Yvonne I. Larrier
Indiana University South Bend
Indiana University South Bend
Yvonne I. Larrier, Counseling & Human Services Department, Indiana University South Bend; Valerie Ratner, Indiana University South Bend. Correspondence concerning this article should be addressed to Yvonne Larrier, Counseling & Human Services Department, Indiana University South Bend, South Bend, IN 46615. E-mail: email@example.com
Developing countries are a primary focus in evaluating global mental health. The field of school counseling has the potential to act as the bridge between mental health needs and the delivery of evidence-based support. Research efforts to evaluate the underdevelopment and underutilization of mental health services in developing countries may assist in reducing stigmatization of counseling services, and subsequently promote the advocacy of culturally specific needs (Raney & Çinarbas, 2005). Stigmatization of mental health services is proposed as a hindrance in the development of school counseling programs. Researchers aim to decrease stigma in both community and school settings in the advocacy of students in developing countries. Efforts to investigate societal beliefs and stigmatization include analysis of general community, administrative, and teacher perspectives (Stockton & Güneri, 2011; Ibeziako, Omigbodun, & Bella, 2008). Ibeziako et al. (2008) argues that “despite evidence on the prevalence of child mental health problems and disorders in developing societies, there has been limited research on how these problems are perceived…”. The literature review at hand aims to provide an assessment of research on perceptions of mental health in developing countries in relation to school counseling services. The research collected places emphasis in analysis of developing countries’ counseling training resources, school counseling identity, perception of mental health issues, and implications in culturally-sensitive counseling development.
A common theme in journal articles regarding school counseling in developing countries is overall lack of education for school counselors, which suggests some overlap in with stigmatization of the mental health services. Stockton and Güneri (2011) propose that underdeveloped counseling education in university settings contributes to the stalling of growth in school counseling. In 2006, Turkey created 39 university-setting counseling programs to meet the need for school counselors. Of the 39 programs, 14 were graduate settings, and 25 were undergraduate training programs (Stockton & Güneri, 2011). The need for school counseling in Turkey is reported as severe enough that undergrad degrees in counseling are based on necessity.
Inconsistency in training programs and virtually no accreditation system have exacerbated efforts to meet school counseling needs. Stockton & Güneri (2011) also reported problems with the content training programs, citing a lack of emphasis in the developmental approach to student mental health as contributing to misconceptions of counseling. Skills development and few hours in practicum are neglected as well.
Stigmatization of mental health services may be partially related to the misconceptions regarding the identity of a school counselor and further confusion of the difference between counseling and guidance. A lack of consistent definition of the roles of a school counselor may affect the perception of the field, adding to stigmatization (Stockton & Güneri, 2011). Stockton & Güneri (2011) noted an association with the term “counselor” and misconceptions of counseling identity. The perception of school staff included a belief that counselors attended only to students with severe problems; and that counselor duties were perceived as remedial rather than preventive (Stockton & Güneri, 2011).
The interchangeable use of “counselors” for “guidance teachers” has also been suggested as adding to stigmatization, in which school counselors were thought of as “teachers who did not teach classes” and “privileged school staff with excessive free time and less work than typical teachers.” This type of stigmatization was shown to be adventitiously reinforced when school counselors were given administrative work (due to a perceived lack of duties), likely contributing to the confusion of counselor identity (Stockton & Güneri, 2011). This cycle of stigmatization could be identified as an issue to target in increasing utilization of mental health services. Strong and consistent definition of counselor roles and duties in education programs and in in school systems may aid in the strengthening of mental health services in developing countries.
Along with counselor identity and duties, Ibeziako et al. (2008) suggests school staff confusion over the mental health services for which a student is applicable, which is likely due to cultural views on what is considered abnormal behavior. Studies have suggested that only adolescent behaviors that affect the teachers’ classroom duties are given school counseling attention (Ibeziako et al., 2008). Ibeziako et al. (2008) adds that “teachers and staff are likely to highlight problems they believe affect the teachers’ ability to educate. This might explain the focus given to mental illness manifesting as problems with academic performance while behavior disorders were not considered to be mental health problems.” Teacher training in mental health issues and support may aid in reducing stigmatization of what behavior and issues are considered as applicable in counseling.
