Ethical practices to be adopted by mental health counselors in India Article by R.Manoj Clinical Psychologist, Psychotherapist and Counselor, CHENNAI

The terms Counselor and counseling are very shoddily in India with every formal face to face interaction being given the name of counseling. Be it just providing informations with the intension of marketing a product or services, be it providing choices of academic courses and institutions, be it providing religious discourses to individuals, be it guidance or advice etc, all interactions which involve so called “INFORMED CHOICES” are only addressed as counseling. This has only resulted in confusion among the lay man about counseling associated with mental health.

Further the profession is losing its sheen due to non-professionals, unqualified, under qualified, untrained professionals functioning in the name of mental health counselors. With no governmental organization or statuary bodies to regulate the profession of mental health counseling, everyone, who ever feels that they know something about human relationships and behavior, with and without the knowledge psychology, psychopathology mental health or  counseling, start proclaiming themselves as counselors and are practicing counseling, according to their own whims  and fancies. This is only endangering the welfare of the profession and the help seekers. With no statutory body monitoring, no prescribed ethics related to the practice is advocated which has only further deteriorated the preparedness of the people entering the profession of mental health counseling.  

I have just attempted to create a draft version of the ethical practices associated with mental health counseling that should be followed in India. This version is based on the ethical standards followed in the western countries which has been customized to Indian population taking into consideration the culture and diversity.

Essential Ethical practices to be followed

 Professional Responsibility

Ø  Mental health Counselors should acquire the necessary qualification, training and standards for practice before they enter the profession. In India it should be at the least a post graduation in the field of psychology with specialization in counseling and at the least a 6 months internship under a practicing profession and 6 months of supervised practice.

Ø  They should have a responsibility to read, understand, and adhere to applicable laws, rules, regulations and ethics of practice, which governs the country in which they practice.

Ø  Counselors should practice only within the boundaries of their competence and their areas of specialization.

Ø  They should have a clear knowledge about the boundaries of their own profession and that of other professionals in the field of mental health such as psychiatrists, psychologists / psychotherapists, clinical  psychologists and psychiatric social workers.

Ø  They should continually monitoring their effectiveness of their practice and take steps to improve when necessary.

Ø  They should always try to update their knowledge by participating in continuing education programs, clinical case discussions, seminars and conferences to acquire and maintain a reasonable level of awareness of current scientific and professional information in their fields of activity

Ø  Metal health counselors establish relationships of trust with their clients and continue to maintain it even after they cease to be a client

Ø  Mental health counselors should be able to maintain a balance in safeguarding the welfare and rights of their clients and other affected persons. They should not take a biased approach in favor of their client, just because it’s the client who has approached them for solutions.

Ø  They should be guarded against the pressures that may arise due to personal, financial, social, emotional, organizational or political factors that might lead to misuse of their influence, to either take decisions for or against the clients’ welfare overlooking the professional standards. Any reports given should be strictly based on professional evaluation, the reliability and validity of which is  verifiable and not under any pressure, coercion or persuasion 

Ø  They should uphold professional standards of conduct, clarify their professional roles and obligations, accept appropriate responsibility for their behavior and seek to manage conflicts of interest that could lead to exploitation or harm.

Ø  Mental health counselors should be aware of and respect cultural, individual and role differences, including those based on age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language and socioeconomic status.

Ø  They should not allow their own value systems to interfere in their attitudes towards the client of the process of counseling

Ø  They should ensure that no discrimination based on the above said factors allowed to happen

Ø  They should also be aware of their professional responsibilities to society and to the specific communities in which they work

Ø  They should be willing to consult with, refer to, or cooperate with their own colleagues and other professionals and institutions to serve the best interests of their client.

Ø  If the counselors feels that the clients problems are out of the purview of their professional competence or they cannot manage the client or after a few sessions there is no visible progress towards the intended goals, then they must refer the client to the appropriate professional immediately.

