Abstract
The differences that exist in the world are reflected in
the clients that clinical mental health counselors treat. A theory or approach
that has worked in the past with others may not be well received by a new
client, as people are individuals and need to be treated as such. There are
several types of mental health delivery systems, intertwined into a web of
assistance, which without guidance can leave one tangled and left struggling.
The role of the clinical mental health counselor is to help clients maneuver
through the system, leading to a healthier place.
Delivery Systems
Clinical mental health counselors have a wide array of
delivery systems to use when working with clients. The settings in which
clients obtain care vary as much as the theories used to assist in providing
treatment. According to a 1999 Surgeon General report, mental health care
providers may be formally trained, general health care providers, human
services providers and even volunteer support group leaders. Each group of
providers has different educational and licensure requirements, which leads to
a sometimes more confusing mental health care system. The location in which
treatment is delivered also varies according to several factors, including the
type, financial resources and the severity of mental illness (Sundararaman,
2009). Some of the more common settings include hospitals and outpatient
clinics as well as informal venues such as churches and community centers.
Formally trained providers include psychiatrists,
psychologists and psychiatric nurses. This group has a higher level of
specialized training, usually works in clinic or hospital settings and may be
licensed to request involuntary hospitalization for the treatment of suicidal
individuals (Sundararaman, 2009). General health care practioners do not
receive as much specialized training and their education is continuous since
the scope of practice is much more broad in spectrum. Often mental health treatment
provided by general health care practioners is on an acute basis or for
outpatient visits. Individuals that fall under the social services umbrella,
including school-based counselors and those who work in the criminal justice
field, can also provide mental health services. Since their training is not
specific to mental health, often those who fall into this category do not have
to seek licensure nor are required to receive mental health related training.
The most informal of providers include support groups, such as Alcoholics
Anonymous, Narcotics Anonymous and discussion forums in which there is neither
formal training nor license requirement.
Cultural Considerations
and Barriers
Just as the delivery systems vary greatly, the culture of
those seeking help do as well and counselors need to recognize and address
these differences. Bridging the gap that may exist between client and counselor
often begins with cross-cultural communication, which includes listening,
observing and learning the needs, views and concerns of the individual as well
as their community (Flaskerud, 2007).
Language
and literacy pose potential problems, as clients who do not share a common
language with their counselor run the risk of receiving an evaluation of more
severe disorders, which can lead to misdiagnosis (Partida, 2012), even with the
use of an interpreter. Using a third party to translate can bring another set
of challenges, as they may omit, normalize or answer in a way that would avoid
stigma (Tyson and Flaskerud, 2010). Bilingual questionnaires and brochures can
help to address the language gap, however, if a client is unable to read at the
level of which it is printed, the usefulness of that particular aid is invalid.
Even
when the counselor and client share a common language, there is still the
possibility of cultural differences, which can pose a barrier to receiving
effective therapeutic interventions. One such study identified US Latinos as
being almost twice as likely to experience depression as compared to whites,
but seek mental health services less often, even among those with insurance
(Stacciarini, 2009). Research into the
cultural differences between Latinos and whites is still lacking due to the
small percentage of individuals receiving treatment; however, there are several
programs in place to assist in obtaining mental health counseling among the
Latino population.
In
addition to language and cultural differences, counselors may also encounter
religious barriers as well during their practice. Religion often plays a
central role in the lives of individuals, governing the value system and
beliefs of those seeking treatment. Individuals may be more trusting of
religious organizations, and consult clergy rather than seeking out treatment
in community health centers (Clemens, 2005). Social workers within the mental
health care system have recognized and addressed the issue and include respect
for client autonomy within the International Federation of Social Workers
(IFSW). When therapeutic modalities are not tailored for a specific belief
system, the outcome is often less than desirable, and may result in the client
experiencing more distress than when treatment was initiated.
Geography
also plays a part in the mental health care system. According to the 2000
census, 80% of the US population lives in metropolitan areas, which bring their
own contributing factors to mental illness. Sanitary, stress, close living
conditions and poverty can negatively influence mental health and well-being
(Knowlton, 2001). Community health clinics are often the source for mental
health treatment among urban communities, with an estimated 900 such clinics in
the United States, which are seeing a large increase in co-occurring mental and
substance abuse disorders among their clients (Cristofalo, Boutain,
Schraufnagel, Bumgardner, Zatzick and Roy-Bryne, 2009). Similarly, rural mental
health care presents with its own set of unique factors. The Office of Rural
Health Policy (ORHP) addresses the needs of the rural population, including
availability, access and acceptability of mental health within the community
(Human and Wasem, 1991). ORHP partners with the federal government to improve
the delivery of mental health services throughout rural America and conducts
research among the diverse population.
Consultations
Working with language, culture and religious barriers as
well as geographical uniqueness often places the clinical mental health
counselor in a precarious position, wherein trying to help a client while
balancing the individual intricacies can be difficult. Counselors often call
upon consultants during times of uncertainty, especially when working with
clients whose background is quite different from that of the counselor. Seeking
assistance is not a sign of weakness, as clients are approaching with a similar
need and are viewed as being strong.
Just as some mental health workers specialize in academic
settings, marriage and family or trauma, some have chosen the branch of
multicultural counseling. The Association for Multicultural Counseling and
Development (AMCD), whose mission statement addresses the very fact: “To
promote a greater awareness and understanding of multiculturalism and the
impact of cultural and ethnic differences on the counseling process among
members of the counseling profession and other helping professions.” The key
competencies within the AMCD include counselor awareness of own cultural values
and biases; counselor awareness of client’s worldview; and culturally
appropriate intervention strategies. Finding such a resource within the
community of a counselor in need would prove to be quite useful when finding
oneself working within a diverse population of clients.
Local groups can also lend support for counselors in need
of assistance or gaining a more diverse knowledge base. Community Outreach,
located in Corvallis, Oregon, offers internships that expose a counselor to a
diverse community, including clients experiencing emergency displacements, drug
and medical emergencies and acute crisis interventions among men, women,
adolescents and families with infants throughout the mid-Willamette Valley of
Oregon. In 1995, the Multicultural Assistance Program (MCAP) merged with
Community Outreach, adding another dimension of specialized care among the
community it serves.
Mental health courts are becoming a more common way for counselors
to provide professional consultation within the field. It is estimated that
more than half of all prison and jail inmates have a mental health problem
(Kuehn, 2007), which could benefit more from receiving treatment rather than
being locked up behind bars. Mental health counselors work in conjunction with
the penal system to provide services that may include medication, housing, job
training and psychotherapy (Mental Health Letter, 2006). Rather than spending
their time in jail, offenders are able to obtain the much needed assistance and
counseling. However, there are stipulations, one which addresses the length of
time spent receiving treatment--cannot be longer than the maximum sentence for
the crime.
Conclusion
The role of a clinical mental health counselor varies
greatly, from a community outreach setting to a clinical practice in a large
hospital. Regardless of locale, nationality, religion or cultural background,
the needs of the clients remain the constant top priority. Becoming educated in
multicultural counseling and being open to asking for consulting from peers
will not only help the clients we serve, but also ourselves as counselors…and
people.
*References available upon request
