A 70-year-old woman from Tyamkemaiyum Rural Municipality of Bhojpur recently visited the nearby health post at Kot for the treatment of her respiratory problems after she experienced shortness of breath.

The woman told the health workers that she has been suffering from chronic obstructive pulmonary disease and high blood pressure but had stopped taking medicines for both ailments several weeks back.

“The woman complained that since her ailments were not cured, she had stopped taking the medicines,” said Ganesh Rai, a public health inspector at the health post. “The woman also told us that she did not want to live any more. She was severely depressed.”

This is a common refrain of many people who suffer from mental health problems. They seek care at their nearby health facilities, but most of the state-run centres in the country lack mental health experts.

Moreover, none of these state-run health facilities has a clinical psychologist, as the Ministry of Health and Population has not recruited one, ever. Clinical psychologists are mental health professionals with highly specialised training for diagnosis of mental ailments.

“Whenever there are discussions over mental health problems, everyone agrees clinical psychologists are as important as psychiatric doctors,” said Dr Mita Rana, associate professor at the Department of Psychiatry and Mental Health of the Institute of Medicine under the Tribhuvan University. “But the reality is that the health ministry has not recruited clinical psychologists.”

So far, the Institute of Medicine has produced around 40 clinical psychologists. Of them, more than half a dozen have migrated overseas.

Psychologists holding bachelor’s or master’s degrees in the field have been serving across the country but no agency in the country issues a working licence to them.

“Nepal Health Professional Council registers clinical psychologists, but for that, one has to pass an MPhil-level course,” said Rana. “We have been drawing the attention of the agencies concerned. All of them acknowledge the problem but nothing substantive has been done yet.”

Officials at the health ministry concede that their system doesn’t recognise psychologists and no psychologist serves under the health ministry.

“We have proposed to hire at least one clinical psychologist for a 500-bed hospital, but our proposal is still under consideration,” said Dr Phanindra Baral, chief of the mental health section at the Epidemiology and Disease Control Division. “No one can deny the role of psychologists in dealing with the rising mental health problems in our country, but the authorities are still unable to decide on seeking their help and regulating their services.”

Experts say many psychological problems get solved by proper counselling. Due to a lack of counselling services at the health facilities, there is also the risk of prescribing wrong medicines to patients needing counselling, doctors say.

Rai, the public health inspector in Bhojpur, said that after all their efforts to convince the above-mentioned woman to resume her medicines failed, the health workers informed her son, who lives outside the district with his family, about her health condition. They asked him to consult psychologists and psychiatric doctors at a big hospital.

“We told her son that the discontinuation of medicines for hypertension and respiratory problems without a doctor’s advice will have grave consequences,” said Rai. “If we had a psychological counselling service at our health facility, we would not have had to refer patients to big hospitals in cities.”