ABSTRACT
Lay counsellors play critical roles in mental health service delivery in Ghana. There is a shortage of professionally trained mental health practitioners. Lay counsellors deliver basic counselling and psychoeducation services in schools, churches, health settings and communities. Given the critical role of lay counsellors in mental health delivery in Ghana, it is imperative to understand how these lay counsellors deal with ethical dilemmas in their everyday practice. Unfortunately, there have been limited studies focusing on this group of counsellors. This qualitative study explored the ethical dilemmas experienced by a conveniently selected sample of 27 lay counsellors in Ghana and investigated how these dilemmas were resolved. Data were gathered using in-depth individual interviews and vignettes; and analysed using thematic analysis. Findings showed five thematic domains of ethical challenges faced by the lay counsellors: (1) difficulties negotiating rights and confidentiality; (2) competency issues relating to working on cases they are not trained for;
(3) difficulty managing multiple relationships; (4) dealing with conflicting values; (5) and issues relating to gifts. Four thematic resolution strategies were identified: (1) referrals; (2) personal discretion; (3) consultation; and (4) use of codes of conduct. More so, three challenges were identified in terms of resolving ethical challenges: lack of continuous training; challenges religious values; and challenges with cultural values. The findings are discussed in relation to improving lay counselling practice in Ghana.
CHAPTER ONE
INTRODUCTION
Background to the Study
Lay counsellors are those who provide psychosocial support, but are not clinical, mental health specialists (i.e. social workers, psychologists or psychotherapists) (Juen, Siller, Lindenthal, Snider, Nielsen, Muff & Wiedemann, 2013). Lay counsellors provide additional support such as offering help for people experiencing emotional problems (Martin, 2016). The Ghana Psychological Council recognizes lay counsellors as paraprofessionals (Health Professionals Regulatory Bodies Act, 2013). Tan (1997) describes paraprofessionals/lay counsellors as persons who do not possess formal credentialing, training and experience as mental health professionals but who perhaps work in the field of mental health with people who need support. Lay counsellors are also volunteers in the non-governmental sector who assist to relieve the burden of psychologists, professional counsellors and health care professionals (van Rensburg, 2008). DeMoss (1974) also defines a paraprofessional as a person doing the same tasks as a professional, but who does not have an advanced degree in that specific kind of area. Taken together lay counsellors are people who may have or not have a mental health background with little qualification but have received training to help professional counsellors and other mental health workers by providing counselling services to people.
Lay counsellors provide valuable psychosocial support in many different circumstances, such as manning telephone helplines for patients, assisting people after crisis events or giving focused support to refugees or other vulnerable groups (Juen, Siller, Lindenthal, Snider, Nielsen, Muff & Wiedemann, 2013). Lay counsellors educate clients and provide emotional support, and are
mostly active in fields such as trauma, psychological first aid, gender-based violence, and HIV and AIDS counselling (van Rensburg, 2008). Lay counsellors also help in times of national disasters like floods and fire outbreaks by counselling victims who may be psychologically distressed (Ghana Psychological Association, 2015). However, a report by the chief statistician of the statistical service, David Combat, disclosed that Ghana’s midyear population is now estimated at 27.9 million, up from the 24 million recorded in the 2012 national population and housing census (GhanaWeb, 2015). This increasing population is likely to seek mental health care in various ways including counselling services because urbanization affects mental health through the influence of increased stressors and factors such as overcrowded and polluted environment, high levels of violence, and reduced social support (Srivastava, 2009).
Counselling is a method of relating and responding to others with the aim of providing them with opportunities to explore, clarify, and work towards living in a more personally satisfying and resourceful way (American Counselling Association, 2005). Counselling is a process of self-discovery that can help people learn how to deal more effectively with situations in their lives such as depression, addiction and substance abuse, stress, problems with self-esteem, grief, issues related to mental and emotional health, and relational problems. This process helps people feel more comfortable with themselves, others, and helps develop some of the skills needed to deal with the tensions that come from inside.
Juen, Siller, and Gstrein (2011) also define lay counselling as activity that consists of active listening, information sharing, and support to take informed decisions, all with the objective of empowering the individual to cope with stressful and critical situations. Counselling practice is complex, and ethical dilemmas arise as new challenges confront practitioners (Cottone, 2001).
There are different types of counsellors which include school counsellors, marriage counsellors, lay counsellors and family counsellors. The number of certified counsellors and lay counsellors from counselling-related programs in Ghana has been increasing in recent times (Ghana News Agency, 2012). This is as a result of the demand for mental health care. Although lay counselling should never replace professional counselling, thousands of lay counsellors provide an important service to vulnerable people and to their organizations – and sometimes in areas and situations where no professional counselling is available.
