Orange, yellow and brown. Sama Bajracharya fills the canvas with colours, her forehead creased in concentration and a smile playing at her lips. Sama is 47 and has <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/A-for-autism,270">autism</a>, a neurological and developmental disorder that affects how people interact with others, communicate, learn, and behave. It took years for Sama’s parents to come in terms with and understand her challenges.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240416110452_d76000000456e391ebecd6304ca0352da0df367a097a24fba40845620bd0167e.jpg" data-media-id="editor_1" data-image-id="20240416110452_d76000000456e391ebecd6304ca0352da0df367a097a24fba40845620bd0167e" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Autism awarness with art"> <figcaption>A colourful painting by Sama Bajracharya.</figcaption> </figure>  It was not until a teacher identified her difficulties – an inability to follow lessons, recognise letters and play with other students. She often withdrew and remained isolated. Her parents took her to a doctor who diagnosed her with autism. Because not much was known about the condition at the time, her parents held onto the hope that she would be cured. For 18 years, her mother Ratna Shova Bajracharya took her to traditional healers, dya majus and ayurvedic hospitals. “I did everything that I could, I just wanted to see her live like everyone else happy,” says Ratna Shova.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240416110456_3783e96dfaeb643383995c2bb37ef189a55c704889ea55ef769842526f132a3f.jpg" data-media-id="editor_2" data-image-id="20240416110456_3783e96dfaeb643383995c2bb37ef189a55c704889ea55ef769842526f132a3f" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Autism awarness with art"> <figcaption>Sama with her mother Ratna Shova.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240416110456_a9006224a4e882de540cfc8ad3f9bb298c2b4fb66eaa8f2b48e4b83f68630126.jpg" data-media-id="editor_3" data-image-id="20240416110456_a9006224a4e882de540cfc8ad3f9bb298c2b4fb66eaa8f2b48e4b83f68630126" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Autism awarness with art"> <figcaption>Sama with her sister Nima walking towards a bus station.</figcaption> </figure>  Upon learning there was no cure from a specialist, Ratna had to adjust their lives to accommodate Sama’s needs. This was not easy as sometimes Sama would exhibit aggressive behaviour including self-harm, throwing objects, breaking mirrors and threatening to jump off the window. A turning point came in 2005 when Sama met Sarita Dangol during an art event for people with autism. A senior artist, Sarita started mentoring Sama in arts and crafts. Art became a form of therapy for Sama, promoting mental and physical stability. Read also: <a href="https://nepalitimes.com/multimedia/the-art-of-healing">The art of healing</a>, Sewa Bhattarai Seeing the impact arts had on her, Sarita along with Sunila Bajracharya co-founded Mikha - The Creative Begins in 2022 to help empower other individuals like Sama by providing them a platform to explore and grow through art.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240416110456_da249677323f0b78b936809ea68be00dd17f6530c1f8028723d318c71faafb8e.jpg" data-media-id="editor_5" data-image-id="20240416110456_da249677323f0b78b936809ea68be00dd17f6530c1f8028723d318c71faafb8e" data-rendition-name="original" width="1500" height="1015" loading="lazy" alt="Autism awarness with art"> <figcaption>Sama likes knitting.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240416110456_1dc69dfe3b36b094726ca5ee1fd63f5754a623d4ab8efc8d52e6b5b86a1945f9.jpg" data-media-id="editor_6" data-image-id="20240416110456_1dc69dfe3b36b094726ca5ee1fd63f5754a623d4ab8efc8d52e6b5b86a1945f9" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Autism awarness with art"> <figcaption>Sama hugs her knitting mentor after her art classes.</figcaption> </figure>  Mikha has become a source of joy for Sama, she excitedly attends classes with her classmates Sabha and Ritu both of whom have been diagnosed with down syndrome. In 2023, Sama participated in the International Disability Dance and Art Festival in Delhi and showcased her artistic and dancing talents, instilling a sense of confidence in her.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240416110456_8c1556b05170bbe7cbb2f2a1959e26fe3ccfb294c3a86f4fc9b84ba225ccbffb.jpg" data-media-id="editor_7" data-image-id="20240416110456_8c1556b05170bbe7cbb2f2a1959e26fe3ccfb294c3a86f4fc9b84ba225ccbffb" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Autism awarness with art"> <figcaption>Sama with her friends Sabha and Ritu during their art class.</figcaption> </figure>  Read also: <a href="https://nepalitimes.com/here-now/the-mental-scars-of-violence">The mental scars of violence</a>, Sewa Bhattarai According to the 2021 Census, there are 4,886 individuals with autism in Nepal, out of 647,744 people surveyed. This is 0.8% of the sample population. In 2019, the Autism Care Nepal Society (ACNS estimated) that some 300,000 children were living with autism in Nepal. There has been a <a href="https://nepalitimes.com/here-now/why-are-autism-cases-rising-in-nepal">worrying increase in autism among younger Nepalis</a>, partly due to increased awareness and diagnosis of the condition. Management and support systems, however, are sorely lacking.&nbsp;

