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How ‘professional’ are Sri Lanka’s mental health professionals? 

“Anything that’s human is mentionable, and anything that is mentionable can be more manageable. When we can talk about our feelings, they become less overwhelming, less upsetting, and less scary.” — Fred Rogers

 

Each and every one of us, at one point or another, have used “the hospital at Angoda” as the cult-classic parallel to the worst place one could ever go to, and silently judged a frequently emotional friend who was having “anxiety attacks” whilst also thinking of reaching out to a professional to talk about the noise in our heads and hastily stopping ourselves.
This is the situation of mental health in Sri Lanka. The stigma, of course, is an often discussed topic.

“Sri Lankans are used to saying, ‘aiyo, it will be okay, just forget about it’,” expressed social media personality, TEDx Speaker, and mental health advocate Sharan Velauthan, speaking to The Sunday Morning Brunch

In addition to the stigmatisation of mental health problems, another contributor is how unequipped we are as a country to deal with such issues.

“A therapist will help and advise you, but you have to put the work in as well. I learnt a lot more about myself, my triggers, and how to love myself better”  Social media personality, TEDx Speaker, and mental health advocate Sharan Velauthan


Professional mental health support: Counselling in focus


Clinical psychologist and Open University of Sri Lanka Department of Psychology and Counselling senior lecturer Ransirini De Silva shared that due to the lack of awareness, we use terms such as psychiatrists, psychologists, and counsellors very interchangeably.
According to her expertise, she explained that a psychiatrist is a trained medical doctor that looks into the medical aspect of mental health. 

A psychologist is someone who has followed a degree in psychology and specialised in a particular field related to mental health to deliver psychological interventions. For example, a clinical psychologist would treat people with mental health disorders in a hospital setting, while an educational psychologist would work with students in a school setting to tackle learning-related issues. 

Qualified psychologists may tackle more complex mental health problems whereas counsellors tackle day-to-day conflicts of the mind of clients through professional, yet basic training. However, individual differences of experience and training of the counsellor will colour the diversity of the interventions they are able to deliver. She further added that counselling or therapy is but one practical small arm of all that is encompassed within the vast field of the science of “psychology”.
General counselling comprises psychological services rendered through contact between the counsellor and the client, related to individuals, children and families, couples, marriage, or any other mental health-related concerns.

“You have to respect confidentiality at all times excluding special cases which involve potential harm to the client, particularly with minors”   Counsellor and Shanthi Maargam Assistant Centre Manager Ardlay Mohamed

Professionalism in counselling: A neglected necessity



Counsellor and Shanthi Maargam Assistant Centre Manager Ardlay Mohamed explained that the minimum requirement for counselling practitioners in Sri Lanka is a higher national diploma. In order to achive this, a national diploma in counselling or psychology should be followed, which includes a minimum two years of study.
According to her, the minimum requirement is based on teaching the skills needed to practice. In addition to the higher national diploma, you are required to follow through with an internship which is very similar to practicing, where you have to counsel a number of clients with the discretion of a supervisor. 

Counsellor and Sri Lanka National Association of Counsellors (SRILNAC) Past President Joseph N. Thilakaratne stressed that the development of a counsellor comes from experience.
“The more you practice, the more you learn. Regardless of the qualifications, the sizable drawback is in gaining experience. For doctors, they have specified artificial anatomies or natural body specimens that are assigned to conduct anatomy investigation,” he explained. “For mental health professionals, we are not only working but also training in real time. Our trial runs are on live test experiments in the form of the first few clients that come to us.”
Mohamed added that the skills needed for counselling cannot be taught in a matter of months. Thilakaratne echoed her sentiments by adding that at least 50 clients have to be handled initially, for one to gain sizable knowledge on how exactly to tackle counselling.

 

The dangers of a ‘bad counsellor’

 

A “bad counsellor” in most cases is a para-qualified individual, according to the experts we spoke to. Mohamed revealed that she knows for a fact that there are many who have barely completed a couple of months of their diploma courses, but are yet practising. 

Mohamed elaborated that the basics of counselling involves privacy, empathy, understanding, active listening, non-judgement, and above all, confidentiality. 
“You have to respect confidentiality at all times excluding special cases which involve potential harm to the client, particularly with minors,” she stated firmly.

“If you are counselling a minor, you can talk to the parents. That needs to be done keeping the client at utmost priority; in this case, keeping the client informed of every step, explaining what you would be revealing and why you need to do so. Nevertheless, a counsellor, regardless of the client’s age, should have utmost respect and regard towards them. It’s all about creating a safe space for the client to open up without being criticised or judged.
Mohamed further commented saying that for someone to come into therapy, sizable courage is taken in a society such as that of Sri Lanka that stigmatises it. 

“I greatly appreciate people who care about themselves enough to have the courage to seek professional help,” she said.
Depending on the severity of a certain issue, the situation of a client can turn from bad to worse in the case of improper counselling methods.

