A major feature of our healthcare system is that we have a single key to open all locks. For all sorts of problems we have a doctor, namely, a primary care physician or non-specialist, who is already overburdened. These doctors usually do not have the time to listen to patients with symptoms of mental health problems
Nepal's Ministry of Health recently finalised the organogram of a local 15-bed primary hospital. But it fails to include a human resource dedicated to mental health. Recent reports show that mental health problems are rising. According to WHO's 'suicide worldwide' report of 2019, suicide rates in Nepal, Japan and Germany are 9.8, 12.2 and 8.3 respectively.
According to the World Health Observatory, the number of psychiatrists available per 100,000 population in these three countries is 0.36, 11.87, and 13.2 respectively. Likewise, the number of psychologists available per 100,000 population in these countries is 0.52, 3.04, and 49.55 respectively.
Thus, the responsibility of care to be provided to mental health patients in Nepal comes under primary care physicians who are already overburdened.
The official findings clearly show that non-communicable diseases are more prevalent, and mental health problems are rising, such as anxiety, depression, suicide, schizophrenia, substance abuse, violence and digital addiction.
When I started to work as a primary care physician, one of the main challenges was dealing with patients with mental health concerns.
Unlike physical illnesses, a mental illness patient requires adequate time for appropriate counseling, which we don't have.
Most primary care providers also lack basic skills in counseling and don't have any alternate human resources to deal with such patients. I could refer the severe cases to a psychiatrist.
But what about for mild or moderate problems? Just giving a few minutes to them is insufficient to know the problem details and to make appropriate decisions for comprehensive (humane) and sustainable solutions.
Our present care for mental illness is more medical dominant, limited to treating the physical aspect of a person. One mistake we make is that we consider doctors or drugs to be the final authority in all sorts of health-related concerns.
However, a doctor should not be held liable to solve the defects in the policy.
Moreover, we cannot expect the doctor to visit people with mental health issues in the community.
That could be the role of separate health personnel - social worker, psychologist, counselor, nurse or doctor focussed on mental health and well-being. In many nations with better healthcare systems, the psychological or counseling approach is used as an integral part of the health service.
The government is implementing programmes for non-communicable diseases and mental health, but this is more medical-oriented, and it has undermined the importance of lifestyle factors.
For non-communicable diseases, lifestyle modification is an important part of care which can be facilitated better by a counselor.
Psychological or counseling service is the rational service needed for everyone, even the people who do not have signs or symptoms of mental illness.
Right to health won't be ensured unless we prepare for the basic care to be available to anyone, not to be limited to the right to physical health. Regarding mental illnesses, more mass awareness activities are also needed. The solution to mental illness begins when we start to look at things more fairly. It is only possible when we come above the stigma and myths. People should be encouraged to talk about the mental health issues they are having and share the problems. Asking for help is not a sign of weakness, rather it is the right human approach. It could be due to physical health, relationship issues, social situations, family, financial, or other personal issues.
Understanding and managing mental health problems can be diverse.
Some of them take a few sessions of talking or sharing, and/or learning a coping skill. Some may need more counseling sessions and also need to have compliance with medication.
Though taken under the same category 'mental illness': mild anxiety or severe psychosis are different diseases with different levels of severity.
A major feature of our healthcare system is that we have a single key to open all locks. For all sorts of problems we have a doctor, namely, a primary care physician or non-specialist, who is overloaded to take care of gynecological or obstetric, orthopedic, pediatric, medical, surgical, emergency, and many other types of cases. These doctors usually do not have the time to listen to patients with symptoms of mental health problems.
Doctors are more trained in medical management and can prescribe medicines.
Though they know the important role of counseling approaches, they are insufficiently trained in them. Hence, to complement the services of the physicians, a trained person in psychosocial counseling approaches for mental health is needed.
Our healthcare system is medical-dominated, and we rarely provide services of counselors or psychologists.
We also do not have an autonomous body to regulate psychosocial service providers. Having different categories of licences for counselors or psychologists has not been made mandatory.
Counseling is not advising, or suggesting. Its core is attempting to understand the problem of the person, and attempting to assist the person to look for an appropriate solution. It has rational approaches based on behavioural, neurological and psychological sciences combined.
The service of counselors or psychologists is helpful not only to make people's mental health normal but also to make apparently healthy people more organised, productive and purposeful.
For a short-term solution, we can train health service providers, such as social workers, paramedics, nurses or doctors on psychological counseling and/or medical treatment whenever relevant. In the long-term, we should integrate the service of mental health counselors or psychologists into the primary health facility.
A version of this article appears in the print on August 29, 2022 of The Himalayan Times.