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Autism awareness with art

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114111148/63721d9c9c7e80680e0bd4f9jpeg.jpg" alt="" width="1006" height="640"/><figcaption>Anjana Rajbhandary with Sloane, a Labrador Retriever mix she adopted recently. Photo courtesy of: ANJANA RAJBHANDARY</figcaption></figure>Last year, when I was still struggling with <a href="https://www.nepalitimes.com/opinion/coping-with-anxiety-in-new-lockdown/" target="_blank" rel="noopener noreferrer">pandemic-induced anxiety</a>, my best friend Shailu suggested I get a puppy. Shailu herself is mom to two golden doodles and told me how having pets has made her much happier.According to <a href="https://www.psychologytoday.com/us/blog/the-right-balance/201804/how-dogs-drive-emotional-well-being">Psychology Today</a>, dogs help people be present in the moment. When you are playing with or walking your dog, that is what you are doing because you need to pay attention to your puppy, preventing your mind from wandering into the senseless territory.Spending time with a dog can significantly lessen one’s negative emotions because they make you feel loved. Plenty of studies have proven that canines make people happier. But how do you make the right choice when choosing a dog?“Do your research! Don’t get a dog just because you like the way they look,” says Serena, an animal care worker with over 20 years of experience. She strongly recommends opting for a dog that best fits your lifestyle which dictates whether you can give the dog the level of activity it needs.“If you are an active person, get a high-energy dog but if you are a homebody, better to choose the one that needs fewer walks and is fine lounging around with you,” she adds.Read also: <a href="https://www.nepalitimes.com/review/adventures-of-a-kathmandu-street-dog/" target="_blank" rel="noopener noreferrer">Adventures of a Kathmandu street dog</a>, Nepali Times<a href="https://www.instagram.com/dog_father_pranav/">Pranav R. Joshi</a>, a veterinarian with 14 years of experience strongly recommends adopting a dog for mental health benefits. “Dogs radiate an energy towards people that automatically helps because no matter how tired you are, even if it is for 5 minutes, it can positively impact your mental health,” he explains.When you come home tired from work and do not feel like talking to anyone, dogs act as a bridge. They bring families together because even if they don’t talk to each other, they will talk about their furry friends. Experts also encourage teaching children to take care of pets to instill a sense of responsibility from a young age.Having a dog also makes it easier to start conversations, they give you something to talk about. And even if conversations start with dogs, it encourages people to bond with others over time. <a href="https://www.nytimes.com/2018/02/27/well/family/dog-date-men-women-love-dating-relationships.html">Studies</a> have found that single men are more likely to meet women if they have a dog with them. So, your little best friend might even help you find love.“Dogs help people become more sociable and improve relationships,” adds Joshi who has been running <a href="https://www.facebook.com/vetforyourpet">Vet for your Pet</a> clinic since 2009.Andréa Schneider started <a href="https://www.facebook.com/DreasDogsitting/">Drea’s Dogsitting LLC</a> in 2019 because of her love for animals, she wanted to spend every day doing it. “Socialising your puppy from an early age is an investment in happiness and peace for years to come,” she says, adding that the business has allowed her to know more people from her community. Such a practice also helps shape the dog’s personality from an early age.Read also: <a href="https://www.nepalitimes.com/here-now/angel-meets-an-angel/">Angel meets an angel</a>, Sonia Awale<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114111148/63721d9e9c7e80680e0bd4fajpeg.jpg" alt="" width="1920" height="1280"><figcaption> </figcaption></figure>Another animal lover is Lisa Huey who has been volunteering for the non-profit <a href="https://lolin.org/">Love of Labs</a> since 2020 and has fostered five dogs since. Fostering and adopting older dogs is not common in Nepal, but she is a strong advocate and as such is against leaving pets outside to sleep or keeping them in a cage for too long.“How you treat the dog is how the dog will age,” she says. “Dogs age like people. We have to feed them a healthy diet and keep them active, and as they get older, they need supplements for their health issues. You should treat your dog like a family member.”Dogs are intelligent beings but training them can be time-consuming as they need time and practice to learn and retain commands. Imagine someone speaking to you in a foreign language you do not understand. It is the same for dogs so one must be patient.We adopted Sloane, a Labrador Retriever mix, and couldn’t be happier. Having her has immensely helped my<a href="https://www.nepalitimes.com/opinion/readjusting-to-life-post-covid/" target="_blank" rel="noopener noreferrer"> mental and physical health</a> since we need to give her plenty of exercise to keep her healthy, labs tend to put weight on quickly. She is good with strangers, very playful, and has high energy, so she keeps us plenty busy.People with pets, in particular dogs, are happier because they provide companionship as well as a sense of security. They are a great addition to your life, they add structure to your day. They make you more responsible because they depend on you for their welfare.In short, dogs make you a better person or bring about your best version.Read more: <a href="https://www.nepalitimes.com/latest/microchipping-nepals-dogs/">Microchipping Nepal's dogs</a>, Aria ParasaiAnjana Rajbhandary writes this fortnightly Nepali Times column Life Time about mental health, physical health and socio-cultural issues.

Anjana Rajbhandary

Canine therapy

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114111144/63721c239c7e80680e0bd47ajpeg.jpg" alt="" width="3000" height="2000"/><figcaption>Illustration: FREEPIK</figcaption></figure>Three years ago, when people went to get a manicure, it was a manicure. Today it is called 'self-care'. Earlier, taking a bath used to be a relaxing way to end a stressful day. Today a soak is also 'self-care'.This is not a diss on <a href="https://www.nepalitimes.com/banner/beauty-parlour-defies-lockdown-to-reopen/">beauty salons</a> of which there are now too many to count in Kathmandu, but self-care is much more than that. Self-care is a common terminology in the field of psychology and is often used to see how patients are <a href="https://www.nepalitimes.com/latest/the-other-pandemic-mental-health/">taking care of themselves</a> physically, mentally, and emotionally.Self-care is also subjective, what one person needs in their life is not the same for others. Before the pandemic, it was limited to taking proactive actions such as eating healthy, staying active, taking your medications as prescribed, and speaking with a therapist. They were intended to slowly change one’s habits so one could become happier and healthier.Navigating the global market that is saturated with products geared towards self-care without ruffling a few feathers is tricky. Last summer, one of my mentors asked me what I thought of the present-day definition of self-care. Both of us have experience with non-profits where we worked with children and adults. Every program we worked on was geared towards improving people's lives, but before the pandemic, we did not ever think of suggesting that a manicure could be self-care.Shainna Ali, Ph.D., LMHC, NCC, tells Psychology Today, 'Self-care is a continuous process of proactively considering and tending to your needs and maintaining your wellness.' She describes it as a holistic practice. A great example of self-care is a physical activity that you incorporate into your life because of the bodily and mental benefits. It is not a one-and-done act, you must stay consistent.The oversaturated market has found a <a href="https://www.nepalitimes.com/here-now/dalits-disasters-and-discrimination/">vulnerable</a> niche, I admit I have myself fallen for it. After all, they deploy some of the cleverest tactics, promoting buying products to reward themselves 'because we deserve it'.Of course, it is lovely to own a bathroom filled with <a href="http://archive.nepalitimes.com/news.php?id=15716#.Yk2Sc9NBz0s">skincare products</a> and scented candles, but soon enough you will find the true meaning of self-care lost amid the piles of online shopping receipts. Go ahead and get yourself that amazing bubble bath, but you cannot buy self-care.We have confused the real meaning of self-care as the <a href="https://www.nepalitimes.com/latest/covid-19-affecting-food-security-in-nepal-wfp/">Covid scare</a> fades. I love having a vanity filled with luxurious skincare products, but that is not exactly self-care for me. That is more of an indulgence, which we all deserve from time to time. People actually need to self-reflect and analyse what they need in their lives.Read also: <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/Caring-essence-of-nursing,2273">Caring is the essence of nursing</a>, Anjana RajbhandaryDuring the pandemic, a lot of people <a href="https://www.nepalitimes.com/latest/half-of-nepalis-lost-jobs-in-past-month/">lost jobs</a> and had to take care of sick family members. Many reported <a href="https://www.nepalitimes.com/latest/the-other-pandemic-mental-health/">feeling depressed and hopeless</a>. Soon, the value of mental well-being started to take precedence and people started indulging in self-care. So the term came to mean immediate gratification, but it does not guarantee a long-term solution.One of my friends is a working mother but the distraction of home life affected her ability to work efficiently. Then she took up running, just an hour every day, as an act of self-care. It gave her time away from the household chaos but it also improved her fitness level. Eventually, she was happier with a better ability to handle the stress.Another friend justified eating a whole box of cookies as an act of self-care. When the concept is blurred like this, people can define it in any way they want, even to their own detriment. Her choice of self-care ended with weight gain and lowered self-esteem.No amount of rubbing lavender lotion on the skin is going to fill the void left by <a href="https://www.nepalitimes.com/opinion/coping-with-covid-fomo/">pandemic-induced loneliness</a>. A bubble bath is not going to make up for it either, humans need family and friends.It has been two years, and what started as a movement to <a href="https://archive.nepalitimes.com/article/nation/diabetes-in-south-asia,3018">take care of physical</a> and mental health during the pandemic has taken a turn. Self-care has become a staple in the world of marketing -- synonymous with promoting <a href="https://www.nepalitimes.com/opinion/decarbonise-now/">consumerism</a>.If it makes you happy, go for it, but when did buying myself a pair of jeans become self-care? It will not help if you do not have a supportive environment around you. At most, self-care achieves the temporary well-being of your mind.At the end of the day, you have to do what works for you. If practicing an act of kindness is helping you, go for it. But engaging in <a href="https://www.nepalitimes.com/here-now/make-sure-bicycling-is-not-injurious-to-health/">physical activity</a> and eating ice cream every day cannot fall under the same category. The results of the two choices are vastly different.Before we jump on the 'self-care' bandwagon, let us ask ourselves if our choice of self-care is indeed improving our lives or just an excuse to do whatever we want.Anjana Rajbhandary writes this fortnightly Nepali Times column Life Time about mental health, physical health and socio-cultural issues.Read more: <a href="https://www.nepalitimes.com/opinion/the-female-social-anatomy/">The female social anatomy</a>, Anjana Rajbhandary

