Leocata Angela M, Kaiser Bonnie N, Puffer Eve S
Stanford University, United States.
University of California San Diego, United States.
SSM Ment Health. 2021 Dec;1. doi: 10.1016/j.ssmmh.2021.100036. Epub 2021 Oct 23.
Lay-counselors have become a key human resource in the field of global mental health, aiming to address the estimated one-million-person shortage of mental healthcare providers. However, the role of lay-counselors is ambiguous and in tension: their role is quasi-professional, with specific training and skills that set them apart within communities, yet their role is also defined in contrast to professional mental healthcare providers. We explore how these tensions manifest through the material technologies for protocolizing and evaluating lay-counselor roles. We draw on our ethnographic fieldwork within two global mental health interventions that represent different ends of the spectrum of lay-counselor involvement, in order to explore the possibilities and limitations of such material technologies. Thinking Healthy Program-Peer delivered is a cognitive behavioral therapy-based intervention for women with perinatal depression delivered in Goa, India, and Tuko Pamoja (Swahili: "We are Together") is a family therapy intervention to improve mental health and family functioning in Eldoret, Kenya. First, we explore how intervention manuals - the step-by-step protocols that guide therapy delivery - can both constrain counselors to a script and enable their novel contributions to therapeutic encounters. Then, we examine assessment tools used to evaluate interventions writ large and lay-counselors specifically. We describe how, even where lay-counselors are encouraged to bring their own expertise into therapy delivery, this expertise is not often reflected in evaluation tools. Instead, the focus tends toward fidelity checklists, which require adherence to the manualized intervention and can penalize counselors for "going off book." Even though lay-counselors are often recruited specifically because of their existing roles and "local expertise," we argue that the material technologies of interventions can at times limit how their expertise is enabled and valued. We offer recommendations for global mental health programs to facilitate greater recognition and valuing of lay-counselor expertise.
非专业咨询师已成为全球心理健康领域的关键人力资源，旨在解决估计达100万人的心理健康护理提供者短缺问题。然而，非专业咨询师的角色模糊且存在冲突：他们的角色具有准专业性，通过特定培训和技能在社区中脱颖而出，但他们的角色也是相对于专业心理健康护理提供者来定义的。我们探讨这些冲突如何通过规范和评估非专业咨询师角色的物质技术表现出来。我们借鉴了在两项全球心理健康干预措施中的人种志实地调查，这两项措施代表了非专业咨询师参与程度的不同范围，以探索此类物质技术的可能性和局限性。“思维健康同伴交付计划”是一项针对印度果阿邦围产期抑郁症女性的基于认知行为疗法的干预措施，“团结起来”（斯瓦希里语：“我们在一起”）是一项旨在改善肯尼亚埃尔多雷特心理健康和家庭功能的家庭治疗干预措施。首先，我们探讨干预手册——指导治疗实施的分步方案——如何既能将咨询师限制在一个脚本中，又能使他们对治疗过程做出新颖贡献。然后，我们研究用于评估整体干预措施特别是非专业咨询师的评估工具。我们描述了，即使在鼓励非专业咨询师将自身专业知识融入治疗实施的情况下，这种专业知识也不常反映在评估工具中。相反，重点往往放在忠实度检查表上，该表要求遵循手册化干预措施，可能会因咨询师“偏离手册”而对其进行惩罚。尽管招募非专业咨询师往往是因为他们现有的角色和“当地专业知识”，但我们认为干预措施的物质技术有时会限制他们的专业知识如何得到发挥和重视。我们为全球心理健康项目提供建议，以促进对非专业咨询师专业知识的更多认可和重视。
