<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

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Nepal sees spike in suicides during pandemic

<figure><img width="1500" height="842" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101116/636b70529c7e80680e060071jpeg.jpg" alt=""/><figcaption>Photo: SONIA AWALE</figcaption></figure>Michael Eddleston is a professor of Clinical Toxicology at the University of Edinburgh with over two decades of experience in suicide by ingesting pesticide. He is also the director of Centre for Pesticide Suicide Prevention and was recently in Nepal as a principal investigator of a research analysing self-poisoning in the country. Excerpts of his conversation with Nepali Times.Nepali Times: What is pesticide suicide?Michael Eddleston: All of us feel suicidal from time to time. Unless you are very depressed or have a mental illness, you survive the feeling and move on with your life. The green revolution brought highly toxic pesticides into homes that people drank in the moment of impulse without a second thought. Suicide rates went up massively in Asia because spontaneous acts of self-harm became lethal. These are accidental suicides, people don’t really want to die, drinking pesticide or a poison in many parts of Asia is an expression of anger or frustration.What is the burden of pesticide suicide in the region?Pesticide suicides have killed some 15 million people, mostly in this region of South and East Asia since the 1960s. The numbers have come down to about 150,000 people a year. China alone used to have 180,000 pesticide suicides per year back in the 1990s and it has come down to 50,000, partly due to mechanisation and restriction of Highly Hazardous Pesticides (HHP). In Nepal, 15-20% of suicides are from ingesting pesticides and about 1,000 people die every year. Read also: <a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/here-now/suicide-by-pesticide-in-nepal/" target="_blank" rel="noopener">Suicide by pesticide in Nepal</a>, Sonia Awale<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/here-now/nepals-suicide-rate-vastly-underestimated/" target="_blank" rel="noopener">Nepal's suicide rate vastly underestimated</a>, Sewa BhattaraiDo 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 Organization-Nepal Crisis Hotline: 1660 0102005Mental Health Helpline Nepal: 1660 0133666What can we do about it?Ideally we could move away from all pesticides like Sikkim has done with natural farming. But this might take time so for now the simplest answer is to ban HHPs and replace them with less toxic chemicals. So when people take poison, it’s not toxic and they don’t die. There’s a clear data from Sri Lanka, Bangladesh and South Korea showing that when you ban just a few particular pesticides which people are commonly using for self-harm, the suicide rate falls rapidly and remarkably without affecting agriculture output. Sri Lanka banned Monocrotophos and Methamidophos in 1995 and in the next 20 years there was 70% reduction in all suicides saving around 93,000 lives at a cost of $50 per lives saved. This is one of the most effective public interventions from anywhere in the world. So legislation does work.What are the most toxic pesticides in Nepal? Dichlorvos and 3g tablets of Aluminium phosphide are the most hazardous pesticides in Nepal and the good news is that both of these have been addressed by the government already, they were recently banned. We are also identifying another toxic compound, a combination of Chlorpyrifos and Cypermethrin. What we have seen from case studies elsewhere is that after each ban something new always comes up but we have also found that they always kill less than those prior pesticides. https://www.youtube.com/watch?v=Dy5SX0RnYhA&amp;feature=youtu.beHow can we be sure people won’t go for another method after the ban?Yes, people often argue that pesticide bans don’t work, they will simply do something else. But that something else is often further away. I can walk to a tree to hang myself or to jump off a bridge but by that time I get there I might get bored, meet a friend on the way or get distracted one way of the other. Pesticides have high toxicity because they are hazardous and close by but if you switch to something else it will always be less toxic. And what we have seen in Sri Lanka is that when you ban pesticides, people don’t switch to other things and don’t attempt suicide again because they are not intended to begin with. But are you not treating a symptom rather than a disease, which is mental illness?Yes I accept that we are not dealing with the cause, but with the symptom but I want people to live. If you don’t live, you can’t see your psychiatrist. And it is not purely mental health. It’s also about culture and communication. If I have no other way of telling people how angry or upset I am, then I will stand in front of you and drink a bottle of pesticide to tell you how I feel. It is the same in the UK, Nepal and Sri Lanka. The only difference is the lethality of method. So I can’t stop suicide or self-harm as an individual but I can stop people from dying after self-harm, which means they get a chance to seek help if necessary.It’s a concept of harm minimisation, it’s not stopping people from self-harm because it’s difficult to change human behaviour and how people direct their anger and violence towards themselves or other people but we can make it safe. Which groups are more vulnerable?When we look at the patterns of self-harm, it’s found among young women between 15-20 years of age more than in anybody else. Women are generally sober and take a very small dose of poison. If you get rid of HHPs, these women suicides fall away and that was the case in China and Sri Lanka. Middle-aged men have more deaths because they tend to be intoxicated when they take poison and they take it in a higher dose so even if it’s a less toxic poison, the higher dose is enough to kill them. Suicide is a combination of people harming themselves and lethality of the method. How has the progress been in Nepal so far?Pesticide suicide in Nepal is comparatively smaller but that is also probably due to the number of bans the government has implemented over the last 15 years. Methyl parathion was a huge problem here in the 1990s and 2000s until it was banned and now there are no cases of suicides using this pesticide. It has been replaced more recently by Dichlorvos but that was also recently banned and will be out of shops in couple of years. There has been a remarkable changes going on here in Nepal to remove the most toxic pesticides and replace them with less hazardous alternatives. Tell us about your work here in Nepal.What we are trying to do in Nepal is work with our clinical colleagues, Nepal Public Health Foundation and the police laboratories to identify the most problematic pesticides that are killing people in Nepal and once we identify those, we will take that information to the concerned authorities and see how they want to move with that. Nepal has made a success and has thought about pesticide suicide carefully. What we are doing is bringing the focus on suicide and showing how to get rid of accidental suicides.