You can’t buy self-care

<figure><img width="3700" height="1900" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114101116/637208159c7e80680e0b54cajpeg.jpg" alt=""/><figcaption></figcaption></figure>The coronavirus disease is one of the most well-documented health crises of recent times, with its correlation to almost every sector in society -- including the <a href="https://www.nepalitimes.com/here-now/post-pandemic-mental-health-epidemic/" target="_blank" rel="noopener noreferrer">mental cost</a> of prolonged lockdowns and the stress during the pandemic. Studies have linked a higher prevalence of anxiety, depression, post-traumatic stress disorder (PTSD), hypochondria, obsessive disorders and psychotic symptoms among the general population in the last two years.But for the first time, <a href="https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0262958&amp;fbclid=IwAR3GhEvU6qnCjQuwR-HEye8Jk3foYOofrmAgpLCgHZEhjm9r_2PWAOpZCBE" target="_blank" rel="noopener noreferrer">a new study</a> squarely links the rise in suicide ideation with the pandemic in Nepal. Police records also show a spike in suicides and self-harm cases in the past two years.Suicide cases had been rising even before the pandemic with 5,509 in 2018 and 5,898 in 2019. However, it jumped to 6,968 during the first year of the pandemic in 2020 — putting the <a href="https://www.nepalitimes.com/banner/nepal-sees-spike-in-suicides-during-pandemic/" target="_blank" rel="noopener noreferrer">suicide rate</a> at 23.9 per 100,000 population.‘The yearly increase in the suicide rate from 2019 to 2020 is 16%, which is more than threefold higher than a yearly increase in the suicide rate from 2018 to 2019 (5%),’ states the paper published on PLOS ONE last month.Titled ‘Association between COVID-19 pandemic and the suicide rates in Nepal’ and conducted by Binod Acharya, Keshav Subedi, Pramod Acharya and Shweta Ghimire, research analysed a total of 24,350 suicides in four years from July 2017 to June 2021 based on Nepal Police data.It investigated changing <a href="https://www.nepalitimes.com/latest/the-other-pandemic-mental-health/" target="_blank" rel="noopener noreferrer">suicide rates</a> in Nepal during the Covid-19 pandemic period (April 2020 to June 2021), compared to the pre-pandemic period (July 2017 to March 2020), adjusted for seasonality and long-term trends in the suicide rate.Males had a higher suicide rate (26.9 per 100,000) than females (16.5 per 100,000), but suicide rates went down over the last two years among males, but was sustained for a longer duration among females. <img width="542" height="600" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114101116/637208189c7e80680e0b54cbjpeg.jpg" alt=""><img width="533" height="600" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114101116/6372081b9c7e80680e0b54ccjpeg.jpg" alt="">For example, all the pandemic months except April and May of 2020 and February and March of 2021 had a significantly higher suicide rate compared to the same months in 2019. In comparison to the same month in 2019, July 2020 (just after the first lockdown) had the highest increase in the suicide rate with an increment of 55%.Researchers have pointed out limited or lack of economic resources, public health infrastructure and awareness about mental health as leading factors for the increase in suicides in Nepal during the pandemic.Nepal is one of the countries with highest suicides rates in the world according to the World Health Organization (WHO). The 2021 Nepal Health Research Council (NHRC)’s National Mental Health Survey found the prevalence of suicidality (current suicidal thoughts, lifetime suicidal attempt and future likelihood of suicidal thoughts) at a high of 7.2% among Nepalis. During the study period of this latest survey, the highest proportion of the suicides were observed in Bagmati province (5,709; 23.4%), followed by Province 1 (5,161; 21.2%), Lumbini (4,757; 19.5%), Madhes (3,053; 12.5%), Gandaki (2,369; 9.7%), Sudurpaschim (2,176; 8.9%), and Karnali (1,125, 4.6%).But Sudurpaschim and Karnali provinces, two of the provinces with the lowest Human Development Index (HDI), had the highest increase in suicide rates associated with the Covid-19 pandemic.‘Sudarpaschim and Karnali regions are also known to have a historically high proportion of seasonal <a href="https://www.nepalitimes.com/here-now/in-the-minds-of-nepals-migrant-workers/" target="_blank" rel="noopener noreferrer">migrant workers</a> in India. People in this region could have experienced additional distress as their migrant family members lost their jobs in India because of the business closure and lockdown,’ states the study.Alternatively, Province 1 which has the highest HDI and relatively low poverty rate among seven provinces has had consistently high pre-Covid-19 suicide rates, but had the smallest increase during the pandemic.Official data shows that Nepal registered an early increase in the suicide rate and mental health problems during the pandemic. Many factors come into play: lack of financial stimulus packages in the beginning, irresponsible media reportage about the virus, conflicting messages by authorities and the s<a href="https://www.nepalitimes.com/here-now/nepal-health-workers-battle-covid-19-but-also-stigma/" target="_blank" rel="noopener noreferrer">ocial stigma of being infected</a> all added to the psychological stress in the public.Restrictions during the pandemic also meant that mental health patients were unable to get timely consultation and medication, further aggravating their condition. ‘Public health interventions to the pandemic, especially the severe ones like lockdowns and business closure, should incorporate economic safety nets and mental health service delivery mechanisms catered to geographic, socio-economic differences and needs,’ recommend the researchers. <img width="1500" height="1000" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114101116/6372081d9c7e80680e0b54cdjpeg.jpg" alt="">Suicides are preventable and treatment of mental health disorders can save lives. A comprehensive suicide surveillance system to maintain detailed suicide and attempt statistics within the jurisdiction of public health agencies rather than just the law-enforcement agencies can be a start.Addressing the underlying cause of <a href="https://www.nepalitimes.com/opinion/coping-with-anxiety-in-new-lockdown/" target="_blank" rel="noopener noreferrer">mental health problems</a> is still the most effective way to prevent suicides. This requires increased awareness and education through various platforms including social media, mass communication and school curriculum, which will in turn also help reduce the stigma associated with psychological disorders. Besides consultation and medication, family support plays a crucial role in healing people with trauma, depression or psychosis. Telemedicine, in particular, has been essential in preventing self-harm during the pandemic but these services need to be scaled up to cover the whole country.The paper concludes: ‘The Covid-19 pandemic is associated with an increased suicide rate in Nepal. The findings may inform policymakers in designing appropriate public health responses to the pandemic that are considerate of the potential impact on mental health and suicide.’Do not shy away from seeking help. If you, or anyone you know, would like to speak to a trained mental health professional, please contact:TUTH Suicide Hotline: 9840021600Transcultural Psychosocial Organisation-Nepal Crisis Hotline: 1660 0102005Mental Health Helpline Nepal: 1660 0133666Centre for Mental Health and Counselling Nepal Toll-free: 16600185080, Hotline: 1145Koshish Toll-free helpline: 166001-22322 (Bagmati Province)Patan Hospital Helpline: 9813476123National Suicide Prevention helpline operated by Mental Hospital Lagankhel and TPO: 1166

