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Unaddressed mental illness crippling Nepal’s productivity: Dr Ritesh Thapa
Mental health problems are escalating rapidly across Nepal, taking a heavy toll on social harmony and worker productivity, costing more than Rs 18 billion annually. Yet government efforts in early prevention, public awareness, and access to treatment remain critically inadequate
Psychiatrist Ritesh Thapa. All photos: Bidhya Rai
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KATHMANDU: Various studies have shown that mental stress, anxiety, depression, and despair have seriously impacted the work capacity and productivity of Nepalis. The country suffers an economic loss of more than Rs 18 billion annually due to mental illness. However, even as the problem continues to grow, there is a lack of adequate budget, infrastructure, and skilled human resources for its prevention and treatment. In this context, edited excerpts of a conversation conducted by Bidhya Rai with psychiatrist Ritesh Thapa, who works in the mental health sector in the UK, during his visit to Kathmandu:
What changes did you find in society upon returning to Nepal after five years?
Society turned out to be quite changed. I found that people have become more enraged and impulsive than before, and the tendency to dispute over minor issues has increased. While traveling on the road for about an hour in Lalitpur and Kathmandu, I saw disputes occurring in 3 places between drivers of motorcycles, taxis, and public buses. This is not a good sign.
Previously, there was not this much anarchy in our society. Now, even over minor dissatisfaction, a tendency to move toward extremely harsh or violent reactions is visible. I also felt that incomplete knowledge formed from 15-second content on social media is increasing anger and anarchy.
Knowledge helps understand situations from a different angle. When knowledge is incomplete, anger dominates in many situations, and a person can become reactive. Nepali society used to be known for respect and hospitality. Foreigners also used to say that Nepalis are honest. I felt as though that identity were somehow fading away.
How do you view the anger and frustration seen in the new generation?
It is natural for the new generation to be more active and to some extent more enraged than the older generation. However, frustration is seen more in South Asia, including Nepal. The mindset of “anything goes” or “I will show them” has also increased.
A tendency is seen to present even the violence in political movements and damage to structures of national importance as achievements. This also indicates something about the mindset of the youth.
The younger generation, especially Gen Z, has grown up in an environment that expects immediate results. They see the development and service delivery of developed countries on the internet and seek similarly fast, easy, accessible, and quality services in Nepal as well. However, the socio-economic condition of the country is different.
They do not have direct experience of what a struggle-filled life the previous generation lived. Frustration can grow when they do not immediately get changes like those seen on the internet. This is not only their fault; the social and technological environment in which they grew up has also constructed such a psychology.
Compared to the available healthcare workforce, the patient burden is overwhelming. In Nepal, a single doctor has to examine 150 to 200 patients a day, whereas in the UK, seeing around five patients daily is considered sufficient.
A tendency is also seen to immediately accept something if liked and immediately boycott it if disliked. Such an exclusionary habit is not healthy.
After seeing a classmate who studied with them go abroad, get a job, or make financial progress, one may feel pressure to achieve that accomplishment immediately as well. Such aspirations and expectations increase stress among the youth.
They are heavily dependent on technology. They may find it tedious when having to wait in line to receive services at public bodies because they grew up in an environment where many services, from shopping to payments, are received instantly right from the mobile phone in hand.
How is social media impacting mental health?
In Nepal, I see that more attention is given to negative content than to the proper use of social media. There is a tendency to harm others, spread hatred, and fuel anger based on incomplete or false information.
It is not that nothing has happened in Nepal over the past 30 years. Changes have occurred in many sectors. However, negative narratives have become more dominant through social media.
I also used to look at information on social media a lot at one time. Later, I realized that doing so was not right. It is difficult to distinguish between correct and incorrect information there. Therefore, one should follow reliable sources for information and intelligence.
Rather than depending solely on 15-second incomplete content, one should cultivate the habit of reading books, listening to detailed podcasts, and using reliable sources that provide full details.
The UK government is also celebrating 2026 as the ‘National Year of Reading,’ stating that increasing dependence on social media is impacting children’s thinking, understanding, upbringing, and education.
