For over eight years, working closely with individuals and families in mental health care in Nepal has repeatedly shown me a difficult reality: we often begin trying to understand suicide only after a crisis has occurred. Families arrive frightened, devastated and searching for an explanation.
“He was always a strong person.”
“He was the person who counselled others when they were struggling.”
“He was always the one motivating the rest of us.”
“He seemed perfectly fine.”
These reactions reveal something about how we understand psychological distress. We tend to associate vulnerability with visible weakness. We assume that a person who supports others must themselves be coping; that someone who appears confident, successful or emotionally strong cannot also be struggling internally; or even that a professional who understands mental health should somehow be protected from experiencing psychological distress themselves.
But psychological suffering does not work that way. Being resilient does not mean being immune to distress. Being the person others depend on does not mean that person always knows how to ask for help. And professional knowledge does not make doctors, psychologists, counsellors or other mental health professionals immune to psychological distress themselves.
Seeing red
As we mark World Suicide Prevention Day, this is one narrative I believe we urgently need to change in Nepal: the idea that suicide happens only to people who are visibly vulnerable or “not strong enough.” Sometimes, the people carrying significant distress are also the people everyone around them considers the strongest.
Perhaps one of the greatest contradictions in the way we discuss suicide is that we can be remarkably willing to talk about it when it happens in someone else’s family, yet deeply uncomfortable discussing psychological distress within our own. We speculate about why someone died, what went wrong in their relationships, family or career, and who might have been responsible. But when someone sitting at our own dining table says, “I am not coping,” our response can quickly become, “Don’t think like that,” “You need to be stronger,” or “When I was your age, we went through much worse.”
Often, these responses come from love rather than indifference. Parents want their children to become resilient; families want to reassure someone that their problems can be overcome. But reassurance can become dismissal when we compare one person’s suffering with another’s. The unintended message can become: your distress is not serious enough to deserve attention.
One of the most important lessons I have learned through my clinical work is that the event immediately preceding a suicidal crisis is not necessarily the whole story. A relationship may have ended, an examination may have failed, a job may have been lost, or a financial crisis may have occurred. From the outside, it is tempting to conclude: that is why it happened.
But when we work more closely with people in distress, a much more complicated picture often emerges. A relationship breakdown, for example, may initially appear to be the central problem. As therapy progresses, we may discover long-standing insecurity, fears of abandonment, low self-worth, unresolved emotional experiences, or symptoms of depression and anxiety that existed well before the relationship ended. The breakup mattered deeply, but it may have been the trigger rather than the entire explanation.
That distinction matters. Suicidal distress rarely fits neatly into a single explanation. Hopelessness, shame, loneliness, feeling trapped, financial difficulties, family and social expectations, relationship problems, and untreated mental health difficulties can interact and accumulate over time. What becomes visible to everyone else may simply be the final crisis in a struggle that has been developing for much longer.
Another pattern I have encountered is the feeling of becoming a burden. Some people begin to believe they are failing the expectations of their parents, spouse, children or friends. Their circumstances narrow around them until they struggle to imagine that things could become different. At precisely the time they most need connection, they may withdraw from it.
Sometimes that withdrawal has a history too. A person may have tried to talk before, only to hear, “Don’t make such a big issue out of it,” “You need to be strong,” or “We went through much worse in our time.” Eventually, they may stop trying to explain themselves. This is why suicide prevention cannot begin only when someone says, “I want to die.” It must also involve creating an environment in which people can talk about distress much earlier and have confidence that somebody will take them seriously.
I have met families who, after a suicide, remember moments when they had sensed something was wrong—a change in behaviour, a concerning statement, or something that simply did not feel right—but accepted the person’s reassurance that everything was fine. This is not about blaming anyone. Most people are simply not equipped to assess suicide risk or know what to do next. Prevention therefore requires more than recognizing warning signs. We also need to know how to respond.
Another common myth is that asking someone about suicide will put the idea into their mind. It does not. When we notice significant withdrawal, isolation, hopelessness, self-harm or unusual behaviour, we should not be afraid to ask if they are okay. When seriously concerned, we can ask directly about suicidal thoughts. Listen without judgment, take the distress seriously and help the person access professional support. If there is immediate risk, do not leave the person alone and seek urgent help. Sometimes prevention begins with one person noticing, listening and staying present.
Looking back at many crises I have encountered, I often wish support had begun months earlier. Families should not wait for a suicidal crisis before seeking professional help. There is also a misconception that approaching a mental health professional means hospitalization. Often, early support may simply involve assessment, counselling, treatment and helping the person develop healthier ways of coping. We need to seek help when distress begins, not only when it becomes an emergency.
Suicide prevention cannot be the responsibility of mental health professionals alone. Prevention begins in homes where distress can be discussed without judgment; in schools where behavioural changes are recognized rather than simply disciplined; and in workplaces where struggling is not automatically interpreted as weakness. We do not all need to become counsellors, but we can become better at noticing, listening and knowing when to seek help.
There are reasons to be hopeful. Over the past decade, I have seen a noticeable change, particularly among young people in Kathmandu. More are willing to talk about their mental health and seek counselling or psychiatric support when they are struggling. But this change is not reaching everyone equally. Outside major urban centres, stigma, limited awareness and a lack of accessible services can still make seeking help difficult. The next step for Nepal must be to take the mental health conversation beyond Kathmandu—through community awareness, accessible services, and confidential, non-judgmental support that people can reach before distress becomes a crisis.
For years, we have told people who are struggling to speak up, reach out and ask for help. But perhaps changing the narrative requires something from the rest of us too.
When someone finally says, “I’m not okay,” are we prepared to listen without judgment, without comparing their pain with our own, and without simply telling them to be strong?
Suicide prevention is not only about encouraging people to speak. It is also about creating families, communities and institutions where they feel safe enough to be heard.
After years of working in mental health, this is what I have come to believe: sometimes the most important question is not why someone did not ask for help, but whether we had created a space where they believed they could.
The author is the director of the Chaitanya Institute for Mental Health, Nepal.