Suicide Watch

<figure><img width="1500" height="1000" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101116/636b70369c7e80680e060067jpeg.jpg" alt=""/><figcaption>A customer buys a bottle of pesticide over a counter in Kathmandu. Photo: MONIKA DEUPALA</figcaption></figure>Of the 25,308 <a href="https://archive.nepalitimes.com/article/nation/down-and-out,3158" target="_blank" rel="noopener">suicides</a> recorded by the police in Nepal in the past five years, poisoning was the method of choice of 6,213 and pesticides were the most common form of poison used. Suicide by <a href="http://archive.nepalitimes.com/news.php?id=17916#.XhbkaVUzaUk" target="_blank" rel="noopener">pesticides</a> is the easiest, cheapest and the quickest way to kill oneself in Nepal.A <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-017-4542-y" target="_blank" rel="noopener">2015 study in Chitwan</a> showed that 90% of all poisoning cases resulted from deliberate ingestion of pesticides. Hospital and forensic data over the years reveal that pesticide self-poisoning kills at least 1,000 people in Nepal annually.“Pesticides are in fact a far greater threat than what police records show. There are many people who make the attempt and survive due to insufficient dose or medical treatment,” says Ravi Shakya, a mental health specialist at Patan Hospital. “If we also count attempted suicides, pesticide is the most preferred method of suicide in Nepal.”Read also: <a href="https://www.nepalitimes.com/here-now/nepals-suicide-rate-vastly-underestimated/" target="_blank" rel="noopener">Nepal's suicide rate vastly underestimated, </a>Sewa BhattaraiShailesh Thapa Chhetri of Nepal Police agrees: “Previously, hanging used to be the most common method of suicide, as people had the easiest access to ropes. Now, access to pesticides is even easier. Almost every household has pesticides, whether to kill cockroaches or to spray in the farms.”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 Organization-Nepal Crisis Hotline: 1660 0102005Mental Health Helpline Nepal: 1660 0133666And as the import of pesticides increases, the hazardous chemicals will only be more accessible for self-harm. The Ministry of Agriculture and Livestock Development claims that Nepal’s pesticide consumption is 396g per hectare but research by the Netherlands-based Wageningen University shows it to be <a href="https://www.nepalitimes.com/from-the-nepali-press/banned-pesticides-are-widely-used-in-nepal/" target="_blank" rel="noopener">2.9kg per hectare in vegetable patches</a>. “Pesticides that kill people are readily available in the market, they do not need prescriptions and anyone can buy it,” says Dilli Ram Sharma, former Director General of the Department of Agriculture. “To make matters worse, farmers <a href="https://archive.nepalitimes.com/article/nation/pesticide-laced-vegetables-continue-to-poison,1555" target="_blank" rel="noopener">always go for the most toxic ones</a> that kill all pests at once.”Read also: <a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/latest/suicide-watch/" target="_blank" rel="noopener">Suicide watch</a> <figure><img width="1500" height="844" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101116/636b70399c7e80680e060068jpeg.jpg" alt=""><figcaption>Agrochemical shops in across the country provides easy access to the hazardous pesticides. Photo: BiIKRAM RAI</figcaption></figure>A <a href="http://www.forensic.gov.np/assets/upload/images/pdf/Trends-of-clinical-toxicology-cases-in-Nepal.pdf" target="_blank" rel="noopener">2014 National