Ø  Counselor’s ultimate goal should be to encourage client growth and development in ways that foster the interest and welfare of clients and promote formation of healthy relationships

Confidentiality

Ø  Counselors should be aware of  the fact that their client trusts them to keep confidential the Information he/ she  shares with you. so it becomes mandatory that the informations are not revealed to anybody else

Ø  Except in cases with involve law it should not be revealed unless he/she gives you permission in writing to disclose it.

Ø  If there is a need to comply with a court order to release information,  the counselors can inform the client of the court order and release information which are strictly relevant to the order, necessary and verifiable

Ø  The clients should be informed about the limitations related to confidentiality, in the initial phase of the counseling session itself

Relationship Boundaries

Ø  Counselors should avoid non professional interactions with the present and former clients.

Ø  Counselors should also be careful enough not to enter into dual relationship such as relationship based on religious, social , emotional, sexual or business interests with their present or former clients.

Ø  Counselors should also ensure that there is no conflict of interest in the relationship which can result in damage to the client in any way or  lead to exploitation of the clients for any personal gains

Ø  Physical contact except formal contact such as handshakes,  with the client should be completely.

Ø  No intentions suggesting physical intimacy or sexual contact should be expressed by the counselors during the session or otherwise.

Ø  In case if such expression arise from the client, the counselors should be able to assertively block such expression and if the same continues then the client should be referred to any other competent colleague.

Informed Consent:

Ø  The counselor should provide adequate information in the language which can be understood by the client about the counseling process

Ø  Counselors should ensure that an informed consent form which has the above said details is signed by the counselee or by the guardian in case the counselee is a minor

Ø  Clients should be given the freedom to choose whether to enter into or remain in a counseling relationship

Financial remuneration

Ø  The counselor has the freedom to decide the fees of his/ her professional services based on the facilities available in the premises, locality and the financial status of the client

Ø  In case they have a established fees, the counselors has all the right to provide concessions  if they feel that the fees is beyond the paying capacity of the client.

Ø  In such cases the counselor should ensure that there is no deficiency in his/her services because the remuneration is lower than the set standards

Ø  In case the counselors feels that the same cannot then they should assist clients in finding comparable services which is affordable to the client.

Advertising: 

Ø  In case the counselor wants to advertise their services to the public they should ensure that the content of such advertisement clearly illustrate their credentials, competencies and experience in an accurate manner that is not false, misleading, deceptive, or fraudulent.

            I  hope that if people who want to take the profession of counseling are willing to follow these codes of ethics they will do justice to the profession and the society 

WHY AWARENESS ABOUT MENTAL HEALTH SHOULD PRECEDE EVERY OTHER HEALTH AWARENESS CAMPAIGNS by R.Manoj Clinical Psychologist, Chennai

Mental health is the key to physical well being. The role of mental health is not just limited to the impact of stress on physical well being. The core cause associated with any illness, be it life style based diseases such as diabetic, hypertension, cardio vascular (heart) diseases or various infectious diseases, can be traced to poor of lack of mental health. Here the role of poor mental health can be identified by the gulf between the knowledge and use of knowledge.

Many of us know what is healthy life style and eating habits. We know that we need to take a healthy diet, which has enough of each essential nutrient, contains many foods from all of the basic food groups, provides the right amount of calories to maintain a healthy weight, and does not have too much fat, sugar, salt, or alcohol. But we fail to do it and even if we start doing it, it is just restricted to the time period when the symptoms have restricted our functional ability.

We know importance to exercise on health and well being. We know that being physically active can help us to continue doing things we enjoy and help us to stay independent at any age and regular physical activity over long periods of time can produce long-term health benefits.  But we just refrain from doing it finding some excuse or other. When we are ill we claim that we cannot involve in physical exercise due to the impact of illness and when we are better we feel that “now we are healthy, why waste time on it while there are more important tasks to be completed”.

The other important factor associated with physical wellness about which there is lesser awareness is sleep. Good sleep not just give you rest, but also helps in healing. A simple review of our sleeping time may only show that in most occasions, we are wasting our time for sleep on unimportant activities such as goalless browsing or purposeless chats. Even though we experience various troubles in our day time functioning due to lack of sleep, we never try to adopt healthy sleeping patterns. Most of the days we force ourselves to be awake till we are pushed into sleep.

