Suicide prevention hotlines in Nepal: Slow progress calls for an integrated response

In the last fiscal year 2020/21, the Nepal Police recorded 7,141 suicide cases. Among them, 3,938 of the suicide victims were men, 2,449 women and the remaining children.

Nepal Police data alone shows that the number of suicides increased by 14.2% from the previous fiscal year 2019/20 despite suicide prevention efforts from government and non-government sectors.

As one of the important parts of suicide prevention strategies, several hotlines are operational in Nepal with the aim of providing empathetic support and anonymous counseling to people with suicidal thoughts.

Although these hotlines have benefited many callers by deterring suicidal thoughts and instructing them to seek medical attention, their ideal effectiveness is still uncertain due to the lack of a proper integrated system and coping strategies. suicide prevention, which requires multi-sector roles, see helpline operators, mental health experts and other stakeholders.

Focus on empathetic support, but not enough followings

Photo: Andreas Nadler/Flickr

According to Dr. Rabi Shakya, head of the department of psychiatry at the Patan Academy of Health Sciences, an average of about three calls reach the hospital’s helpline in a day asking for help.

Patan Hospital has been operating a 24-hour suicide prevention hotline since 2016 as part of its suicide prevention strategy.

Looking at the data of phone calls received from suicidal people over the past six months, the number of male callers is higher than that of females, Shakya informs. Most of them are young people.

There is a team of eight doctors at the hospital to handle these calls. Yet, there is no such system as follow-ups.

“We assume the caller stopped his decision to kill himself once he hung up the phone, although we don’t know his decision,” Shakya says. “Our main goal is to provide therapy-based advice and convince them to seek medical help and visit the hospital.

“Unfortunately, we do not track any callers. We don’t have a rescue team either. If a caller comes to visit us for medical support, we assume the helpline has been effective,” Shakya informs.

An official from the Department of Psychiatry and Mental Health at Tribhuvan Teaching Hospital shares the main aim of the Suicide Prevention Hotline, officially launched a year ago, is to provide emotional ventilation while maintaining confidentiality and emphasizing their problem-solving techniques. .

Similarly, Parbati Shrestha, project coordinator at Transcultural Psychosocial Organization Nepal (TPO Nepal), a suicide prevention NGO, says that on average, her organization receives about eight calls a day. There are three full-time psychologists who are responsible for advising callers. They listen to their issues, question their expectations, and build trust that whatever the caller shares will be kept private so they can open up more comfortably.

“The psychologist tries to find out if their problems are related to mental health issues or if they have taken medical support to deal with this problem. Based on the conversation, the psychologists analyze if the caller needs help. regular support or not and follow up with these callers and provide regular support and if necessary we also put them in touch with psychiatrists.

Effectiveness evaluation

Photo: Ccnull

According to Shrestha, many people with suicidal thoughts are reluctant to seek help from healthcare facilities and to share their problems with family and friends because of the social stigma attached to mental health issues and suicide. Therefore, suicide prevention hotlines that maintain caller confidentiality can be effective.

Psychologist Kripa Sigdel says brief interventions have been effective in reducing suicidal thoughts among callers around the world. In countries like Nepal where there is a social stigma around suicide, it works much better, she argues.

However, the question arises about the supervision of helplines. Sigdel doubts that there has been any monitoring of the effectiveness of helplines whether they perform follow-ups and whether they have supported callers with coping techniques and much more.

“It is very important to reflect and work on next steps after calls. For example, after ending calls, relevant stakeholders should think about how and where to send them for advice or how to provide regular support “, she believes.

As a result, in some cases requiring physical intervention, TPO’s Shrestha says her organization immediately alerts the police while keeping callers engaged and rescuing them in time. Out of 616 calls from the suicide prevention hotline number 1166 operated jointly by the Psychiatric Hospital and the TPO, around 137 people came to seek support from psychologists, she reports.

Similarly, out of around 120 calls received by the suicide prevention hotline run by TUTH and handled by a team of three psychologists and nine psychiatrists 24 hours a day, around 38% of the calls come from the inside the Kathmandu Valley.

Among them, five callers went to TUTH for medical support, informs the head of TUTH.

Meanwhile, stating that awareness of mental health issues, including suicide prevention and helplines, is very city-centric, psychologist Sigdel suggests the country needs to improve the effectiveness of helplines. existing hotlines instead of adding numbers.

Then it will be easier to maintain the data and perform checks and balances. Moreover, this topic should always be addressed in speeches, advises Sigdel.

Meanwhile, Shrestha and Shakya stress the need for a multisectoral role in tackling this major health issue. Shrestha explains: “Many people don’t yet realize or recognize suicide as a mental health issue for which a person can seek medical help, in the presence of social stigma and lack of awareness. In order to fight this stigma and prevent suicides, all sectors including media, NGOs, government, academic institutions, pesticide distributors and other stakeholders need to work actively and in integration.

Government efforts

To improve the effectiveness of these helplines, the government approved the National Mental Health Strategy and Action Plan, which included suicide prevention as one of its main elements.

“We worked only according to this plan. At the same time, we recognize and support the efforts of non-governmental sectors in suicide prevention and mental health issues,” shares Dr. Phanindra Prasad Baral, Chief, Mental Health Section, Division of Epidemiology and Disease Control Department. of health.

According to Basanta Kunwar, a former spokesperson for the Nepal Police, police personnel have also rescued people who have attempted suicide after being informed by various individuals and groups, including the helpline operators.

If you need help :

  • Patan Hospital Suicide Prevention Hotline: 9813476123
  • TUTH Suicide Hotline: 9840021600
  • Government Suicide Prevention Hotline: 1166

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