What are the main causes behind mental health problems?
Its causes are multidimensional biological, personal, economic, and social. If the previous generation of a family had mental health problems, certain problems can also appear in the later generation. This is the biological or hereditary aspect. The way an individual thinks and the style of receiving others’ input also affect psychology.
Mental stress, anxiety, and depression have severely eroded worker productivity, costing Nepal over Rs 18 billion annually in economic losses. Yet, despite this escalating crisis, prevention and treatment efforts continue to suffer from critical shortages in funding, infrastructure, and skilled healthcare personnel.
Social causes like violence, abuse, and discrimination can seriously affect mental health. Domestic violence does not only involve physical violence; it also generates mental stress and pain in the victim.
Unemployment, economic hardship, decline in agricultural production, and poverty are also linked to mental health. If a family struggles to fulfill basic needs for a long time, it can lead to mental health problems.
Nepal is at high risk of disasters. Earthquakes, floods, landslides, inundation, heavy rainfall, drought, cold waves, and heatwaves do not only cause physical damage; they can also have long-term effects on the mental health of affected individuals.
What changes have you seen in mental health after the earthquake, the COVID-19 pandemic, and recent political developments?
We saw an increase in the number of people coming with mental health problems after the 2015 earthquake. After that came the COVID-19 pandemic. After COVID-19, people started talking about mental health issues more openly than before. However, many people had to struggle with the economic crisis.
Recently, there were political movements and changes of power. Youth lost their lives, and damage was caused to national structures. Fires, commotion, and a conflict-ridden environment increased fear, terror, and despair from children to adults.
Even with political changes, public life has not been able to change as expected. People are forced to go abroad to fulfill basic needs. Inflation and financial burdens are increasing. This can increase problems like depression and anxiety. When not finding healthy ways to cope with problems, some people may become dependent on alcohol or drugs.
I remember a person I met after the 2015 earthquake. Their house and property were destroyed in the earthquake, and the family suffered great loss. Afterwards, while coping with sleeplessness and mental pain, they started becoming dependent on alcohol.
The effect of such events can be even more long-term in children. The instability, conflict, destruction, and anger seen and experienced during childhood can affect their mental health for a long time afterward.
How can the general public distinguish the symptoms of depression and anxiety?
When experiencing depression, a person can remain sad for a long time. Interest in activities that previously felt enjoyable may decrease. Students may not feel like going to school or college, working individuals may find it difficult to go to the office, there may be a desire to stay isolated from family and friends, and energy and vitality may decrease.
Symptoms such as feeling annoyed or irritated and increased irritability may also appear. If such symptoms persist continuously for more than two weeks, it is appropriate to be cautious and consult a specialist.
In anxiety, excessive worry, fear, or apprehension of something bad happening can dominate. Even if a person is managing a livelihood, work productivity and daily life can be impacted.
When experiencing depression, an individual may also exhibit extreme despair and signs of risk. Therefore, rather than ignoring symptoms as ordinary, one should seek timely medical assistance.
How do mental health problems differ according to age and gender identity?
In children, problems can arise when they do not receive family love, affection, and adequate care. Adolescents can be affected by physical and emotional changes and fluctuations in relationships.
Adults face pressure to earn an income and bear family responsibilities. Gender and sexual minorities can suffer mental health impacts when facing rejection, discrimination, violence, and abuse from family or society.
Pregnant women and new mothers can have their mental health affected due to pregnancy anxiety and lack of support from husbands or families. According to statistics from the World Health Organization (WHO), mental health problems are also significantly seen in pregnant women and new mothers.
Mental health problems in old age are somewhat different. Other physical illnesses are also added with age. Memory power may begin to weaken, and it can gradually take a serious form.
What kind of mental health problems are seen in senior citizens?
Symptoms of anxiety and depression can be seen. Behaviors such as increased irritability, unwillingness to take medicine or food, sadness, anger, crying, or seeking the company of sons and daughters more frequently may be observed. After dementia begins, memory power and daily life tasks start being affected.