Suicides: a pandemic within a pandemic

<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161148/636d1dac9c7e80680e0af3cejpeg.jpg" alt="" width="1024" height="443"/>This summer, I finally reached my weight goal after struggling for over two decades.<a style="font-size: 15px; letter-spacing: 0.01em;" href="http://archive.nepalitimes.com/regular-columns/all-in-mind/love-yourself-and-have-a-healthier-attitude,532" target="_blank" rel="noopener noreferrer">I gained over 20 kgs in high school</a> in three months. It was a shock to me and my family, and ever since I have tried to lose weight. It did not just affect my self-esteem but also my health.‘Moti’ became synonymous with my name.‘How could you let yourself get so fat?’ people asked me.They made fun of me when I was at my heaviest, and they continue to criticise me as I work towards being healthier.I had tried everything possible to <a href="https://archive.nepalitimes.com/article/nation/slim-dreams-of%20women,3658" target="_blank" rel="noopener noreferrer">lose weight</a> quickly, but as easy as it is to gain weight, it is as difficult to lose it. So when I finally managed to do it, I shared it on my social media, only to be met with backlash.‘You looked better before.’‘I would never deprive myself of food.’‘Are you okay? We are worried about you.’‘You have an eating disorder.’In college, I did not live a healthy lifestyle. Partying, overindulging in food and alcohol, and barely sleeping did not help matters. I wanted to be healthy, but I was not doing anything to change my bad habits.I am at a healthy weight now, and it is a result of daily exercise and a more nutritious diet of protein and vegetables. I stopped eating <a href="https://www.nepalitimes.com/banner/nepalis-binge-on-junk-foods-the-west-rejected/" target="_blank" rel="noopener noreferrer">processed food</a> and cut down my alcohol consumption. I never deprived myself of food, I only stopped overeating.It is considered rude to comment when people gain a few extra kgs. But when someone loses a little weight, everybody thinks they have the right to comment on your body because it is coming from a place of ‘concern.’But how did I gain all the weight in the first place? I was 17, living in Italy. I was having pizza and gelato every day but never exercised. I could not walk half a mile without having to rest or catch my breath. I once even sprained both my ankles because I fell while walking.When <a href="https://www.nepalitimes.com/here-now/omicron-may-not-be-as-risky-but-take-care/" target="_blank" rel="noopener noreferrer">Covid</a> forced us all into lockdown, I decided to make it happen, achieve my weight goals.It was not easy, the most challenging part was being disciplined. But after three months of consistency and daily exercise without giving up, I noticed that I had lost weight and did not have the stomach issues I used to. It took time, but I started to enjoy healthier foods, I began to feel better and happier, and I was not always hungry like I used to be.It takes work, but people are quick to judge and call it deprivation. Many tried to school me when I tried to stick to my diet. When I shared my little victories, they called me vain because I felt the need to lose weight, and some even told me I had an eating disorder. I felt attacked. Instead of support, I was called shallow.Most of these people did not even know me or the amount of work I was putting into this. Much of the reproach also comes from individuals who are not happy with themselves so they take it out on others. There is no polite way to put it, it is just the truth.But for the first time in years, I am happy with how I look and feel, I have been waiting for years to experience this. I can walk for miles. I no longer have to worry about having stomachache when eating out.This is the <a href="https://www.nepalitimes.com/opinion/we-are-what-we-eat/" target="_blank" rel="noopener noreferrer">healthiest relationship I have ever had with food</a>. I enjoy eating, I cook a lot, and food has become a positive part of my life.I am just shocked and disheartened by people’s reactions. I did not expect everyone to help me in my process, but I also did not think I would receive this much hate or people would think they have the right to tell me how I should look.We hate it when someone comments on our body, so what makes it acceptable to comment on others? People will always have opinions, but why be so cruel?So, if you do not have any words of encouragement or something positive to say, it is better to say nothing at all.We have the right to love our bodies. After 20 years of struggling with my weight, I finally feel healthy. I am happy with how far I have come. I am proud of myself, and I will not let anyone shame me for my body.Anjana Rajbhandary writes this fortnightly Nepali Times column Life Time about mental health, physical health and socio-cultural issues.

Too fat or too thin, but never quite right

<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161124/636d17e79c7e80680e0ac791jpeg.jpg" alt="" width="4096" height="2730"/>Children and young people across the world could feel the <a href="https://www.nepalitimes.com/here-now/post-pandemic-mental-health-epidemic/" target="_blank" rel="noopener noreferrer">impact of Covid-19 on their mental health</a> for many years even after the worst effects of the pandemic are gone, a new UNICEF report warns.The annual <a href="https://www.unicef.org/reports/state-worlds-children-2021" target="_blank" rel="noopener noreferrer">State of the World’s Children 2021: On My Mind </a>this year focuses on promoting, protecting and caring for children's mental health and is a comprehensive look at how children, adolescents and caregivers will be affected for many years into the future.Early findings from UNICEF and Gallup’s survey Changing Childhood Project previewed in the report show that one in five respondents aged 15–24 admitted to feeling depressed and losing interest in things. The survey interviewed approximately 20,000 children and adolescents from 21 countries as well as 40 and older.One-third of respondents of a Chinese online survey last year cited in the report reported feeling scared or anxious.“With nationwide lockdowns and pandemic-related movement restrictions, children have spent indelible years of their lives away from family, friends, classrooms, play – key elements of childhood itself,” said UNICEF Executive Director Henrietta Fore. “The impact is significant, and it is just the tip of the iceberg.”According to the Institute of Health Metrics and Evaluation (IHME)’s 2019 Global Burden of Disease Study, more than one in seven adolescents aged 10–19 globally is estimated to live with a <a href="https://www.nepalitimes.com/opinion/coping-with-anxiety-in-new-lockdown/" target="_blank" rel="noopener noreferrer">diagnosed mental disorder</a>, some of which include depression, anxiety, schizophrenia, ADHD, autism, and eating disorders.WHO’s 2019 Global Health Estimates show that almost 46,000 adolescents die from suicide each year.Here in Nepal, community respondents say that <a href="https://www.nepalitimes.com/latest/tackling-nepals-mental-health-pandemic/" target="_blank" rel="noopener noreferrer">mental health is among the primary concerns</a> of children and adolescents. Nepal Police data shows that 8% of those who died by suicide nationwide in the last five years were minors. Some 20% of suicide ideation and calls to psychological helplines across Nepal are associated with violence, and 25% with economic deprivation.Statistics show a <a href="https://www.nepalitimes.com/latest/in-nepal-lockdown-a-domestic-violence-spike/" target="_blank" rel="noopener noreferrer">direct correlation</a> between the lockdown and incidents of gender-based violence, sexual violence, and violence against children in Nepal. There have been 7,141 reported deaths due to <a href="https://www.nepalitimes.com/banner/nepal-sees-spike-in-suicides-during-pandemic/" target="_blank" rel="noopener noreferrer">suicides nationwide in the last 12 months</a>, up from 6,252 the year before.Additionally, recent surveys reveal that a significant number of households with children <a href="https://www.nepalitimes.com/latest/1-in-5-nepal-families-lack-food/" target="_blank" rel="noopener noreferrer">experienced economic and livelihood losses</a> during the 2020 lockdown, and the economic fallout continued into the 2021 lockdown as households experienced<a href="https://www.nepalitimes.com/latest/half-of-nepalis-lost-jobs-in-past-month/" target="_blank" rel="noopener noreferrer"> job losses</a>, with little to no support from the government.At least one in every seven children globally has been directly affected by lockdowns. More than 1.6 billion children have <a href="https://www.nepalitimes.com/latest/covid-19-cancels-regions-gains-in-education/" target="_blank" rel="noopener noreferrer">lost access to education </a>during the pandemic, and the disruption to routines, recreation, as well as impact on family income and health has left young people with exacerbated mental health issues.Mental health issues cause long-term harm to children and young people’s education, life outcomes, and earning capacity. Indeed, a new analysis by the London School of Economics indicates that mental disorders leading to disability or death among young people cost economies nearly $390 billion annually.Despite the epidemic of mental health crisis among young people who are dealing with unaddressed psychological disorders, it doesn’t attract the investment from governments it deserves, and there were significant gaps between mental health needs and funding even before the pandemic.Indeed, the UNICEF report found that only about 2% of government health budgets are allocated to mental health spending globally.The report also notes that genetics, environmental factors including parenting, schooling and relationships, exposure to violence or abuse, discrimination, poverty, as well as humanitarian and health crises have an impact on children’s mental health.And while caregivers, safe school environments, and positive peer relationships can help reduce the risk of mental disorders, the stigma surrounding mental health and lack of funding prevent children from accessing required mental health resources.The report has called on world governments as well as the public and private sector to commit to addressing the <a href="https://archive.nepalitimes.com/article/nation/stigma-and-silence-mental-health-nepal,3486" target="_blank" rel="noopener noreferrer">stigma surrounding mental health</a>; promoting mental health for children, adolescents and caregivers; taking experiences of children and young people seriously, and identifying and caring for vulnerable groups with psychological conditions.Said Fore: “Mental health is a part of physical health, we cannot afford to continue to view it as otherwise. For far too long, in rich and poor countries alike, we have seen too little understanding and too little investment in a critical element of maximising every child’s potential. This needs to change.

