Doctor of Philosophy in Counselor Education and Supervision, Licensed Professional Counselor Hasmik Chakaryan addresses the lack of clinical counseling programs and professionals in Armenia illustrating the current mental health state of the people, offering possible reasons and solutions
Text : Hasmik Chakaryan | This article was adapted from its original version published by Springer, August 2018. Adaptation and editing by Silva Hovakimyan
Photo : Webster university
Historical and Socio-Cultural Context
Because historical and geopolitical factors have greatly influenced the development of the Armenian society, its mentality, as well as the culture, educational system, socio-economic state, and the political structure, a careful examination of past events is necessary in order to understand the current mentality of its people and draw accurate conclusions regarding future implications for a counseling profession. The collective memory of trauma caused by wars, attempts of ethnic cleansing, generational migration and natural disasters, as well as the fear of re-victimization have been passed down from one generation to the next significantly affecting the psychological wellbeing of the Armenian people.
The destruction of state structures, monetary value, as well as the systems of economy, healthcare and education created a cycle of generational poverty and a chain of mental and emotional illness. Armenians still struggle with complex psycho-social issues that impact their daily lives due to all the above mentioned unresolved traumas. Another contributing factor to the psychological state of the people is the ongoing threat of war by Azerbaijan. To add to the already vulnerable condition of the state, people from the nearby regions struck by war and terrorism are flooding the country which lacks structures to meet the needs of these refugees.
Cultural Overview
Armenia represents a mixture of eastern and western trends of mentality and ways of living. Talking to strangers about personal\family problems is discouraged; e.g. it is unacceptable to talk about genetic diseases and disabilities, including mental and emotional disorders. Epigenetic trauma syndrome and sense of self-preservation, in addition to constant fear of another war/disaster have led the society to become very overprotective of their cultural norms and traditions. In this relation-based culture, meaningful connections among close people serve as surrogate for counseling, as connectedness and sharing are important elements in collectivist cultures.
Current Status of Education and Mental Health Services
For mental illness treatment, there is generally only psychiatric hospitalization available. People have little to no understanding as to what clinical counseling is and what these services can accomplish. Negative stigma attached to mental health among the general population create barriers to education and services. The only mental health training programs in the country are psychology programs which heavily focus on theory and research and struggle with lack of practical training. According to alumni of psychology departments in Yerevan, the capital of Armenia, students have no requirement of practical training to complete their degrees and have very little access to clinics where they could potentially complete face to face clinical training. Over the past several years, there has been a blooming increase in the opening of many psychological centers, however, the field is highly disorganized and no oversight is provided in order to regulate and guarantee quality services. There are no systems of licensure, supervision, code of ethics, etc., to regulate the entire field and profession and to provide accountability for the professionals practicing in this area.
Ongoing interviews from 2007-2018 with mental health professionals regarding the state of mental health in Armenia revealed the following common themes: outpatient services are extremely scarce, and way beyond the financial affordability of the general population. Anyone who deems oneself a psychotherapist can start a private practice and provide psychological services. There are no routine, unified and officially recognized standards and regulations to guide and oversee an ethical and evidence-based mental health services. Thus, each agency or specialist comes up with their own “ethical standards” which are often non-written but rather orally conveyed concepts. This makes it very hard for consumers to seek legal defense against malpractice because there is a lack of definition as to what that practice entails, and what patient/therapist rights and responsibilities are.
Need for Counseling
Considering the current state of mental health in Armenia, this field needs immediate attention, improvement and further development. The increasing demand for mental health services in the country and the above mentioned contributing factors have opened a space for a proposal to establish a clinical counseling degree program which would train the students mostly coming from both BA and MA psychology programs to offer supervised therapy services to the public. There already are educational programs that have the potential to develop and serve the foundation for a Clinical Counseling program. Graduating students can work towards obtaining licensure in the future when necessary standards and criteria have been placed nationwide. Counseling is a profession which can fit within the context of the Armenian culture to address people’s mental health needs, provide education, training, professional services, and scholarship. The essential tasks are providing fact-base rationale for the necessity to establish counselor education in Armenia; providing ongoing education on how counselor education can benefit the education and healthcare sectors; and providing rationale and ongoing education on how this profession can improve people’s mental health.
