When we talk about mental health, much of the conversation still takes place behind closed doors. For too long, mental health has been understood primarily through the presence or absence of mental illness. But it encompasses far more than a clinical diagnosis. It includes our emotional, psychological and social well-being: how we think, feel, relate to others, cope with stress and participate in our communities.
A person can be surrounded by people and still struggle alone. A student can sit in a classroom full of classmates while quietly falling apart. A worker can show up every morning with a smile while carrying a burden no one sees.
We notice attendance, performance and productivity. We see smiles, conversations and completed tasks. What we often miss is the anxiety before the day begins, the exhaustion carried silently through it and the thoughts that follow someone home.
Perhaps that is why mental health remains such a difficult conversation. We have become better at discussing mental illness, but we are still learning to recognise the conditions that shape mental well-being.
People do not experience mental health in isolation. Their homes, schools, workplaces, incomes, relationships and communities all influence how they think, feel and cope. So, perhaps the question should not simply be, “What is wrong with this person?” It should also be, “What is happening in this person’s life?”
The scale of the challenge
Mental health conditions often emerge early in life, yet many remain unrecognised and untreated. The World Health Organization estimates that one in seven adolescents aged 10–19 experiences a mental disorder. Depression, anxiety and behavioural disorders are among the leading causes of illness and disability in this age group, while suicide remains a major cause of death among young people.
Nepal faces significant challenges of its own. The Nepal Demographic and Health Survey 2022 included a mental-health module for the first time, assessing symptoms of anxiety and depression among women and men aged 15–49. Using internationally comparable criteria, the survey found moderate anxiety symptoms in 33 per cent of women and 21 per cent of men. Among adolescents aged 15–19, Nepal-specific thresholds indicated anxiety symptoms in 13 per cent of females and 7 per cent of males.
The findings also point to a substantial treatment gap. Only 12 per cent of women and 13 per cent of men who reported symptoms of anxiety or depression had sought care. Nepal’s 2021 census estimated a suicide mortality rate of 18.1 per 100,000 people, equivalent to an average of approximately 14 deaths by suicide each day. Research, including findings from the National Mental Health Survey Nepal 2020, also indicates that a large proportion of people with common mental disorders do not receive treatment.
These figures reveal more than the scale of mental-health challenges. They raise questions about whether people can recognise distress, find appropriate support and access care without stigma or other barriers.
In my experience conducting mental-health training and awareness sessions in schools and colleges in Kathmandu, young people are often willing to discuss their concerns. They have questions, experiences and feelings they want to share. What they frequently lack is a safe space to speak openly, reliable information and a clear pathway to support.
In rural communities, the barriers can be different. Some people have limited access to information about mental health and may not recognise psychological distress as a health concern that can be identified, treated and managed. When services are distant, trained professionals are scarce and stigma persists, seeking help becomes difficult even before someone reaches a health facility.
This is why simply telling people to “seek help” is not enough. We must ask a more fundamental question: Have we created the conditions in which people can recognise distress, speak about it safely, access support early and continue receiving care when they need it?
Beyond treatment
If mental health is shaped by the conditions in which people live, learn, work and grow, the response cannot begin and end with treatment.
Counselling, psychiatric care and medication are essential for those who need them. But they are only part of the picture. A public health approach asks us to look upstream, at the circumstances that influence mental well-being long before someone enters a counselling room.
What happens when a child grows up under relentless academic pressure? When a young person leaves school with little hope of employment? When a family faces financial insecurity, violence, substance use or social isolation? Or when someone in a rural community recognises that they are struggling but the nearest appropriate service is hours away?
These are not merely individual circumstances. They are public health concerns.
Recognising this broader picture does not diminish the importance of clinical care. Rather, it highlights the need to combine treatment with prevention, early intervention and action on the social conditions that contribute to psychological distress.
Nepal’s policy response
Nepal has taken steps to integrate mental health into its broader health system. The Public Health Service Act, 2018, and its associated regulations provide a legal foundation for health services, including mental-health care. The National Mental Health Strategy and Action Plan 2020 sets out a framework for integrating services into primary health care, protecting the rights of people with mental-health conditions and strengthening coordination across levels of government.
The National Mental Health Care Programme 2022 further outlines a package of services across different levels of health facilities. Efforts to train frontline health workers in identifying and managing common mental-health conditions also reflect the importance of bringing care closer to communities.
These initiatives point towards a necessary shift: mental-health support should not depend entirely on access to specialist hospitals or services concentrated in major cities. Primary health-care facilities and local governments must play a greater role in prevention, early identification, treatment and referral.
However, policies and programmes matter only when they translate into meaningful support in people’s everyday lives. A policy document cannot, by itself, reduce stigma in a classroom. A national programme cannot automatically make a young person feel safe enough to ask for help. Nor can a specialist service in a major city resolve the access barriers faced by someone living hours away.
The real test of mental-health policy is not simply what is written at the national level, but what becomes possible for an individual in their community.
This requires moving beyond a system that waits for people to become severely unwell before responding. Mental health must be addressed earlier, before distress becomes a crisis, a student drops out, a worker experiences burnout or a family is left searching desperately for support.
Schools can become places where children learn not only mathematics and science but also how to understand their emotions, cope with stress, build healthy relationships and seek help when necessary.
Workplaces can look beyond productivity and recognise the importance of psychological safety, supportive leadership and reasonable working conditions.
Primary health-care facilities can integrate mental-health support into routine services rather than treating it as a separate concern that requires travelling elsewhere.
Communities, too, have an important role. A public health approach does not mean turning everyone into a mental-health professional. It means creating environments where distress can be recognised early, conversations can take place without judgement, basic support is available and people know where to seek specialised care.
It also requires action beyond the health sector. If poverty, unemployment, violence, social isolation, unsafe environments and educational pressure affect mental well-being, then schools, workplaces, municipalities, social services and other public institutions all have a role in protecting it.
Listening to people with lived experience
Mental health cannot be improved by the health sector alone. Because it is shaped by social, economic, environmental and individual factors, it requires a coordinated response across society.
Perhaps this is the shift Nepal needs to make: from treating mental health as a specialised service for a relatively small group of people to recognising it as a shared public health responsibility.
We need accessible mental-health services, but we also need mentally healthier schools. We need psychiatrists and counsellors, but we also need supportive families, safer workplaces and connected communities. We need treatment for those who are unwell, but we must also invest in prevention for those at risk.
Most importantly, seeking help should become an ordinary part of looking after our health. A person should not have to reach a crisis before someone asks how they are doing. A student should not have to leave school before we recognise that something is wrong. A worker should not have to break down before a workplace acknowledges the pressure they are carrying. And a family should not have to overcome multiple barriers before mental-health support becomes available.
As we mark World Mental Health Day, we must also move beyond talking about people experiencing mental-health conditions and begin listening meaningfully to people with lived experience (PWLE).
Their experiences are not simply personal stories. They are a valuable source of knowledge that should inform how we design policies, deliver services and make decisions. People with lived experience must have a meaningful role in shaping the systems intended to support them, rather than being treated only as recipients of care.
This means involving them in policy development, programme design, service evaluation and decisions about their own care. It also means recognising their dignity, respecting their autonomy and ensuring that their voices are heard without stigma or prejudice.
Ultimately, the question is not only how we can treat people when they become unwell, but also how we can build a society that supports mental well-being, prevents avoidable distress and makes care accessible to everyone.
Mental health does not begin when someone enters a counselling room. It is shaped much earlier, in our homes, schools, workplaces and communities.
This World Mental Health Day, let us move from awareness to meaningful action, and from designing mental-health systems for people to building them with people with lived experience.