The other pandemic: mental health

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141148/636d01669c7e80680e0a3628jpeg.jpg" alt="" width="1500" height="1000"/><figcaption>Photo: MONIKA DEUPALA</figcaption></figure>A53-years-old laboratory assistant at a reputed hospital in Kathmandu recently bought aluminium phosphide tablets and ingested three of them. He started vomiting immediately, and had to be rushed into emergency.Because of his poor cardiopulmonary status and low mentation, he was intubated and transferred to the ICU. But that did not save the patient, who died a few hours later. The reason for self-poisoning was later found to be marital discord.Aluminum phosphide is a pesticide that is widely available across the Subcontinent because farmers use it as a fumigant to protect stored grain from insects and rodents. But increasingly more people are using this lethal inorganic compound for <a href="https://www.nepalitimes.com/latest/suicide-watch/">suicide attempts. </a>Aluminium phosphide releases the highly toxic phosphine gas in the presence of moisture. When ingested, therefore, it reacts with the contents of the stomach, releases phosphine and leads to serious multi-organ damage to the heart, brain, kidney and lungs. Since there is no specific antidote, the <a href="http://archive.nepalitimes.com/news.php?id=17916#.YTrBPZ0zZPZ">death rate is very high. </a>A recent large study involving 4,148 patients conducted by the <a href="https://centrepsp.org/">Centre for Pesticide Suicide Prevention</a> at the University of Edinburgh in collaboration with Nepal Public Health Foundation revealed that aluminium phosphide accounted for 61% of all pesticide self-poisoning fatalities in hospitals. In the same study, of the 2,535 pesticide deaths, 300 were caused by aluminium phosphide.There has been a sharp rise in suicide deaths since the Covid-19 pandemic with widespread societal impact of lockdowns and economic difficulties on mental health of individuals. According to the Nepal Police, there were <a href="https://www.nepalitimes.com/here-now/nepals-suicide-rate-vastly-underestimated/">7,141 reported deaths due to suicides</a> nationwide in the last 12 months -- up from 6,252 the year before. Many more make attempts to end their lives.Mental health doctors in Nepal report an increase in patients suffering anxiety, depression, post-traumatic stress disorder, hypochondria, obsessive disorders and psychotic symptoms in the population in the past two years. Subsequent studies have drawn a direct correlation between the pandemic and a spike in mental health problems due to job loss as well as increased domestic and sexual abuse during the lockdowns.<a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/here-now/suicide-by-pesticide-in-nepal/" target="_blank" rel="noopener noreferrer">Pesticide ingestion</a> is the second most common method for suicide in Nepal as they are cheaper, do not need prescription, and are easily available in agro-vet shops. Most farming families also have pesticides readily available in their homes.Deaths by suicide due to pesticide ingestion are preventable, and there are evidence-based cost-effective interventions such as bans on hazardous agro-chemicals or limiting access to them.Sri Lanka and Bangladesh have clear data on how strict bans on just a few of the pesticides commonly used for self-harm can bring down the rate of suicides rapidly and without affecting agriculture output as the government replaces them with non-lethal agrochemicals.Back in the 1990s, Sri Lanka had one of the highest suicide rates in the world with 57 deaths per 100,000 population. Twenty years after it banned the pesticides Monocrotophos and Methamidophos in 1995, suicide deaths fell by a remarkable 70% to 17 deaths per 100,000 people. That is 93,000 lives saved at $50 per person.Similarly, after Bangladeshi banned 21 Highly Hazardous Pesticides (HHPs) suicide by pesticide ingestion fell dramatically from 6.3 per 100,000 population in 1996 to 2.2 in 2014.This is proof that legislation and strict regulations work. The good news is that in August 2019, Nepal’s Pesticide Registration Board banned eight hazardous chemicals in Nepal including aluminium phosphide and dichlorvos.This means that the production or import of the 3g tablet of aluminium phosphide which also goes by its trade name Celphos, Quickphos, Alphos, are restricted in Nepal. All remaining stockpiles after two years of phase-out period will be deposited in a government-built warehouse not to be sold anymore.But given that a past government ban on ‘dirty dozen’ pesticides has been ignored by farmers, often unaware of just how harmful they are to human health and nature, they have continued to use them in vegetable patches in Kathmandu Valley. Bans alone are not the answer, they also have to be enforced with punitive action for infringement.What we have seen from case studies elsewhere is also that after every ban on a hazardous pesticide, some new brand always comes up. The government must therefore replace HHPs with less toxic chemicals so that when people do ingest them they are not as lethal. Lack of accessibility to hazardous chemicals also means that people have to choose a more difficult method of suicide, which in turn discourages many and prevents more deaths.Apart from regulation, farmers need to be educated on how to use pesticides responsibly and about their handling that includes using personal protective gear, gloves, masks and visors. Something as simple as marking the pesticide bottle or packet with red, yellow or green to indicate how lethal they are also saves lives.Rakesh Ghimire is an assistant professor at the Tribhuvan University Teaching Hospital in Kathmandu, and was a national principal investigator of the study ‘Intentional Pesticide Poisoning and Pesticides.’<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141148/636d01699c7e80680e0a3629jpeg.jpg" alt="" width="89" height="103">Do not shy away from seeking help. If you, or anyone you know, would like to speak to a trained mental health professional, contact:TUTH Suicide Hotline: 9840021600Transcultural Psychosocial Organisation-Nepal Crisis Hotline: 1660 0102005Mental Health Helpline Nepal: 1660 0133666Centre for Mental Health and Counselling Nepal Toll-free: 16600185080, Hotline: 1145Koshish Toll-free helpline: 166001-22322 (Bagmati Province)Patan Hospital Helpline: 9813476123National Suicide Prevention helpline: 1166

