Ankur Counseling and Training Center
Nepal Youth Foundation Nepal
Overview
Mental health, which encompasses both mental well-being and mental illness, is a crucial component of overall health. According to the National Mental Health Survey 2020 done by Nepal Health Research Council (NHRC), approximately 10% of the adults had experienced a mental health disorder in their lifetime, and 4.3% of the population of 15,088 (including 9,200 adults and 5,888 adolescents) were identified as having a mental disorder. The prevalence of suicidality was notably high at 7.2%, highlighting a significant need for mental health services. Mental health is considered a critical public health issue, often described as the “submerged portion” of an iceberg. This metaphor serves as both a warning and a call to action for mental health professionals to work toward reducing the prevalence of mental health issues through their expertise.
Mental Health Workforce
Professionals who provide mental health services, whether specialized or general, are collectively known as the mental health workforce. This workforce includes a diverse range of professionals such as psychiatrists, psychologists (both clinical specialists and graduates in psychology), primary care physicians, psychiatric nurses, mental health and substance use counselors, social workers, care managers, community psychosocial workers and individuals with lived or ongoing experiences of mental health challenges who are actively engaged in service delivery. Many psychologists and counselors in Nepal have graduated from Tribhuvan University (TU), obtaining various degrees including Master’s, PhD, and even bachelor’s and post-bachelor’s degrees. The TU Institute of Medicine (IOM) also produces MPhil graduates, and a small number of NGOs have been training psychosocial counselors on six-months counseling training modality based on the needs of their projects. However, only MPhil graduates from the IOM are licensed by the Nepal Health Professional Council (NHPC). There is a need for clearer monitoring and supervision, as many practitioners (both self-certified and certified by international boards) are currently practicing without a national regulatory body. The Nepalese government has overlooked this issue, allowing the potential for malpractice and lack of accountability. Adherence to ethics and professional boundaries has become a significant concern, particularly for Nepalese psychologists (with MA degrees) and mental health counselors, mostly having six-months training (psychosocial counselors).
Need for Regulation and Guidelines
Although the Nepalese government has issued a few written statements acknowledging the necessity for guidelines and a national board for mental health professionals, progress remains limited. The Public Health Service Act 2018 emphasized the need to establish a regulatory body to oversee the quality of services provided by available human resources, ensuring a balance in their production and utilization, as noted in the Public Health Services Regulations 2020. Additionally, the National Mental Health Strategy and Action Plan (2022) provides a step-by-step strategic action plan for the mental health workforce. The National Health Care Program 2022 offers guidance for service providers regarding the required human resources and the capacity building that should be supervised by the NHTC. While the National Integrated Health Information Management System recognizes the need to include this information in its database, many national-level policies and strategies have yet to be effectively implemented. In 2018, the Epidemiology and Disease Control Division (EDCD) of the Department of Health Services (DoHS) was designated the official unit to oversee and operationalize mental health services. The EDCD has established five key strategies to improve access to mental health services. One significant obstacle to further development and delivery of mental health care is the absence of a social welfare network or umbrella organization governed by the government.
Survey on Mental Health Workforce in Nepal
Recently, an online survey was conducted to assess the current situation of the mental health workforce, their needs, and ongoing practices. Thirty-five respondents, all graduates of TU currently working as expert mental health professionals in national and international organizations, participated in the survey. The survey results could be an eye-opener for the Nepalese government, revealing the absence of a national board, lack of guiding protocols for professional ethics, insufficient supervision and monitoring, and no provisions for ongoing education or professional training and research. Nonetheless, all participants stated they adhere to international guidelines for professional ethics. The survey highlighted an urgent need to establish a national-level body for certification and governance of the mental health workforce. Key feedback from the survey emphasized the following necessities:
- There is a need for a robust licensing system grounded in professional qualifications, ensuring that every mental health professional possesses a legitimate and recognized identity. This will help unite mental health and psychosocial support (MHPSS) workers.
- A dedicated certification process should be introduced to acknowledge the expertise of individuals with international degrees, which will broaden the talent pool in our mental health workforce.
- It is essential to achieve a balanced production and utilization of the mental health workforce to effectively meet the growing needs of our communities.
- The mental health and well-being of caregivers must be safeguarded, as they play a vital role in the overall healthcare system.
- We should champion the Nepal government’s national policies, planning, and strategies to foster a robust and responsive mental health infrastructure.
- Decentralizing the mental health workforce will promote greater accessibility and responsiveness across various regions.
- Collaboration and coordination between the government and other organizations should be strengthened to create a cohesive mental health support network. It has become evident that there is a need for a connection between mental health policy, strategic planning, implementation, and the mental health workforce for the promotion, prevention, treatment, and recovery of mental health.
The government of Nepal could establish comprehensive guidelines for overseeing mental health workers, particularly those holding a master’s degree and higher (excluding psychiatry and MPhil). Whether providing one-on-one clinical services, group services, or community mental health services, the mental health workforce has been contributing both directly and indirectly to support the government’s implementation of its mental health program policy and strategic goals.
Therefore, the mental health workforce can assist the government in preparing and implementing effective policies while ensuring that the guidelines are applied correctly. It is recognized that both the mental health workforce in Nepal and the government need to explore ways to create a supportive environment that facilitates the strengthening of mental health services and collaboration among mental health workers. The conclusions of an online survey and this article also highlight the pressing need to bridge the gap between government policy and the current mental health services available, particularly through psychologists.
The author presented the findings of the survey at the 2nd International Conference in Community Mental Health in Chitwan, Nepal May 1-3, 2025.
Chhori Laxmi Maharjan, PsyD, completed her Doctoral degree in Clinical Psychology from California Institute of Integral Studies in 2019. She specialized in SandPlay therapy for children with trauma and Psychodynamic Psychotherapy. Her career in psychology began in 2004 serving adults and children living with HIV/AIDS. From the beginning of her career, she felt a special connection with children experiencing family separation and associated with childhood traumas. That lead her to join Nepal Youth Foundation in 2006 as a psychologist. Now she is the director and principal psychologist of Ankur Counseling and Training Center within Nepal Youth Foundation. She provides psychological counseling services to individuals on a daily basis. She also leads training and other outreach programs provided by Ankur in the areas of child development, adolescents health, peer counseling, parenting, teacher’s training, psychological first aid, self-care, among others. She has been offering clinical supervision to mental health professionals. She is a part time ( adjunct faculty) teacher for the Mphil program at Institute of Medicine, Tribhuvan University and Psychology Departments/Program (Central, PK and counseling psychology).
Leave a Reply