Code of Ethics and Standards
To establish the counseling degree and profession, it is crucial to have clearly stated guidelines, ethical codes and standards of practice. Khachaturyan stated in his overview on Armenia that no elaborated and generally accepted policies exist in either research or application in Armenia. Moreover, no general state programs or requirements are in place for training professional applied psychologists in the country and thus each educational organization is responsible for designing its own program. There are no codes of ethics published on any of the organizations’ web pages or periodicals.
Media
The role of mass media is very important in raising awareness among the general public on basic educational and health care concerns, needs and terminology. Any changes within any system, such as the educational and healthcare directly affect the people, thus the public must be kept aware and educated on such matters. It is recommended to conduct national surveys and find out Armenians’ perceptions of mental illness. Further surveys on availability, accessibility, as well as quality of mental health services would help get necessary data to continuously improve the field. Raising public awareness on mental health and educating people about stigma, myths and facts is crucial. Raising awareness among the general public helps to create a more informed society.
Ministries
Conducting discussions with the Ministries of Education and Healthcare with research data indicating mental health needs among public and importance of a regulated clinical counseling profession to help address these needs both on educational and clinical levels, as well as a long-term plan for continuous improvement of the mental health field is vital for necessary funding and legislation. Ministries of health and education can also help create mental health agencies where licensed specialists and interns can work together to address population’s mental health needs.
Educational Program
Funding for starting and maintaining a graduate counseling degree program and opening centers for clinical practice will need to be obtained not only through state but also through local and international donors. Clinical counseling is a separate department from psychology and thus needs to function independently with its own academic leadership and must oversee required practicum and internship processes. This department must set the foundation for the standards and guidelines of best practices for the profession. Ongoing evaluation process must be conducted.
Continuing Education and Oversight
It would be necessary for the members of this new profession to facilitate professional workshops and conferences on national and international levels to ensure continued education and exchange of experience in order to create unified standards of practice and code of ethics. Once initial steps have been successfully established, the formation of a unified national professional association and a board for licensure will be initiated. This board can also enforce the requirements for continuous education and licensure by offering a standard national licensure test. Formation of an overseeing body which investigates disputes and unethical conduct as an independent entity for the sake of unbiased professional practice will be required.
Concluding above illustrated steps is a multi-phased plan which requires the participation of several professional entities to lead to the establishment of clinical counseling departments in universities offering an MA degree and a PhD in future.
Interdisciplinary Approach
The profession of clinical counseling cannot act independently from other disciplines because collaboration between all fields is vital for clients’ best care and safety. This comes in play especially in cases of reporting harm to self or others, child abuse, domestic violence, victim advocacy, offender services, etc. Further steps will include branching out into other fields by creating counselors’ offices in hospitals, nursing homes, orphanages, correctional system, as well as organizational structures, including high-risk employment facilities.
Interdisciplinary collaboration will allow all systems within the society working together for one goal – addressing mental health concerns of the public and ensuring safety of victims and rehabilitation of offenders. It will encourage public access to affordable services. It will also allow the mass media to create pathways of delivery of accurate information from reliable sources to the public. This type of strategy will ensure transparency in the system of healthcare and education and will continuously raise public awareness regarding mental health. For this, laws and regulations must be put in place and enforced to guarantee smooth processes within all sectors of the system.
Conclusion
To start such a vast project, it is important to investigate the scene and prepare statistics on current state of mental illness and outcomes of developing counseling services. Counseling professionals are urged to maintain ongoing evaluation of their educational programs, training, clinical services, and advocacy. The latter is vital in the Armenian context to not only guarantee proper representation of the mental health clientele but also to gain trust in the society. Ongoing evaluation and improvement of counseling education and services will in time guarantee state and national recognition and acceptance of the profession. This includes the conduct of ethical and empirical research studies by the professionals in the field, as well as continuous preparation of specialists to provide best practices and quality services to the Armenian population.