Breaking the pesticide-suicide link

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141124/636cfc2c9c7e80680e0a0b73jpeg.jpg" alt="" width="1500" height="1000"/><figcaption>Photo: MONIKA DEUPALA</figcaption></figure><ul><li>Two years ago after going through a bad relationship, a 36-year-old Kathmandu-based doctor started getting suicidal thoughts. During the long months of lockdown, he would be on the rooftop and imagine jumping off to end it all. But before long he realised that he was causing self-harm, and sought help. He was diagnosed with depression, eight months into treatment he is rid of suicidal thoughts and is back to his outgoing ways.</li> <li>The bubbly young woman used to be the life of every party, but few of her friends and relatives realised what was going on inside her mind. As the pandemic hit, she started having violent thoughts about harming others and herself. The 22-year-old tried to deal with it herself, but two months ago she sought help from a mental health doctor. She was diagnosed with Obsessive Compulsive Disorder (OCD) and started treatment. Looking back, she advises others to also seek professional help in time.</li> <li>The young woman felt worthless, lacked confidence, avoided crowds and had self-inflicted cuts on her arm. Her inability to come in terms with her sexuality aggravated her sense of insecurity. When the pandemic foiled her plans, she blamed everything on herself, she felt irritated and uncertain, stopped attending virtual classes and her eating habits changed. She finally sought help for her depression and she is now under regular psychiatric counselling and medications. Grounding exercises in particular have helped her overcome self-harm and feelings of inadequacy. “I am okay now,” she says.</li></ul>As the pandemic turns lives upside down, there has also been a global <a href="https://www.nepalitimes.com/here-now/post-pandemic-mental-health-epidemic/" target="_blank" rel="noopener noreferrer">outbreak of mental health disorders</a>, and Nepal has reported a rise in suicides. However, as these cases show, professional counselling and medication can save lives.Recoveries rarely make news, only suicides do.“Most of my patients who attempted suicide have gone on to lead normal lives after they get treatment, and oftentimes they look back to their mental health crisis as nothing more than a lapse of judgment,” says psychiatrist and researcher Rishav Koirala.There has been a sharp rise in <a href="https://www.nepalitimes.com/latest/have-suicides-increased-during-nepal-lockdown/" target="_blank" rel="noopener noreferrer">suicides in Nepal</a> since the Covid-19 pandemic in March 2020 and subsequent lockdowns. Nepal Police data shows that in the last 12 months, there have been 7,141 reported deaths due to suicides nationwide, up from 6,252 the year before.Do not shy away from seeking help. If you, or anyone you know, would like to speak to a trained mental health professional, please contact:TUTH Suicide Hotline: 9840021600Transcultural Psychosocial Organisation-Nepal Crisis Hotline: 1660 0102005Mental Health Helpline Nepal: 1660 0133666Centre for Mental Health and Counselling Nepal Toll-free: 16600185080, Hotline: 1145Koshish Toll-free helpline: 166001-22322 (Bagmati Province)Patan Hospital Helpline: 9813476123National Suicide Prevention helpline operated by Mental Hospital Lagankhel and TPO: 1166<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141124/636cfc2e9c7e80680e0a0b74jpeg.jpg" alt="" width="640" height="475"><figcaption> </figcaption></figure>In a survey last year, <a href="http://www.tponepal.org" target="_blank" rel="noopener noreferrer">Transcultural Psychosocial Organisation (TPO) Nepal</a> which works with mental health compared five years of suicide data for March-July to see if there was any change during the lockdowns in 2020 and 2021.The results are revealing: suicides have been increasing steadily at an average rate of 8.5% every year, but it spurted to 19.4% in the first four months of the lockdown. Researchers also conducted key informant interviews across Nepal, who reported witnessing an increase in <a href="https://www.nepalitimes.com/latest/suicide-watch/" target="_blank" rel="noopener noreferrer">suicidal behaviours</a> in the community as well as health facilities.“We now have both quantitative and qualitative evidence that mental health problems have increased following the pandemic,” says TPO Nepal’s executive director Kamal Gautam. “And given that the majority of suicides are caused by psychological problems, we can say that Covid-19 has significantly contributed to its increase.”Mental health professionals have long been warning of an epidemic of psychological disorders following the Covid-19 crisis. They have reported an increase in anxiety, depression, post-traumatic stress disorder (PTSD), hypochondria, obsessive disorders and psychotic symptoms among the general population in the last two years.Economic collapse, job loss and slashed income due to the pandemic as well as <a href="https://www.nepalitimes.com/latest/in-nepal-lockdown-a-domestic-violence-spike/" target="_blank" rel="noopener noreferrer">increased domestic and sexual violence</a> and added workload during the lockdowns have all acted as contributing factors. In addition, those afflicted do not have normal social interactions that used to be a safety valve during more normal times.Moreover, many patients on treatment and medication have relapsed due to the limited access to health services, counselling and psychotropic drugs during the pandemic, and in many cases because of Covid phobia.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141124/636cfc319c7e80680e0a0b75jpeg.jpg" alt="" width="1052" height="690"><figcaption> </figcaption></figure>Up to 80% of suicides have mental health disorders as an underlying cause. A significant portion of cases are also a result of impulsive behaviour.Experts agree that the official <a href="https://www.nepalitimes.com/here-now/nepals-suicide-rate-vastly-underestimated/" target="_blank" rel="noopener noreferrer">numbers on suicides are vastly underestimated</a> due to a lack of suicide registry. Official figures are based solely on police data and post-mortems, and because of stigma associated with mental health, many families also often refrain from revealing the actual cause of death.Official records also do not take into account <a href="https://www.nepalitimes.com/here-now/in-the-minds-of-nepals-migrant-workers/" target="_blank" rel="noopener noreferrer">suicides of Nepali migrant workers overseas</a>, mainly Malaysia and South Korea. Similarly, suicides among those in the LGBTIQ community who have lost their limited sources of livelihood during the pandemic have been largely neglected.“Reported cases alone are not conclusive, but given that we now have a year and a half long trend and data, we have seen a significant increase in mental health disorders, and can assume that pandemic has played a crucial part in the rise in the number of suicides,” adds Rishav Koirala.