September 10 marks World Suicide Prevention Day. It is also the final year of WHO's global campaign theme, Changing the Narrative on Suicide, accompanied by a simple call to action: Start the Conversation.
As a doctor, I often meet people who tell me they never saw it coming. After a suicide, family members and friends search for warning signs and ask themselves what they could have done differently. Too often, they are left only with regret.
The truth is that suicide is often far more difficult to recognise than we would like to believe. Many people experiencing suicidal thoughts do not tell others directly that they are struggling. Some fear being judged, others worry about burdening loved ones, and some simply cannot find the words to describe what they are feeling. This makes suicide not only an individual tragedy but also a major public health challenge.
Nepal's numbers should concern all of us. Although authorities are yet to release consolidated figures for the last fiscal year, Nepal Police records for 2024/25 show nearly 6,900 suicide deaths, or about 19 deaths every day. Men accounted for most of these deaths, although the burden among women and adolescents remains significant. Hanging was involved in most cases, while self-immolation was among the least common methods.
Yet a series of public self-immolation cases in mid-2026 received widespread national attention. These tragedies triggered extensive media coverage, protests and political debate about socio-economic hardships and government policies. While multiple social and economic factors may have contributed, the intense publicity surrounding these incidents also raises concerns about possible contagion effects among vulnerable individuals, a phenomenon well documented in suicide-prevention research. This underscores the importance of responsible media reporting and careful public discussion of suicide-related events.
Police data show that suicide deaths have remained persistently high in recent years, with annual figures approaching or exceeding 7,000. Experts have noted that Nepal's suicide rate has risen significantly over the past decade rather than declined.
Behind every statistic is a person who believed, even if only briefly, that there was no other way forward. Behind every death is a family struggling to make sense of an unimaginable loss. One misconception I frequently encounter is the belief that suicide is always the result of a long and carefully planned process. While that can be true, research and clinical experience show that some suicidal crises are remarkably brief. Sometimes, a split-second decision can lead a person to take their own life.
Overwhelming emotional pain, acute conflict, financial setbacks, examination failure or intense hopelessness can temporarily narrow a person's ability to see alternatives. If support becomes available during that critical period, the outcome can be very different. This is why conversation matters.
Many people worry that asking someone about suicide will increase the risk or plant the idea in their mind. Evidence does not support this fear. On the contrary, asking direct and compassionate questions can help people feel understood and create an opportunity to seek help before a crisis escalates.
The signs are not always dramatic. A person may withdraw from social activities, lose interest in activities they once enjoyed, experience persistent sadness or irritability, struggle with sleep, increase their use of alcohol or other substances, or express feelings of hopelessness and worthlessness. None of these signs automatically means someone is suicidal, but noticeable changes in mood or behaviour deserve attention rather than dismissal.
It is equally important to recognise that suicide rarely has a single cause. Mental disorders such as depression, bipolar disorder, substance use disorders and psychotic illnesses can increase vulnerability, but they are only part of the picture. Relationship difficulties, unemployment, debt, social isolation, chronic illness, academic pressure, and experiences of violence or loss may also contribute. In many cases, several factors converge at the same time.
Nepal has recently decriminalised attempted suicide. Criminalisation never addressed the underlying problem; it only deepened the stigma faced by survivors and their families. That stigma persists today as well. We must stop viewing suicide through a moral or criminal lens and recognise it as a public health and social issue.
Young people deserve particular attention. Globally, suicide remains one of the leading causes of death among adolescents and young adults. In Nepal, many are growing up amid intense academic competition, uncertainty about employment, migration-related family separation and the constant influence of unregulated social media content. Most cope well; some do not. We have seen students in competitive academic programmes take their own lives. We should not wait for tragedy before investing in emotional wellbeing in schools and colleges.
Preventing suicide is not the responsibility of psychiatrists or police alone. It requires families willing to listen, teachers who recognise distress, employers who take mental health seriously, journalists who report responsibly, and policymakers who invest in accessible mental health services.
People in crisis rarely need perfect words. They need someone willing to listen without judgment and take their suffering seriously. A conversation may not solve everything, but it can be the first step toward recovery. Every life is precious, and every act of care can make a difference.
In Nepal, anyone in emotional distress can seek support through the toll-free Suicide Prevention Helpline at 1166.
This World Suicide Prevention Day, we must move beyond awareness as a slogan. The real challenge is whether we are prepared to notice distress, reach out to someone who seems different, and have a conversation that may feel uncomfortable but could be lifesaving.
Dr Adhikari is a neuropsychiatrist