Perception on Mental Health Issues
The underutilization of and lack of development of school mental health services is addressed regarding community and school staff perceptions and stigma. In a study by Ibeziako et al. (2008), key informant techniques were used in order to assess Nigerian school administration and teacher perceptions of mental health issues in their schools. Nearly all school administration and teachers believed that spiritual problems accounted for mental illness in students. Rather than attributing abnormal behavior of students to mental illness, staff attributed disruptive behavior to merely “poor academic ability,” “slow academic ability,” and described such students as “idiots,” “morons,” and being “forgetful” (Ibeziako et al., 2008). Rather than abnormal student behavior being considered as qualifying for counseling services, perceptions of causation of behavior seemed to be correlated with the type of treatment staff believed was appropriate, such as prayer, punitive measures, and isolating students. Key informants observed from their interviews with staff, that required mental health training would benefit teachers. School administrators acknowledged barriers in delivery of school counseling and described ignorance and stigma as strong causes of counseling misconceptions.
When staff was asked how parents of students might feel about counseling services, a common response was that parents might feel resistant, especially if both the student and parents shared similar behavioral problems. When asked how school counseling services may best be received in the community, school administration replied that stakeholders in the community and the Ministry of Education involvement would reduce stigma (Ibeziako et al., 2008).
Rahman, Mubbashar, Harrington, and Gater (2000) identified the investigation of community perception of what qualifies as applicable to mental health services as a means to understanding the underdevelopment and underutilization of counseling services. Stigmatization and confusion about the causes, and subsequently the treatments of behavioral problems, may be best examined by the cultural context of each developing country. Raney and Çinarbas (2005) suggest that underutilization of mental health services may partly be explained by low income and folkloric/religious (e.g. praying) resources as alternatives to mental health services, rather than due to a more direct stigmatization of counseling.
However, stigmatization in countries, such as Jamaica, has been suggested as playing a large role in the underutilization of counseling services (Palmer, Palmer, & Payne-Borden, 2012). Palmer et al. (2012) described Jamaican citizens’ attitudes towards mental health services as affected by stigma, resulting in reluctance to seek services. The cultural context of such stigma may be attributed to reluctance to share problems, especially relating to mental/behavioral areas, with non-family members, such as counselors.
Assessing a culture’s perspective on what counts as behavior in need of counseling support, and the methodology in treating problems, may help in understanding the relationship between the community and the receiving of counseling support. Often, communities in developing countries perceive abnormalities in behavior and mental status as being “fixable” or better maintained by the individual’s family or by spirituality/religion compared to external forms of support [i.e. counselors] (Lee, Oh, & Mountcastie, 1992).
Culturally-Sensitive Counseling Development
The research at hand frequently suggested that counseling services should focus on culturally-specific needs (Ibeziako et al., 2008; Rahman et al., 200o). Ibeziako et al. (2008) emphasized needs assessment research as a crucial feature in facilitating a more successful development and utilization of counseling services. Neglecting a community’s perception of mental health issues and their forms of treatment only maintains stigmatization. Assessment may serve a second purpose beyond identifying needs. Assessment is likely to aid in the identification of a community’s existing resources and its local strengths, preserving cultural values (Rahman et al., 2000).
Ibeziako, P. I., Omigbodun, O. O., & Bella, T. T. (2008). Assessment of need for a school-based mental health programme in Nigeria: Perspectives of school administrators. International Review of Psychiatry, 20 (3), 271-280.
Lee, C. C., Oh, M. Y., & Mountastie, A. R. (1992). Indigenous models of helping in nonwestern countries: Implications for multicultural counseling. Journal of Multicultural Counseling & Development, 20 (1), 3-10.
Palmer, G. J., Palmer, R. W., & Payne-Borden, J. (2012). Evolution of counseling in Jamaica: Past, present, and future trends. Journal of Counseling & Development, 90, 97-101.
Rahman, A., Mubbashar, M., Harrington, R., & Gater, R. (2000). Annotation: Developing child mental health services in developing countries. Journal of Child Psychology and Psychiatry, 41 (5), 539-546.
Raney, S., & Çinarbas, D. S. (2005). Counseling in developing countries: Turkey and India as examples. Journal of Mental Health Counseling, 27 (2), 149-160.
Stockton, R., & Güneri, O. Y. (2011). Counseling in Turkey: An evolving field. Journal of Counseling & Development, 89, 98-104.