Manorama Sadda and her husband, Umesh, from Siraha’s Betauna, spent years watching their son Pratik struggle with communication and behavioural issues. What began as subtle delays in speech and awkward social interactions eventually translated into academic difficulties.

By the time their son was nine, his teachers were growing concerned. Yet, for Manorama and Umesh, the possibility that their child could have a deeper intellectual or emotional challenge never crossed their minds.

“We thought he was just a bit slower than other children,” Manorama says. “Everyone around us said boys take time to mature, so we didn’t worry. We had no idea it was something serious.”

Their son’s autism was recognised too late, and only after 2020 when his teacher recommended they seek professional help. “We had never heard of such problems, and we didn’t even know where to go,” Umesh says.

In Nepal, children’s mental health issues are often neglected due to a lack of awareness, social stigma, and insufficient medical infrastructure.

For many parents, by the time they seek help, the damage has been done, with lifelong implications for their children’s development.

“Although children and adolescents comprise over 42 percent of Nepal’s population, mental health awareness in this demographic remains woefully inadequate,” says Dr Arun Raj Kunwar, a child psychiatrist at Kanti Children’s Hospital.

According to Kunwar, the Child and Adolescent Mental Health (CAMH) Unit at Kanti Children’s Hospital in Kathmandu, established in 2015, remains the only full-time child and adolescent psychiatry outpatient clinic (CAP OPD) in the country.

“In the absence of dedicated inpatient units for children, young patients who need hospitalisation are often placed in adult psychiatric wards—an alarming violation of international standards,” says Kunwar.

The limited access to mental health services outside major urban centres is stark.

Accessing this service was a struggle for parents like Manorama and Umesh. “We spent months going from one hospital to another,” Umesh says. “The facilities for children’s mental health are almost non-existent outside Kathmandu. We ended up taking our son out of school and coming to Kanti Children’s Hospital for treatment.”

Specialised mental health services for children in Nepal are sparse, and the few centres that do exist are concentrated in cities like Kathmandu.

Experts like Kunwar have witnessed this firsthand.

“We are doing what we can, but it’s far from enough,” says Kunwar. He explained that between July and December 2015, the hospital registered around 600 cases. By 2018, this number had surged to over 2,400, and by 2019, it had climbed to 3,000. In 2023, the figure exceeded 6,000.

However, Kunwar says that the rise in numbers should not be mistaken for a progress in accessibility and awareness. “At first glance, the increasing figures might suggest improvements in screening, but the reality is that we still struggle to make these services accessible to all,” he says.

With 42 percent of Nepal’s population being children and studies showing that every child requires some form of psychological support during their developmental phase, Kunwar says that countless cases across the country remain undiagnosed and untreated.

The National Mental Health Survey Nepal-2020 reports that 5.2 percent of adolescents suffer from mental disorders, with neurotic and stress-related conditions being the most prevalent at 2.8 percent. Additionally, 0.6 percent of children and adolescents are affected by depression.

However, much like Kunwar, experts believe the actual rate of mental health issues could be higher, estimating that 10 to 15 percent of this population may be dealing with various mental health challenges. They attribute the lower figures in the survey to methodological limits.

A lack of trained professionals compounds this shortfall. There are fewer than a dozen child and adolescent psychiatrists in the country.

“Even in state-run facilities, only a handful of specialists are available,” adds Kunwar. “For a country with such a large population of children, this is a glaring problem.”

One big reason behind the delay in seeking mental health care is the stigma associated with mental health disorders. For many parents, admitting that their child might have a psychological issue is seen as shameful, leading to avoidance or denial.

As Dr Kunwar explains, “Even though awareness is spreading slowly, parents often come to us only when the situation becomes severe. This is due to both the lack of awareness and the stigma associated with mental health.”

A 2019 study published in the ‘International Journal of Mental Health Systems’ highlights the prevalence of child and adolescent mental health disorders in Nepal, with anxiety disorders, behavioural problems, and post-traumatic stress symptoms (PTSS) being the most common.

However, much of this research remains limited. “Nepal lacks large-scale, national-level studies that can truly assess the extent of mental health issues among children,” the study notes.

With such data missing, the government’s response remains insufficient, leaving many families without the needed resources.

Even the mental health of school children has been affected. A study published in the Journal of Lumbini Medical College, which is available on nepjol.info, found that among 902 secondary school students, 5 percent had mental health problems, while 14 percent were likely to develop them.

Peer problems, emotional difficulties, and conduct disorders are common, yet teachers and parents remain largely unaware of how to recognise these signs or provide support. Early screening in schools, the study says, could help detect these issues before they become more severe.

But, in reality, schools have not been able to do so.

For Nepal to properly address the mental health situation of its population, both awareness and infrastructure need immediate attention.

Experts warn that prolonged periods of neglect, especially during formative years, could lead to more severe problems later in life.

Yet, support remains scarce, especially in rural areas where parents like Manorama and Umesh live. “The government needs to act quickly to expand mental health services beyond Kathmandu,” Kunwar says. “If we don’t intervene now, we risk creating a future generation burdened by untreated mental health issues.”

To tackle the rising mental health issues among children and adolescents, the Ministry of Health and Population announced in August 2024 that it would start training health workers to assess mental health conditions in this age group.

The plan includes training 150 medical officers, nurses, and paramedics to screen children and adolescents for mental health concerns. Experts like Kunwar hope the government will continue to expand such initiatives, particularly in rural areas, to ensure that even children in remote regions have access to essential mental health services.