Dr Nabin Lekhak was going about his day at Patan Hospital’s outpatient psychiatry department when he got a phone call. The person on the other end told Lekhak that he didn’t want to live anymore and was about to kill himself. But Lekhak had been trained to handle such situations and he knew that he needed to keep the person talking.

“He told me that he was frustrated since he wasn’t living the life that he had expected,” Lekhak recalled in a conversation with the Post. “I realised that he was severely depressed so I tried to explore options that would orient the conversation towards aborting his suicidal thoughts.”

After talking for 20 minutes, the caller agreed to seek medical treatment. The immediate crisis has been averted.

Lekhak, along with three other resident doctors and five consultant psychiatrists, make up the team that answers a crisis helpline for suicide prevention operated by Patan Hospital. In addition to their regular duties, these doctors are responsible for providing help to distraught callers who reach out on the suicide helpline.

Patan Hospital, as part of its suicide prevention strategy, has been operating a 24-hour crisis helpline for suicidal individuals since 2016. The number for the helpline, which is answered by the department of psychiatry, is 9813476123.

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. There is evidence from around the world that crisis helplines are effective in reducing thoughts of suicide and self harm among callers, but there are also concerns about their efficacy.

According to doctors, the crisis helpline is therapy-based, where the doctor offers empathic listening to individuals who are having suicidal thoughts.

According to Dr Pawan Sharma, a consultant psychiatric at Patan Hospital, the primary objective of a crisis helpline is to convince the caller to visit the hospital to seek medical help and to get emotional support from friends and family.

“Many people who are suicidal don’t seek help from health services or ask for support from family and friends due to the stigma surrounding suicide and mental health problems,” said Sharma. “The confidential service provided by crisis helplines can give them the confidence to share their thoughts and seek help.”

Since Patan Hospital provides only therapy-based interventions, counsellors believe that their objective has been accomplished if the caller decides to halt their suicide attempt.

“Once the caller puts down the phone, we don’t know what decision they have made at the end,” said Sharma. “However, we would like to believe that they went to the nearby hospital to seek help.” The hospital conducts no follow-ups of callers.

Suicide is a major public health problem worldwide, with some research suggesting that the problem is more severe in Asian countries. In Nepal, data on suicides is only recorded by the police. According to a review of the Nepal Police’s five-year data, over 5,000 Nepalis kill themselves every year. But medical personnel and researchers believe that the number could be significantly higher.

Despite suicide being one of the leading causes of death among Nepalis, doctors say that they barely get one or two calls a month. Sharma believes that this has to do with a lack of awareness among people regarding the helpline and the stigma surrounding mental illness.

But there are differences among mental health professionals regarding the efficacy of helplines like the one that Patan Hospital operates. The psychologists at Transcultural Psychosocial Organization (TPO), which provides mental health and psychosocial support, acknowledge the importance of therapy-based crisis helplines but they believe that emotional support alone isn’t enough while dealing with acutely suicidal individuals.

“For suicide prevention, telephone helplines should be supported by a team of professionals offering diagnostic and treatment facilities while keeping the police force alert at the same time,” said Jamuna Maharjan, clinical manager at the TPO.

Maharjan related one incident where a person had called them saying that he was going to kill himself. Their counsellors had to persuade the person to provide his location while informing the police to track him. Eventually, the police rescued him from the middle of the forest, said Maharjan.

Without the resources and proper mechanisms, physical intervention like this can be a tough ask, which is why TPO’s helpline—16600102005—focuses on a broader spectrum of psychosocial problems rather than just suicide.

“Our helpline is not a suicide hotline because we don’t have the manpower and facilities to help rescue those who are on the verge of committing suicide,” said Parbati Shrestha, programme coordinator at the TPO. “However, anyone suffering from depression or any other mental health problems can seek help. We provide a psychiatric follow up for diagnosis, suicide risk assessment and treatment.”

The TPO started helpline services after the earthquakes in 2015. According to 2018 records, they received 232 calls from 114 individuals, of whom 64 were male and 50 female.

Mental health professionals say that the support from the government is crucial when it comes to dealing with mental health and suicide prevention.

“Most civil society programmes are projects, which means we have a limited budget to run hotlines and intervention programmes,” said Shrestha.

Nepal currently does not have a national strategy on suicide prevention. As a result, no concerted efforts have been made to address this growing mental health issue at the national level. A 2017 paper published in the Asian Journal of Psychiatry states that programmes aimed at suicide prevention in Nepal are primarily led by mental health professionals and non-governmental organisations.

According to doctors, government support can go some ways towards erasing the stigma against mental health and suicide. It can also help clear up misconceptions.

“People think that those who are suicidal cannot be helped,” said Dr Maan Kaji Thapa, a resident doctor at Patan Hospital’s Department of Psychiatry. “But the suicidal state is almost always transient and treatable. People commit suicide not because they don’t want to live. There are different factors that lead a person to consider suicide.”

Thapa believes that helplines can assist callers with their mental health and can direct them towards proper treatment and support.

“Although crisis helplines limit face-to-face interactions with callers, right advice and kind words can often be equivalent to being physically present,” said Lekhak.

There are currently four helplines that offer help with psychosocial problems. While the Tribhuvan University Teaching Hospital suicide hotline and Patan Hospital crisis helpline for suicide prevention operate 24 hours, TPO provides helpline services between Monday to Friday from 9:30 am to 4:30 pm. The mental health helpline Nepal is out of service.

Patan Hospital Helpline for Suicide Prevention: 9813476123

Transcultural Psychosocial Organization-Nepal Crisis Hotline: 16600102005

TUTH Suicide Hotline: 9840021600