Scaling up suicide prevention in Nepal: a collaborative effort

The COVID-19 pandemic had a profound impact on mental health worldwide, with evidence pointing to an increase in anxiety and depression. In response to concerns around increased risk of suicide, Nepal has intensified its suicide prevention efforts. The Parliamentary Committee on Women and Social Affairs met to accelerate suicide prevention efforts, and a national mandate has since paved the way for the development of a national suicide prevention strategy and the establishment of a dedicated mental health and suicide prevention office.

"We are in a critical moment for mental health and suicide prevention, there is momentum, there is will and commitment from the grass roots level to national authorities" said Dr Rajesh Sambhajirao Pandav, WHO Representative to Nepal.

National leadership and strategic action

The government of Nepal, with support from the World Health Organization (WHO), the United Nations Development Programme (UNDP)and local NGOs, has taken critical steps to address suicide. A national suicide prevention action plan is being developed, led by the National Planning Commission in Nepal. This plan aims to ensure coordinated efforts among key stakeholders, accountability and sustained political commitment to suicide prevention.

Nepal is working to move beyond the often fragmented and one-size-fits-all approaches to suicide prevention. Guided by WHO's LIVE LIFE initiative, Nepal has adopted a multifaceted strategic approach to suicide prevention that acknowledges the complex nature of suicide and engages relevant stakeholders. The Ministry of Health and Population (MoHP) Nepal, in collaboration with WHO, convened a series of policy dialogues to engage municipal representatives, including mayors, local administration officers, and health section chiefs, in the implementation of comprehensive and community-based approaches to mental health and suicide prevention.

Limiting access to highly hazardous pesticides

Phasing out highly hazardous pesticides is a critical intervention in suicide prevention. Through collaborations with the health and research sectors, data on self-poisoning incidents were used by authorities within the agricultural sector to advocate for stricter regulation. Since 2019, Nepal has banned 26 highly hazardous pesticides. These bans, supported by research showing no negative impact on agriculture, are expected to significantly reduce suicides by pesticide poisoning, as has been the case in other countries in the region enacting bans.

Media personnel participate in training on responsible reporting of suicide in Nepal. @ WHO Nepal

Supporting responsible media reporting on suicide

Responsible media reporting can increase awareness about mental health and suicide, challenge stigma and misconceptions, as well as promote help-seeking behaviours. Sensationalized reporting can, however, inadvertently increase the risk of imitative suicidal behaviours. Recognizing the critical role of the media in suicide prevention, WHO Nepal, in collaboration with the National Health Education Information and Communication Centre (NHEICC), has trained 293 journalists on responsible media reporting practices, using WHO's resource for media professionals which has been endorsed by the Department of Health Services.

Prioritizing early interventions and follow-up support

The Government of Nepal is prioritizing early identification of suicidal behaviors and follow-up support through capacity building for primary care workers and gatekeepers (people likely to come into contact with at-risk individuals). Local adaptation of WHO's Mental Health Gap Action Programme (mhGAP) has led to the development of a National Mental Health Care Program 2022. A capacity building program, endorsed by the Government, has also been developed for school nurses, counselors and teachers in collaboration with WHO and UNICEF. Moreover, MoHP and WHO, using mhGAP resources, are working towards a national protocol for assessment and management of people with suicidal behaviour to provide focused guidance to assess suicide risk at health facilities as well as tailored support.

A 24/7 suicide prevention helpline, supported by WHO and a local NGO, has been established by the MoHP. Extensive and coordinated awareness raising campaigns promote the helpline and suicide prevention included walkathons, cycle rallies, and drama performances. The helpline has already provided ongoing counseling to over 700 individuals.

Cycle rally to raise awareness for suicide prevention and the crisis helpline. @ WHO Nepal

Strengthening surveillance for targeted intervention

To effectively address suicide, Nepal has also prioritized the development of a suicide and self-harm case registry. This tool, which is currently being piloted in two districts, will help monitor trends in suicidal behaviour, identify at-risk groups, and guide future interventions and service provision, ensuring that efforts are both targeted and effective.

Dr Pandav reflects on the significant progress made in Nepal, stating "Nepal's comprehensive approach to suicide prevention is laying a solid foundation for lasting change. Continued monitoring and collaboration will be crucial to sustaining this momentum." With coordinated actions like pesticide bans, media training, and community support, Nepal is making bold strides to reduce suicide and create a healthier future for all.

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