We also know the role of hygiene in preventing illnesses. But we never take initiative to maintain a clean environment around us, but gain solace in making complaints about the civic administration for not taking adequate measures.

Even in people who don’t have adequate knowledge or claim so, which result in them becoming victims of these illness, when the professional provide adequate informations after the onset, they find it difficult to adapt to the necessary changes, for maintaining health and preventing escalation.

The flabbergast fact is that, all the above said facts are not just restricted to lay people, but present in most of the professionals who are promoters physical or mental health. They preach but rarely follow.

Inspite of all the information and understanding of the importance of the above said facts, we have never tried to probe and find out what has been preventing us from adopting these healthy habits. It’s not just limited to prevention; even the people who have becoming prey of life style diseases do not want to adopt the healthy life style to prevent the escalation of these diseases. Even if a few adopt it, they do not maintain consistency and in few other cases, where people who follow healthy habits are easily persuaded to leave it by the ones who do not follow them. The surprising fact is, a good percentage of them fear the consequences, and do not want to suffer from escalations, but limit their non-adherence by expressing helplessness.

We can term the cause as negative attitude, lack of motivation, habituation, laziness, learned helplessness, false belief systems such as exercising unnecessary excessive control etc. But aren’t all these indicators of poor mental health.

There are robust awareness programs are being done through media and various others programs by medical professionals and organizations; to advocate the adoption of preventive measures, to avert various life style based diseases. Awareness programs about importance of maintaining hygiene, as a preventive measure to avoid contact of diseases due to bacterial or viral infections and are being done in an exuberant way. But the vital factor, the mental health factor associated with all these illnesses are not being addressed. If the role of mental health with the focus on changing the attitudes, increasing the motivation and changing the false belief systems to ensure that people adopt healthy habits and life styles, is not addressed then all these program will only become futile exercises resulting in wastage of money and resources

Apt mental health, improves the quality of our lives in ways including better physical health; faster recovery from illness; fewer limitations in daily life; higher achievement and better relationships.

MENTAL HEALTH –THE PRAGMATIC INTERPRETATION, R.Manoj Clinical Psychologist, Psychotherapist and Counselor, Chennai

10^th of this month (October) we are celebrating world mental health day. Mental health is important at every stage of life, from childhood and adolescence through adulthood. World Mental Health Day incepted in 1992, is a day for global mental health education, awareness and advocacy. But even after 22 years of celebrating this day, whenever I ask anyone, I come across, whether they know the real meaning of Mental health, nearly every one answer is “if you don’t have any mental illness or mental problems then you are mentally healthy”. This just conveys the meaning that mental health is just being devoid of mental illness. But even the World health organization has categorically said the being healthy is not just being devoid of illness. I also tried to search the web to check whether there is comprehensible explanation of mental health only to find that most of the sites give brief statement of mental health and just shifts to the content of symptoms of mental problems and illnesses which only emphasizes that efforts have not been taken to give a well-structured idea about mental health.

The obvious fact is that mental health is not just being devoid of mental illness and lack of mental health or poor mental health need not necessarily mean that a person has mental problems or illness. Mental health includes our emotional, psychological, and social well-being. Mental health is characterized by mental functions that result in productive activities, fulfilling relationship with others and the ability to adapt to changes and cope with adversity. It is determined by how we think, feel, and act. It is also determined by, how we handle stress, relate to others, and make choices. In other words mental health is the status which is before the onset of mental problems or illnesses or lack of mental health or poor mental health is a status what can be termed as “prone to mental problem or illness”.

Being Mentally Healthy is a status that allows people to:

·         Realize their full potential

·         Cope with the stresses of life effectively

·         Work productively

·         Make meaningful contributions to themselves their families and communities

·         Connect with others without barriers

·         Stay positive

·         Maintain adequate physical activity

·         Have no reservations in Helping others

·         Act in an emotionally balanced way even in demanding situations

People who are mentally healthy have:

·         A sense of contentment.

·         A zest for living and the ability to laugh and have fun.

·         The ability to deal with stress and bounce back from adversity.

