicides occur below the age of 18. Yet conversations about suicide remain rare. Many families do not report cases because they fear stigma or legal complications. This silence makes prevention more challenging.

Research shows that stigma is one of the strongest barriers to mental health care in Nepal. A scoping review published in the journal Epidemiology and Psychiatric Sciences in 2022 found that stigma is closely tied to values that matter deeply to Nepali families, such as community acceptance, family honour, marriage prospects and perceived productivity. When these values feel threatened, families hesitate to seek help. Parents worry their daughters will lose marriage opportunities. Workers fear losing their jobs. Many individuals avoid care simply because they do not want to be recognised. These social pressures create a cycle of suffering that stays hidden inside homes.

Even within the health system, the gaps are significant. A study published in Academic Psychiatry in 2016, conducted across rural district hospitals in Nepal, found that most primary care providers had received between zero and 15 days of mental health training during their entire education. Many had never received any continuing medical education in mental health. As a result, providers often felt unprepared, uncertain or anxious when treating patients with emotional or behavioural problems. Without proper training or supervision, outdated practices continued to be passed down. This training gap remains one of Nepal’s most urgent needs.

Nepal drafted its first mental health policy in 1996, but implementation has been slow. Funding is limited. Mental health receives less than 1 percent of the national health budget. Many health facilities lack private counselling rooms. Essential psychiatric medications such as amitriptyline or risperidone are not easily available outside major towns. Referral systems are uneven and often weak where they are needed most.

Despite these obstacles, a quiet and promising shift has been taking place in recent times. Telepsychiatry is bringing support to communities that once felt unreachable. Young people are beginning to speak more openly about stress, identity and emotional wellbeing. Schools and municipalities are slowly welcoming counsellors and psychosocial workers. Mental health is gradually becoming part of the national conversation on chronic diseases and public health. The Nepal Health Research Council has reported an increase in non-communicable diseases, including mental disorders, reflecting a broader recognition that mental health is an essential part of overall well-being.

To build on this momentum, Nepal must take several essential steps. Mental health services need to be integrated into primary care, so that support is available in every local unit. The country needs more trained professionals as well as a stronger network of psychosocial workers and counsellors. Essential medications must be reliably stocked. Policies must be backed by resources, timelines and accountability. Most importantly, stigma must be confronted through open dialogue, education and community involvement.

Nepal’s mental health journey has been shaped by silence, struggle and slow progress, but it is also a story of resilience. Emotional suffering is not a personal weakness. It is part of being human and deserves compassion and care. If Nepal continues to invest in accessible services, awareness and community-based support, the next chapter of our mental health story can be one of dignity and healing rather than silence.