At around ten on Sunday morning, a man rang up the suicide prevention hotline of Nepal Mental Hospital.

The man, who said he was 26 and a student pursuing master’s degree, told the health worker who took the call that he was at Tribhuvan University’s gate and was feeling like hanging himself.

“He asked us for help and wanted us to save him as he was having strong suicidal thoughts,” Sushila Jirel, the health worker who took the call, told the Post. “We called the nearby police station and sought help to rescue him. We counselled him, prescribed some medicines and gave him another date for follow-up.”

The man could not do any harm to himself because of the timely intervention.

Suicide affects people of all backgrounds and almost all ages. But not many people can communicate their feelings, like the 26-year-old man did on Sunday. Doctors say there could be multiple reasons that invoke suicidal thoughts among people.

“Very few people having suicidal thoughts or other mental health problems contact health workers or dial the hotline numbers,” said Dr Basudev Karki, a consultant psychiatric at Nepal Mental Hospital. “Failure to provide proper counselling could be tragic. Many don’t even talk about their feelings with family members.”

Sucide is a reaction to stressful life situations and people taking their own lives is doubly tragic because it can be prevented.

Globally, telephone crisis helplines have become integral parts of suicide prevention strategies. Along with being accessible, crisis helplines provide timely and anonymous advice to callers and are effective in deterring suicidal thoughts.

Doctors say the crisis helplines are therapy-based, where the doctor offers empathic listening to individuals who are having suicidal thoughts.

There are suicide prevention helpline numbers and mental health counselling services but not many having thoughts of taking own life contact either because they hesitate or are not aware of such assistance, according to experts.

According to Nepal Mental Hospital, health workers at the hotline receive around 10 phone calls every day.

Data provided by Nepal Police suggest 6,792 people died by suicide (over 18 people on average each day) in the fiscal year 2021-022. The number was lower than the previous fiscal year 2020-2021 when 7,117 (over 19 each day) took their own lives.

The second wave of the coronavirus pandemic hit the country in 2021, killing over 8,000 people and infecting hundreds of thousands. Due to prolonged lockdown and restrictions, hundreds of people lost their relatives and thousands lost their jobs, incurred losses in business and faced other problems. Some people struggled to clear debt or instalments of financial institutions.

An overall increase of the economic burden leads to a rise in anxiety, stress and depression which could result in suicide, doctors say.

“In the last fiscal year, number of suicide incidents declined slightly but still over 18 people have been taking their own lives every day,” said Karki. “The number is not small and most of those suicides are preventable.”

Due to stigma towards mental health patients, and lack of awareness, people in Nepal generally do not like to talk about the mental health problems, experts say. They say that people do not attempt suicide due to one single reason. Whatever the cause, suicide and suicide attempts have a ripple effect—impacting families, friends, colleagues, communities and societies.

According to clinical psychiatrists, even severely depressed people can change their mind if they get proper counselling on time. They say that the impulse to kill oneself does not last long and many people try to get help before choosing to end life.

“Chances of suicide decline when those sufering from mental health problems share their feelings to family members, friends and experts,” said Jamuna Sangraula, a clinical psychologist. “People look fine from outside but no one knows what is happening inside.”

Doctors say incidents of suicide can be prevented by making suicide prevention hotline effective, ensuring easy access to counselling services, detecting mental health problems on time and providing life skills to the people.

“For that, all agencies concerned should team up, come up with a programme and make sincere efforts to implement it,” said Sangraula.

Officials at the Ministry of Health and Population concede that even if the rate of everyday suicide has declined slightly, Nepal still has a high suicide rate.

A study carried out by the Nepal Health Research Council before the start of the pandemic shows that more than 10 percent of the adult population had mental issues in their lifetime and 4.3 percent were undergoing some sort of mental crisis.

The prevalence of suicidality including current suicidal thoughts, lifetime suicidal attempts and future likelihood of suicidal thoughts was found to be prevalent in the 7.2 percent population.

“Depite our efforts we have not been able to reduce the suicide rate significantly,” said Dr Phanindra Prasad Baral, chief of the Non-communicable Disease and Mental Health Section at the Epidemiology and Disease Control Division.

Experts say on most of the occasions, people having suicidal thoughts may not reach out to the helpline numbers, hence others should come forward if an adult behaves irrationally and appears to be delusional.

Nonetheless, experts add, if in Sunday’s case police intervention may have saved the man, it may also deepen the mental health crisis as security personnel involvement can be traumatic for the patient.

The World Health Organization says 800,000 people die by suicide every year across the globe and 16 million people attempt to kill self.

The UN body says one in four people in the world are affected by mental or neurological disorders at some point in their lives and around 450 million people currently suffer from such conditions, placing mental disorders among the leading causes of ill health and disability worldwide.

“Suicide and suicide attempts have a ripple effect that impacts on families, friends, colleagues, communities and societies,” states the UN health agency. “Suicides are preventable and much can be done to prevent it at individual, community and national levels.”

If you or someone you know is considering suicide, please contact the following helplines.

Nepal Mental Hospital suicide hotline: 1166

Tribhuvan University Teaching Hospital suicide prenvention hotline: 9840021600:

Patan Hospital crisis helpline for suicide prevention: 9813476123

The Transcultural Psychosocial Organisation: 16600102005