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.who.int/news-room/fact-sheets/detail/suicide" target="_blank" rel="noopener noreferrer">More than 700,000 people die by suicide</a> every year around the world, that is one in every 100 deaths -- more than HIV, malaria, breast cancer, or war and homicide. And for every suicide, there are many more who make attempts to end their lives.Nepal is among the countries with the highest suicide rates in the world and consistently ranks within the WHO’s top 10 list. The Nepal Health Research Council (NHRC)’s <a href="http://nhrc.gov.np/wp-content/uploads/2020/09/Factsheet-Adults-1.pdf" target="_blank" rel="noopener noreferrer">National Mental Health Survey</a> published earlier this year found the prevalence of suicidality (current suicidal thoughts, lifetime suicidal attempt and future likelihood of suicidal thoughts) to be high at 7.2% among Nepalis.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141124/636cfc339c7e80680e0a0b76jpeg.jpg" alt="" width="1464" height="752"><figcaption> </figcaption></figure>The first of its kind survey in Nepal interviewed 15,088 participants and was carried out before <a href="https://www.nepalitimes.com/opinion/coping-with-anxiety-in-new-lockdown/" target="_blank" rel="noopener noreferrer">the pandemic</a> from January 2019 to January 2020. The study revealed that 10% of Nepal’s adult population had mental health problems in their lifetime with 4.3% experiencing some disorders at present.Mood disorders and neurotic and stress-related disorders were among the most common <a href="https://www.nepalitimes.com/latest/tackling-nepals-mental-health-pandemic/" target="_blank" rel="noopener noreferrer">psychological problems among Nepalis</a>. The prevalence of lifetime disorders was found the highest in Province 1 (13.9%), in the age group 40-49 years (13.3%) and among males (12.4%). As for current disorders, Bagmati scored the highest (5.9%) as well as those in the age group 40-49 years (6.3%) and females (5.1%).These figures correlate with Nepal’s suicide data of the past five years. Despite fewer attempts, men accounted for 57% of total suicides, against 43% of women. Among minors, however, more girls died by suicide, which experts ascribe to possible victimisation and a higher prevalence of borderline personality disorder among younger females.Suicide deaths are also disproportionately distributed across Nepal with Province 1 recording 65 deaths per 100,000 populations. Lumbini and Gandaki follow closely with 58 and 52 per 100,000 respectively. Traditionally neglected by the state and economically disadvantaged Karnali, Far West and Province 2 regions have lower suicide rates.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141124/636cfc369c7e80680e0a0b77jpeg.jpg" alt="" width="2287" height="1816"><figcaption> </figcaption></figure>More people are dying of suicides in urban centres such as Kathmandu Valley and Ilam district, which reported 32 and 38 suicide deaths respectively per 100,000 populations last year against Rautahat’s 18 and Humla’s 6.This is in direct contrast with the global trends where 77% of suicides occur in low and middle-income countries. Unemployment and poor economic condition have long been associated with a high risk of suicides, but only up to a certain point, as proven by recent data. Japan, <a href="https://www.nepalitimes.com/here-now/dead-end-of-the-korean-dream/" target="_blank" rel="noopener noreferrer">South Korea</a> and Hungary with their higher per capita GDPs have some of the highest suicide rates in the world.“Poorer nations have weaker education and health systems, which translates into delayed or even lack of diagnosis but poverty is not a sole factor for suicides,” says Kamal Gautam. “Suicide is complex and there are multiple factors at play which means a linear approach to prevention would be incomplete, it needs an integrated approach.”Addressing underlying mental health disorders is the most effective way to prevent suicides. This means increased awareness and education about psychological disorders, which in turn can help <a href="https://www.nepalitimes.com/here-now/all-in-the-family/" target="_blank" rel="noopener noreferrer">reduce societal stigma</a>. An introduction to and discussion on mental health in the school curriculum can further sensitise the public.In addition to medication and counselling, societal structure and family dynamics is an important support system for individuals suffering from psychosis, trauma and depression. Telemedicine in particular has been essential in preventing self-harm during the pandemic-induced restrictions but mental health services need to be scaled up across the country.On the other hand, a strict regulation must be implemented on the <a href="https://www.nepalitimes.com/here-now/suicide-by-pesticide-in-nepal/" target="_blank" rel="noopener noreferrer">availability of pesticides</a>, an easy means of suicide for many. Access to alcoholic products must also be supervised with Nepalis known to self-medicate to cope with stress and trauma, in turn increasing the risk of self-harm and suicide.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141124/636cfc399c7e80680e0a0b78jpeg.jpg" alt="" width="1280" height="853"><figcaption> </figcaption></figure>But most of all, analysing suicide attempts can be a powerful tool for prevention. On average, there are six attempts behind every suicide. Up to 80% of people with suicidal ideation reveal their intention to either a family member, friends or their doctors within a month before their attempt.“We forget that even before the pandemic suicide rates were very high in Nepal and while the pandemic might have added to the problem, the figures alone don’t mean anything if we fail to also study suicide attempts to find a stronger link between the prevalence and the contributing factors,” says Rabi Shakya, psychiatrist and director of Patan Academy of Health Sciences.He adds: “Historically, there have been more suicides after than during the crisis due to the long-term socioeconomic impacts. So we must start preparing for the pandemic of mental health problems including suicides post-Covid. Our health care workers must be trained and fanned out across the country.”Nepalis are not new to mental health problems induced by a crisis. The 10-year-long Maoist insurgency killed 17,000 people but many more continue to suffer from <a href="https://www.nepalitimes.com/here-now/the-mental-scars-of-violence/" target="_blank" rel="noopener noreferrer">PTSD, depression, anxiety and distress</a>. A 2017 report published in the journal Lancet found as high as <a href="https://archive.nepalitimes.com/article/nation/stigma-and-silence-mental-health-nepal,3486" target="_blank" rel="noopener noreferrer">37.5% of the general public</a> had some form of psychological disorder.The <a href="https://www.nepalitimes.com/here-now/its-all-in-the-mind/" target="_blank" rel="noopener noreferrer">2015 earthquake</a> further added to Nepal’s epidemic of mental disorders. Survivors who had narrow escapes or lost family members reported increased panic attacks, anxiety and trauma.But <a href="https://archive.nepalitimes.com/article/editorial/the-republic-of-insomnia,3311" target="_blank" rel="noopener noreferrer">conflicts, disasters</a> and pandemics have shined a light on mental health with an increased national and foreign investment in prevention and management. With larger chunks of the population impacted, there is now more acceptance and the field is starting to get the priority it warrants.Says Rishav Koirala, WHO focal person for mental health post-2015 earthquake: “The best way to prevent suicides is to address underlying psychological disorders and crises, despite adding to the burden has helped normalise them because many more people can now relate and understand that they are treatable.”

