The cost of pretending everything is okay

“I’m fine” can sometimes be an ordinary answer to an ordinary question. But for people experiencing emotional distress, repeatedly saying it can also become a way of hiding problems that they do not feel able, or permitted, to discuss.

In Nepal, where mental health is increasingly entering public conversation, the pressure to appear fine can remain powerful. A person may continue going to work or college, meeting friends, taking care of family responsibilities and participating in everyday life while privately struggling with anxiety, depression, grief or other forms of psychological distress.

That does not necessarily mean the person has a diagnosable mental disorder. But when distress is consistently concealed, opportunities to recognise a problem and seek support can be missed.

Nepal's National Mental Health Survey found that 10 percent of adults had experienced a mental disorder at some point in their lives, while 4.3 percent had a mental disorder at the time of the survey. Yet concerns about how others might react were among the barriers associated with seeking care. A 2025 WHO report on Nepal says 15.6 percent of adults surveyed in the 2020–2021 National Mental Health Survey were concerned they might be seen as weak for having a mental-health problem, while 10.5 percent feared being seen as “crazy.”

Those numbers help explain why saying “I’m fine” can sometimes be more than a casual response.

When silence becomes a coping strategy

People do not always hide distress because they do not need help. Sometimes they fear what acknowledging the problem could mean.

Research in Nepal has identified reluctance to talk about feelings, concern about family reactions, embarrassment, fear of being considered weak or “crazy” and concerns about employment among barriers to mental-health care. A community study conducted in Chitwan found that financial difficulties were also a major barrier.

The fear of being judged

Mental-health stigma is not simply a matter of using insensitive language. It can influence whether people disclose symptoms, whether families encourage treatment and whether individuals feel safe approaching a health facility.

WHO's 2025 assessment of mental-health conditions in Nepal identifies social and cultural stigma as a significant barrier to accessing services. It also identifies limited awareness, lack of family support and inadequate access to services as additional barriers.

A recent qualitative study in Sudurpashchim Province found that people with mental-health conditions could face derogatory labels, social avoidance, exclusion from family or community activities, and other forms of discrimination. The study also documented beliefs that some mental-health problems were caused by divine punishment, evil spirits or past wrongdoing.

In such an environment, hiding a problem can appear safer than explaining it.

Someone who says they are exhausted may be expected to work harder. Someone who is persistently worried may be told not to think too much. Someone grieving may feel pressure to recover quickly. Someone experiencing depression may simply withdraw without explaining why.

None of these reactions proves that a person has a mental disorder. But they can make it harder to have an honest conversation about mental wellbeing.

Functioning does not always mean feeling well

One of the difficulties in recognising mental-health problems is that distress does not always look dramatic.

People can continue meeting deadlines, attending classes, earning money, caring for children and interacting socially while experiencing significant emotional difficulties. A person does not have to visibly “fall apart” before their wellbeing deserves attention.

This is why mental-health awareness is not only about identifying severe illness. It is also about creating conditions in which people can talk about distress before it becomes more difficult to manage.

Nepal's mental-health system has historically faced substantial gaps in service availability. WHO reported that in 2021 only about one in four health facilities offered mental-health services, with services concentrated largely in major cities.

Access has been expanding. Nepal joined WHO's Special Initiative for Mental Health in 2021, and the programme has supported the integration of mental-health services into primary healthcare. WHO reported in 2025 that thousands of health workers had been trained in identifying, managing and referring people with common mental-health conditions, with services becoming available through dozens of health posts and municipal primary-care centres.

In Karnali and Sudurpashchim, 133 health workers were trained between June 2024 and September 2025 to identify and manage conditions including depression, anxiety and alcohol dependence.

These changes matter because asking for help is meaningful only when some form of help is actually reachable.

The cost is not always visible

The “cost” of pretending everything is okay is therefore not necessarily a single dramatic consequence.

It can be the missed conversation with a friend.

The appointment that was never made.

The symptom that was never mentioned to a doctor.

The family member who knew something was wrong but did not know how to ask.

The person who believed that asking for help would make them look weak.

Mental-health problems also do not exist separately from financial and social circumstances. WHO's 2025 assessment notes that out-of-pocket costs remain an issue for many people and that shortages of human resources can mean treatment is provided by non-specialists.

For someone already reluctant to disclose distress, these practical barriers can reinforce the decision to do nothing.

A culture that is beginning to talk

Nepal's public approach to mental health is changing.

In December 2025, the government launched a National Mental Health Campaign aimed at reducing stigma, normalising help-seeking and ensuring children and adults know where to seek support. WHO and UNICEF said mental-health challenges among children and young people remained significantly underrecognised and undertreated.

In April 2026, Nepal also began consultations to develop a National Mental Health Strategy for 2026–2030, bringing together representatives from health, education, labour, women and children, home affairs and other sectors.

These efforts point to an important shift: mental health is increasingly being treated as part of public health rather than something that individuals and families must handle privately.

But policy change does not immediately change everyday behaviour.

People still need spaces where saying “I’m not okay” does not automatically invite ridicule, shame or judgment.

That can begin with relatively simple changes in how families, schools and workplaces respond. Listening without immediately dismissing someone's feelings, avoiding labels, taking persistent distress seriously and encouraging appropriate professional support can make it easier for people to speak honestly.

The goal is not to treat every difficult emotion as a disorder. Sadness, stress, grief and worry are part of ordinary human experience. The important distinction is whether distress is persistent, severe, worsening or interfering with a person's ability to function and live safely.

In those circumstances, pretending that everything is fine does not make the problem disappear.

Sometimes, the most useful response to “I’m fine” is not to challenge the person or demand an explanation. It is simply to leave the door open: “If you ever want to talk, I’m here.”

For a country working to reduce mental-health stigma, that kind of everyday response can be part of a larger cultural change—from hiding distress to making it possible to ask for help.

The cost of pretending everything is okay

In Nepal, stigma, family expectations and limited access can encourage people to hide emotional distress, while recent mental-health initiatives seek to normalise conversations and help-seeking.

When silence becomes a coping strategy

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