The Kathmandu Metropolitan City has imparted mental health screening training to doctors and paramedics serving at urban health promotion centres.

Officials at the Health Department in the metropolis hope that the move will help hundreds of patients with mental health issues in the city to get timely treatment.

“Getting free treatment for mental health problems comes under the right to get free basic health care services,” said Sajina Maharjan, acting head of the department. “Mental health problem screening training to doctors and paramedics will help in the timely diagnosis of the problems and start of early treatment.”

At least 32 doctors serving at the urban health promotion centres under the city office and dozens of paramedics participated in five-day screening training. The metropolis has upgraded its urban health clinics to urban health promotion centres and started providing services through medical doctors.

“Due to the lack of doctors at our urban health promotion centres, patients suffering from mental health problems have been deprived of timely treatment,” said Nali Bajracharya, a senior public health officer at the department. “Now patients having mental health issues and seeking care at our health centres will also get mental health treatment.”

Though neither the federal government agency nor the city office has data on the number of people suffering from mental health problems in the metropolis, doctors estimated that a lot of people could be suffering from various forms of mental health problems—anxiety, depression and others.

Officials say that they are also planning to provide free medication to patients with mental health problems.

Health workers say that many city dwellers, despite having mental health problems, do not seek treatment and instead turn to drugs and substances to cope. Due to the entrenched social stigma, fear of discrimination and other factors, many patients in Nepal do not talk about their mental health issues.

The general tendency among people to conceal mental health issues due to the stigma attached to it has also forced patients to opt for substance abuse, doctors say.

They say that while drugs and alcohol may provide temporary relief from stress, they are not a solution and can adversely affect mental health and well-being in the long run.

“Treatment in the initial stage of mental illness helps patients achieve better results. For that, early diagnosis is crucial,” said Dr Pomawati Thapa, chief of the Non-communicable Disease and Mental Health Section at the Epidemiology and Disease Control Division. “Other local units should also follow the initiative to provide mental health screening training to health workers, including doctors.”

Nepal is among the countries with highest rates of suicide, which is an extreme manifestation of a mental health problem.

According to Nepal Police data, 6,993 people took their own lives in the fiscal year 2022-2023. This accounts for more than 19 deaths on average daily. Fifty-six percent of those who die by suicide are men.

Doctors say that people do not attempt suicide for a single reason, but due to a complex situation arising from multiple problems.

An increasing number of people are struggling with mental problems owing to the rising cost of living and the struggle to manage even their most basic needs, such as food, housing, healthcare and jobs, experts say.

Whatever the cause, suicides and suicide attempts have a ripple effect, impacting families, friends, colleagues, communities and societies, doctors say.

A study carried out by the Nepal Health Research Council in the past shows that about 13 percent of Nepalis suffer from some form of mental disorder. This means around one in eight Nepalis has mental health issues. Moreover, the country simply does not have enough experts to treat mental health problems, it added.

Studies show the magnitude of suffering, the burden and costs for individuals, families and societies arising from mental health disorders are alarming in Nepal.

“No doubt, mental health problems have been emerging as a major cause of morbidity and mortality in our country,” said Thapa. “All local governments must take initiative to address the problems. Only the federal government agencies cannot do much.”

The World Health Organisation says that one in four people in the world has been 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.