Sonia Awale

Nepal sees spike in suicides during pandemic

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141124/636cfbaa9c7e80680e0a0b46jpeg.jpg" alt="" width="1500" height="1000"/><figcaption>Photo: MONIKA DEUPALA</figcaption></figure>Namaste Aunty,It has been a while. I think the last time we met was at our cousin’s wedding. It was a good one, lasted one whole week, and I can imagine how stressed everyone was, but it went well.It is always a headache to find five different outfits, we cannot repeat saris because God forbid, someone might notice. Also, I did not repeat jewelry because what would people think if I wore the same earrings twice in a week?I know you judged every woman there, you noticed what she wore, how much she ate, who all she spoke to, and you may have also seen some women who were quiet the whole night, either sitting alone staring at the unknown or standing next to their husbands. Not every couple is genuinely happy. But we all gossip and tell tales.But I also know you are strong. To be a woman and a Nepali woman, you have to be. You have the world of responsibilities on your small yet strong shoulders. You have managed households and raised many. I think I am trying to understand how you changed from how I am to what you are at present.I think I know why you are the way you are. It is because we have both lived the same life. You were me at some point, and I hope I am like you in the future, minus some of the qualities that you developed along the way.We both grew up with rules and expectations. We both represented the grace and the shame of our families, where one wrong decision, and we would be scarred for life. That is the life of the <a href="https://www.nepalitimes.com/opinion/boys-will-be-boys-is-never-an-excuse/" target="_blank" rel="noopener noreferrer">woman in our society</a>. We are meant to be pure, untouched and strong enough to wait for a man who comes back home at 3AM.In the beginning, you used to upset me. You always talked about my skin tone, my weight and my <a href="https://www.nepalitimes.com/opinion/dreaded-bliss/" target="_blank" rel="noopener noreferrer">future wedding date</a>. You made me question if I was still of a desirable age. As I grew older, I realised some things.You had a difficult life because you had it more challenging than me. Maybe it was your in-laws, your aunties or the society that tested you every step of the way and hardened your heart with the years.You had to survive, and you did what you had to do to protect yourself. You grew stern and distant. You hid your vulnerability to the point where you forgot you have a heart. You took away your softness to not feel hurt.But when you say something about me, ask yourself if you would do that if I was your daughter. And if you do not have a daughter, think of me as someone you used to be. Please do not teach me also to harden my heart. Please let me live a happy life without the <a href="https://www.nepalitimes.com/opinion/shamed-for-bleeding/" target="_blank" rel="noopener noreferrer">constraints of society</a>. You felt the pain, and you know how much it hurts. I wish for you not to let me go through it.Please try to live the life that makes you happy and <a href="https://www.nepalitimes.com/opinion/maybe-baby/" target="_blank" rel="noopener noreferrer">let me live mine</a> the same way because we only have one. What I feel now is what you felt, you were once tender and kind. It is still there inside you.The beauty in your simplicity is forgotten but remember who you used to be. Remember the light inside you. Remember, you are the same woman who has lived the life we live now and bring to the surface the softness that you have hidden for so long, and all of us will be in a better place.Our lives are divine. Relight the radiance in your compassion. You are a force that can end wars. You are governed by love and kindness. And I know it will be slow, but you and I are meant to get along. You are the light to lead me in the darkness because I trust you to show me the path.Let us not hide the unspoken truth: <a href="https://www.nepalitimes.com/opinion/educating-your-sons-will-protect-your-daughters/" target="_blank" rel="noopener noreferrer">you have been hurt</a>, and you have all suffered, so please understand the pain. Do not hide your true self anymore. It is both our worlds together, let us make it more liveable together.I will always carry love and respect for you in my heart because you taught me that respect is mutual irrespective of age and gender. Help me be a better person. Be the guide that I need. Look at me with the eyes that you wish your aunties looked at you with because you were me once too.I promise to text you before tomorrow’s reception so we do not show up wearing the same shoes.Much love,Your Younger VersionAnjana Rajbhandary lives and works in Chicago. She writes this fortnightly Nepali Times column Life Time about mental health, physical health and socio-cultural issues.

Letter to a Nepali aunty

<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110151112/636d07449c7e80680e0a5fafjpeg.jpg" alt="" width="2560" height="1611"/>It took me months to adjust to lockdown life. Being cooped up in my tiny studio apartment caused a lot of anger and frustration. But as an essential worker at a health centre, I had the freedom to leave the apartment to walk back and forth from work, which helped my mental sanity.This was followed by six weeks of working from home. Being a social person with a wide network of friends, having to stay locked within the four walls was difficult. Living alone, I had to do everything in my power not to lose my mind.I started daily yoga and rode my bike to keep myself physically active and mentally sound. I attempted to meditate several times, but it did not work for me. I Face-timed with people, and though it felt good for the hour that it lasted, once the call was done the emptiness returned.Being an anxious person by nature, spending time alone all day made it worse. You can only watch so much Netflix and exercise to kill the hours. I started to clean more obsessively, but there is a limit to that too. The only respite was the grocery trips, and the chance to get out and breathe fresh air.As a mental health professional, people started asking me how they could take care of themselves in this difficult time. I gave them the best advice I could. But I did not realise that listening to others experiencing the same frustration and anger would only add to my own.Struggling with my inability to stay strong, I started to absorb other people’s negativity and feel weaker by the day. My work recommended we talk to other therapists to help ourselves, and I did. My therapist told me to separate other people’s problems from my own and not take them in, but I could not.I continued to listen to my family and friends about how low they felt. I made sure to be everyone’s cheerleader by checking in on them and encouraging them to try every technique that was proven to work. But while helping others, I did not notice that I needed help myself.I could not share this with others because this was my field of work. How could I, someone trained in helping others with their mental health issues, admit that I was losing my mind?Embarrassed and feeling inadequate, I could not understand how despite following every piece of advice in the book, I could not uplift my spirit. I exercised, ate healthy, cleaned and kept in touch with loved ones, but I kept sinking deeper and deeper into this hole.I kept telling myself that this will pass, and everything will be okay again. I started working with a kind and understanding therapist, and I finally started to feel validated and comfortable in admitting that even mental health professionals need help.Eventually, I got used to the lockdown and staying indoors. I tried gardening, but I could never get myself into it. I moved to another place, and I began to spend time walking in the backyard and looking at the trees and the birds.As the lockdown eased, people were so excited to get back to their everyday lives. I thought I would feel the same. After all, I had been waiting for this and I was fully vaccinated, so I felt safe and responsible about going out.But it had taken me so long to acclimate to being inside that being out in the world again caused me more anxiety. It felt wrong to be outdoors, and I could not enjoy it. I pushed myself to go out and see people, but I would always come home feeling uncomfortable and guilty, thinking of people still struggling at home.A widespread technique practised by mental health professionals is to write down one thing they appreciate in their lives, I started to do that. I am grateful for many things in my life, but the fluctuation between suddenly being stuck indoors and then having the freedom to run around was harder for me than many others that I know of.I find it challenging to go out and enjoy myself also because I got so used to being on my own. Last year in July, one of the psychologists I interviewed for an article had told me that people would have a difficult time readjusting to ‘everyday life’. I could not understand why at the time, but I do now.I have lived in many cities and adjusted to different lifestyles over the years, but by far, this has been the hardest. There is a constant battle between my rational mind, which tells me that we must adjust to changes to live everyday life and move on and my emotional mind that is stubborn and reluctant to change.I am envious of people who can reacclimate when I feel completely stuck. The truth is that, it does not matter what others say, the most important thing is to try and keep trying till you achieve the desired goal.My biggest fear is having to go back to the lockdown days again. See-sawing between a life of freedom and being comfortable on my own is one concern that I never imagined I would have. I did not think it would be this hard.While some people can adapt to changes more quickly, others like me are cautious about adjusting to the new normal because Covid is not over. I yearn for the day when I no longer live in fear. But getting back to my life before the pandemic will not happen overnight. All I can do is be responsible and take care of myself while giving myself time.Anjana Rajbhandary lives and works in Chicago. She writes this fortnightly Nepali Times column Life Time about mental health, physical health and socio-cultural issues.

mental-health