Clinical Psychologist/Senior Lecturer in Psychology, Department of Psychology & Counselling, Faculty of Health Sciences, The Open University of Sri Lanka Ransirini De Silva


Counselling in schools


The horror stories surrounding school counsellors is not new news. The need for accountability and responsibility from schools in recruiting counsellors is another point of interest, learnt The Sunday Morning Brunch in correspondence with students, who requested anonymity. 

A prefect at a leading government school in Colombo revealed that whenever he has attempted to assist a junior in seeking advice from the school counsellor, the counsellor was almost always unavailable in his seat.

Another prefect from a reputed private school in Colombo shared the following sentiments:

“Many who have been to the school counsellor have told me that they would never go there again. A couple of my friends who had problems at home told me that ever since the visit to the counsellor, the entire staff room had somehow been made aware of their situation. It did not help in any way because of the sudden unusual and awkward treatment by the teachers. They would be randomly stopped at corridors and asked about personal family problems in front of others. Going to the counsellor and the backlash that follows is sometimes worse than bottling up your problems,” she shared. 

“The procedure of visiting the counsellor at our school is strenuous enough. You have to take permission from the principal and then get the signature of your class teacher, in most cases, in front of the staff room. It’s not confidential at all and it would be followed with a million intrusive questions from teachers,” shared another student. 

Therefore, it is essential that you look into the qualification of that individual to fulfil the requirement, just as is done in hiring academic staff or any other employees, and the school management have to make efforts to take it earnestly enough.
Clinical psychologist Ransirini De Silva shared that according to her knowledge, certain schools within the national school system assign an already existing teacher as the school counsellor, who is not a mental health professional. She called for schools to ensure that those put in charge of the mental health of students receive correct and adequate training to ensure the ability to deliver ethical mental health interventions.

The absence of a governing body

During our exchange with these professionals, we uncovered that the absence of a governing body to regulate the professionals of the said field allows individuals with inadequate knowledge and experience to practise freely.
De Silva, as a clinical psychologist herself, shared that although clinical psychologists are registered at the Sri Lanka Medical Council (SLMC), the “Sri Lanka Psychological Association” has not yet been recognised through an act in Parliament as a legal body to regulate registration and practitioning of all others who are practising in the field of psychology, although it is recognised as a professional body. Due to this, there is ambiguity regarding the qualifications and experience of “professionals”. This case proves true to counsellors in a much broader sense.

Mental health in Sri Lanka: Where are we at?

Velauthan, a victim of a traumatic experience, realised that he had not dealt with a lot of underlying issues he had gone through growing up such as bullying, mistreatment from family and cool kids in school, having an alcoholic and abusive father, and more.
“When I started talking about my lived experience on social media, I realised there are so many people going through similar experiences that they never speak about,” he shared. 

The experts cumulatively agreed that there needs to be more awareness within the public domain on the importance of mental health and the equal significance of psychological intervention, once conducted responsibly.
“Therapy changed my life. Therapists are there to help you with your thoughts and mine helped me beyond explanation. At my first session, I cried the whole time. The next few sessions were for the therapist to get to know me better. From there, it was constantly working on myself. A therapist will help and advise you, but you have to put the work in as well. I learnt a lot more about myself, my triggers, and how to love myself better,” Velauthan recollected from his personal experiences.
Mohamed said that although a lot of younger people advocate for mental health on social media platforms, a look at the demographics reveal that it is largely Colombo-centric and an issue discussed among the metropolitan crowd of Sri Lanka.
“If your friend tells you that he or she has a severe stomach ache, you advise him to seek professional help immediately. Just as you take care of your physical wellbeing, you need to know that total wellbeing comes from a good balance between stable physical and mental wellbeing.”

Velauthan added that there are different paths to seeking help such as speaking to trusted friends and family, self-help books, journaling, etc.


The way forward 


“Therapy and counselling is not the only path, but it certainly helps. There are plenty of free resources available that we have listed on Samana as well,” said Velauthan.
Samana (https://www.samana.lk/support-list) is a newly introduced up-and-coming platform that strives to make mental health more accessible to all Sri Lankans, an initiative Velauthan himself is a part of. 

“Reaching out for help does not make you less; it should be something to be celebrated because you know that life is a bit heavy right now and you need help. Our work with Samana and other organisations that focus on helping our communities will help normalise the conversation even more,” concluded Velauthan, further stressing the importance of more mainstream media advocacy on mental health and efforts made to amplify voices of mental health advocates, reminding them that they are not professionals, but be a source of reliability and direction to the right therapists.
As much-needed legal systems are yet to be put in place to primarily hold professionals accountable, supporting organisations such as Samana, Shanthi Maargam, and Sumithrayo that focus on the emotional wellbeing of youths and adolescents are a step we as a society may take to make it safer for them to seek help.#

 

Main photo credit: Youssef Naddam on Unsplash