·         A sense of meaning and purpose, in both their activities and their relationships.

·         The flexibility to learn new things and adapt to change.

·         A balance between work and play, rest and activity, etc.

·         The ability to build and maintain fulfilling relationships.

·         Self-confidence and high self-esteem.

There is still a lot of confusion related to understanding the symptoms of mental illness and lack of mental health. Many a times identifying mental problems or illness has been based of deterioration from the pre-morbid state in the functional levels, sleep, interests, appetite, and various other behavior and cognitive symptoms. But in the dynamically opposite paradigm the status of mental health is determined by how a person is able to achieve the fullest of his potential “ the self actualized state”. The lack of mental health is determined by how much he is lagging behind both in his focus on achieving the state and the actual lagging which means the synptoms of mental illness will not be the same as symptoms of lack of mental health. Some of the symtoms which indicate poor mental health are

·         Unproductive, under productive  lifestyle

·         Laziness and lethargy in activities due to poor motivation

·         Poor work - life – relationship - relaxation balance

·         Poor self confidence and self motivation

·         Excessive dependency and need for support to do even very simple tasks

·         Frequent complaints of victimization

·         Frequent seeking of approval of others

·         Expression of feelings of insecurity and fear of failure

·         Uncontrolled anger and aggressive attitudes

·         Tendency to blame others environment and society for their failures

·         Irrational arguments with the intention to protect their self esteem

·         Poor listening skills

·         Inability to reach out for help and support whenever necessary

·         Antisocial behavior

But just like the causes of mental illness the causes of poor mental health can also be put in a bio-psycho- social framework. Some of the important causes are

·         Regression to “survival of the fittest” attitude and trying to achieve by hook or crook, to be in a better position than others, rather than focusing on achieving one’s own goal.

·         Consistent unhealthy lifestyle both on the personal and social front,

·         Consistent physical ill-health

·         Discrimination and perceived discrimination or exclusion based on social status, gender, education, performance

·         Ineffective parenting

·         Traumatic incidents in life and experiences of human rights violations.

·         Rapid social change

·         Physical emotional and sexual abuse including bullying or harassment during childhood or adolescence

·         Poor connection or attachment to the primary caretaker early in life. 

·         Feeling lonely, isolated, unsafe, confused, or abused as an infant or young child.

·         The absence of one or more confiding relationships,

·         Learned helplessness, the negative experiences that lead to a belief that you’re helpless and that you have little control over the situations in your life.

Come let’s understand the real meaning of mental health and celebrate the world mental health. While we take out our time to create  awareness about mental disorders, lets assign more time to preserve  and enhance our mental health and that of all others around us. On this important day let’s vow to

·         Take proactive initiative starting from ourselves to bring about the required change.

·         Overcome the tendency to survive and start living our life

·         Dedicate adequate time self and for every other role we take be it parent, child, sibling, friend and social being

·         Seeking supports to solve our limitations and problems and reach out to people to help them to solve theirs

·         Develop productive goals and start pursuing it without allowing the barriers to stop our venture.

·         Pursue our goals not with a sense of winning but enjoy the course and achieving happiness with our success

·         Focus on developing and expressing positive emotions

·         Avoid suppressing our negative emotions and find appropriate ventilation to our negative emotions,

·         Create empathetic understandings of others and develop effective workable relationships.

·         Avoid blaming others for our problems and develop problem solving and decision making abilities,

·         Stop discriminating or ill-treating others to gain dominance and focus on respecting others to maintain our self esteem.

·         Avoid criticizing others instead motivate them

·         Stop blaming the ills in the society, take a collective responsibility for all those issues which we feel as negative in the society

·         Enjoy the nature and its beauty

·         Bring out the creative talents within ourselves for the benefit of self and society

·         Take efforts to create the awareness about mental health and its importance

·         Overcome the stigma related to mental illness and help people with mental illness, psychological disorders and emotional problems

·         By being happy and making others happy

Preserving mental and social health is the best way to prevent mental disorders. Let start our journey in this direction with the slogan

“We are for ourself but we care for all”