What are the reasons behind the increase in dementia among senior citizens? How can it be managed?
As the average life expectancy of Nepalis increases, the number of dementia patients is also likely to increase. In dementia, memory power gradually weakens.
Problems like repeatedly checking whether a task has been completed or forgetting what was eaten or done a short while ago may appear. Such behaviors can also create stress in the family.
Merely talking about transforming Nepal into Singapore or Switzerland is meaningless while citizens struggle to meet their most basic daily needs. The government must first prioritize fundamental living conditions before expecting public mental well-being to improve.
Incidents of senior citizens with dementia getting lost after forgetting their way also happen. Therefore, if memory problems increase abnormally, the family must have them tested.
Treatment to completely cure dementia is currently not available, but timely identification, proper care, and management can help slow down the rate at which the problem becomes complex.
It is not good to frequently change the room of a person with dementia. A familiar environment makes them comfortable. One can designate a single room, place clocks and calendars in visible locations, and keep reminding them of the day and date.
If there is a habit of frequently stepping outside the home, an identification card or paper containing the family’s contact details can be kept with them. In case they get lost after forgetting the way, it helps establish contact with the family.
What is the situation of mental health services and human resources in Nepal?
It is extremely limited. There is only one government hospital dedicated to mental health treatment across the country, the Mental Hospital located in Patan.
According to records of the Department of Health Services, OPD services from psychiatrists are available in around 36 government hospitals nationwide, including Mental Hospital, Patan Hospital, and the Teaching Hospital located in Maharajgunj. Ward services are available in only 11 of those hospitals.
Compared to the available human resources, the patient pressure is very high. In Nepal, a situation exists where one doctor has to examine 150 to 200 patients a day. In the UK, it is sufficient for me to examine around five patients a day.
If we seek service according to foreign standards, human resources must also be managed accordingly. Access to and quality of mental health services will not improve merely by imposing excessive patient pressure on doctors.
In terms of mental health services, Nepal is far behind the UK.
What is the situation of public awareness regarding mental health?
It has been 15 years since I started working in the mental health field. During this period, people’s awareness regarding mental health has increased. However, it is not enough for awareness to increase only in cities; it must reach villages.
There is still a lack of public awareness in rural areas. The government should regularly disseminate information through its radio, television, newspapers, and news agencies. Previously, awareness-raising programs appeared more frequently on radio and television; now, such content is seen less.
How can the fear and shame regarding mental health treatment be removed?
One should not feel ashamed or hesitate to seek treatment for mental health problems. There is also a misconception that once mental health medication is started, it must be taken for a lifetime.
Just as treatment for other physical health issues is taken normally, treatment for mental health should be taken the same way.
What should the government do in the field of mental health?
The first task is to expand public awareness to every village and neighborhood. Adequate budget must be allocated to build the necessary human resources and infrastructure for disease identification and treatment.
When making policy decisions, the government must also assess the economic and psychological impacts they might have on citizens. Long-term uncertainty regarding whether to invest in sectors like the stock market, trade and business, hospitals, or colleges should not be created due to frequent changes in policy.
When formulating policies, programs, and plans related to mental health, in-depth discussions must be held with experienced psychiatrists, nurses, and psychosocial counselors. Every healthcare worker should be provided training in basic psychosocial counseling. That will help identify the patient’s problems and refer them to a psychiatrist if necessary.
The subject of mental health should be included in the curriculum starting from the school level. This should be kept under high priority by the government.
Merely talking about making the country Singapore or Switzerland is not enough. In a situation where citizens cannot even fulfill basic needs, attention should first be directed towards that.
Because both awareness and testing have increased recently, dementia problems in senior citizens may have begun to be identified more frequently. The census of 2021 has also indicated that the number of senior citizens will increase in the future. Keeping that in mind, plans should be made right now.
Human resources working on senior citizens and their mental health must be produced. Necessary infrastructure must be constructed. The need for quality care homes in the public or private sectors will also continue to grow. To ensure the service quality of such institutions, the government should formulate clear standards and conduct effective monitoring.
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