Forensic Science Laboratory study</a> that looked at the trends of clinical toxicology cases in Nepal from 2002-2012 showed that of the total poisoning cases due to insecticides, 71% were by ingesting the organophosphorus compounds Metacid (Methyl parathion) and Nuvan (Dichlorovos). Pyrethroid, carbamate and organochlorine were also used. Some of these pesticides are actually banned in Nepal, but available over the counter. A Central Police Forensic Science Laboratory study conducted over the past three years shows organophosphorus compounds and aluminium phosphide as the most common active ingredients in poisoning cases. Data from seven tertiary hospitals across Nepal found Celphos (aluminium phosphide used to kill rodents) as the most common pesticide in those admitted for poisoning. The <a href="https://www.centrepsp.org/" target="_blank" rel="noopener">Centre for Pesticide Suicide Prevention</a> in collaboration with the University of Edinburgh and Nepal Public Health Foundation is collecting three years worth of hospital and forensic data to analyse self-poisoning. Prof Michael Eddleston of the University of Edinburgh is the principal investigator and was recently in Nepal. “I don’t think it’s ever possible to use pesticide safely. You have to make pesticides non-toxic to humans, animals and the environment. We are trying to identify the problematic pesticides that are killing people here and provide that information to the concerned authorities so that they are banned and replaced with safer pesticides,” Eddleston told Nepali Times.The Nepal Public Health Foundation is also organising a two-day national conference (9-10 January) focussed on <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/rooftop-gardens-kathmandu,1415" target="_blank" rel="noopener">healthy farming</a> and reducing pesticide use.Indeed Bangladesh, Korea and Sri Lanka have shown that removing highly hazardous pesticides from <a href="https://archive.nepalitimes.com/article/nation/heavy-pesticide-use-and-low-consumer-awareness-affecting-public-health,1394" target="_blank" rel="noopener">agricultural practice</a> is key to preventing suicide deaths without affecting agricultural output. The good news is that some of the most toxic pesticides are being banned in Nepal. In 2019, when the Centre for Pesticide Suicide Prevention pinpointed Dichlorvos and 3g tablets of aluminium phosphide as the most common causes of pesticide suicide in Nepal, the Plant Quarantine and Pesticide Management Centre placed a ban on both the pesticides, to be enforced after a grace period of two years for the chemicals already on the market.  Similarly, before Metacid (Methyl parathion) was prohibited in 2006, up to 68% of Nepalis killing themselves were using the chemical. After the ban, this figure came down to 8%.“Prevention is better than cure and that is exactly what pesticide ban does. And this has a double benefit: it reduces suicide death while also bringing down the rampant use of pesticides in agriculture, leading to a decline in pesticide residue,” adds Sharma, who retired after banning the two pesticides.Despite the ban, however, the smuggling of pesticides across the open border with India remains a challenge, and experts call for crossborder cooperation to fight it.  Says Rakesh Ghimire of Teaching Hospital: “Control of pesticides especially in agricultural areas is important, but as important is pesticide information centres and treatment when the poisoning happens.”

Suicide by pesticide in Nepal

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