Mental health in Nepal has become an issue of growing concern, with a significant rise in mental health disorders, stress, anxiety, depression, and cases of suicide. According to the latest report from Nepal Police, an average of 17 people die by suicide every day, a staggering statistic that highlights the urgency of addressing mental health challenges in the country. While there are psychiatrists and clinical psychologists working diligently to treat mental disorders, the role of trained counselors and therapists is equally important, especially in prevention, early intervention, and helping individuals manage various life stressors. However, the lack of a formal licensing body for counseling and therapy practice raises concerns about the quality and efficacy of mental health services provided in Nepal.
The Existing Framework: Psychiatrists and Clinical Psychologists
In Nepal, psychiatrists are licensed under the Nepal Medical Council and are responsible for diagnosing and treating mental disorders through medical and therapeutic interventions. They are often the first point of contact for individuals with severe mental health issues and are medically trained to handle a broad range of psychiatric conditions.
Similarly, clinical psychologists, who are registered with the National Health Professional Council, play a crucial role in the mental health ecosystem. They work alongside psychiatrists in multidisciplinary teams to provide psychotherapy, behavioral interventions, and psychological assessments, helping to reduce symptoms and improve the quality of life for individuals with mental health conditions. Clinical psychologists focus on evidence-based therapeutic techniques to help patients navigate complex psychological issues and disorders.
The Role of Counselors: Prevention, Support, and Treatment
Counseling, while distinct from psychiatry and clinical psychology, is an essential component of mental health care, primarily focusing on prevention and better management of both diagnosed and undiagnosed mental health conditions. Counselors assist individuals in dealing with a variety of life issues, including relationship problems, career decisions, stress management, and general well-being.
Counselors are often the first point of contact for many individuals seeking mental health support, helping prevent the escalation of mild psychological distress into more severe mental disorders. However, the challenge lies in the fact that counseling in Nepal is not uniformly regulated. Semi-trained and fully trained counselors are practicing without a standardized framework for competence and accountability. This has resulted in variations in the quality of services provided, potentially jeopardizing the mental health of the individuals they serve.
Diverse Training Levels in Counseling
Mental Health and Human Rights
In Nepal, counselors receive a wide range of training, which leads to varying levels of competency and specialization in their practice. Generally, these can be categorized into three broad types based on their education and the duration of training.
Six Months Training: First, there are individuals who have undergone a short-term training program, typically lasting around six months. This group is often involved in providing basic counseling services, particularly in settings where access to more specialized professionals is limited. Their role is usually focused on offering support and guidance in addressing everyday stressors and challenges.
PG Diploma Degree: Next, there are those who have completed a one-year academic program, such as a Postgraduate Diploma in Counseling Psychology. This group has received more structured training in counseling techniques, preparing them to address a wider range of issues, including emotional and psychological well-being, in educational institutions, community organizations, and other settings where intermediate-level counseling is required.
Two Years Degree: Finally, there are professionals who have pursued a full two-year master’s degree in Counseling Psychology. These individuals possess the advanced training necessary to offer specialized services, including working with individuals experiencing mental health disorders, trauma, or significant life challenges. Their training equips them to provide more in-depth therapeutic interventions and support, often in clinical settings or specialized institutions.
These diverse training pathways have created a range of competency levels in the counseling profession, but the absence of a formal regulatory framework to distinguish between them has led to some confusion and inconsistency in the delivery of mental health services.
The Need for a Licensing Body: Standardization and Accountability
Given the varying levels of training and practice in the counseling profession, there is an urgent need for a formal licensing body that can standardize the qualifications, competencies, and scope of practice for counselors and therapists. Such a body would ensure that individuals seeking counseling and mental health support receive high-quality, evidence-based care from properly trained professionals.
We propose the establishment of three levels of counselors:
Para-Counselors: These individuals should hold a bachelor's degree in any field and complete a minimum of six months of training in counseling. They can provide basic counseling services, particularly in community-based settings.
Associate Counselors: Individuals who have completed a one-year Postgraduate Diploma in Counseling Psychology. They can work in more specialized areas such as schools, NGOs, and community health programs.
Counselors: Professionals with a minimum two-year master’s degree in Counseling Psychology. These counselors should be allowed to provide therapy for a range of issues, including mental health disorders, stress, and trauma management.
This structured categorization ensures that individuals receive the appropriate level of care based on the counselor’s qualifications and training. Furthermore, it brings clarity and credibility to the counseling profession in Nepal, allowing clients to make informed decisions when seeking mental health support.
The Phasing Out of MPhil Degrees and the Need for PhD Training
It is important to reserve the title “psychologist” for individuals with PhD-level education, following international norms. The MPhil degree, which was once considered an advanced qualification in the field of psychology, is gradually being phased out in India and other parts of the world. This change reflects a global shift toward more rigorous and research-oriented PhD training for clinical and counseling psychologists, as well as organizational psychologists.
In Nepal, it is essential to adopt this international standard, ensuring that individuals with master’s degrees in counseling psychology are called counselors or therapists, while those with PhDs in the field are recognized as psychologists. This differentiation not only maintains the integrity of the profession but also aligns Nepal with global practices, ensuring that mental health services are delivered by highly qualified professionals.
Grandparenting: Recognizing Pioneers in Counseling Practice
In the context of formalizing a licensing body for counseling and therapy in Nepal, it is crucial to recognize the contributions of professionals who, despite having a general psychology degree, have played a significant role in shaping the mental health landscape. These individuals have been pillars of counseling and therapy practice, providing essential services and training in the absence of structured licensing frameworks.
A "grandparenting" scheme should be introduced to allow such experienced professionals to obtain formal licensing based on their years of practice, contributions, and demonstrated competency in the field. This approach acknowledges the invaluable work of those who have long been involved in counseling and therapy but may not have had access to specialized postgraduate training programs at the time.
Under the grandparenting scheme, these professionals would undergo a structured evaluation process, considering factors such as:
- Years of relevant experience in counseling and therapy.
- Evidence of contributions to mental health services, such as training, program development, or direct client work.
- Continuing education or professional development efforts in psychology or counseling-related fields.
By implementing this scheme, Nepal can ensure that experienced practitioners receive the formal recognition they deserve while upholding the quality and standardization of mental health services. This inclusive approach helps to bridge the gap between past and present training frameworks and ensures that highly skilled professionals can continue to serve the community under the new licensing regulations.
