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Sri Lanka’s Psychosocial Counselors Look to Their Peers to Improve Care

February 15, 2017

By Mihiri Ferdinando

Two years after Sri Lankans voted to elect a new coalition government, and eight years after the bloody, three-decade long ethnic war ended, reconciliation efforts to rebuild the country are beginning to have positive, tangible impact on the daily lives of citizens, particularly in the North and East. Beyond investments in infrastructure and economic growth, however, the new government has also made efforts to recognize and address the psychosocial issues that continue to affect people in the aftermath of the war.

Psychosocial issues continue to affect people in the aftermath of the war, and social stigma prevents trauma-affected individuals from seeking professional help. Psychosocial workers at the Vavuniya Family Rehabilitation Center after a session with a client. Photo by Gemunu Amarasinghe

Long-term psychosocial issues heightened after the end of the war, caused by trauma, substance misuse, domestic violence, psychological problems, and breakdown of social relationships and traditional family structures. The limited provision of mental health and psychosocial support services is compounded by the fact that social stigma prevents vulnerable and trauma-affected individuals from seeking professional help. The country is still witnessing many of these same psychosocial issues across the country 13 years after the 2004 tsunami left hundreds of thousands of people dead, and entire towns devastated.

With an island-wide reach, the government-run State Health Services take on the primary responsibility of responding to the psychosocial needs of communities. These services are provided through a predominantly centralized delivery system with a focus on medical and psychiatric issues. One of the key objectives of Sri Lanka’s 2005-2015 Mental Health Policy was to build the capacity of counselors to extend mental health services at the community level.

As the first point of access for most people seeking assistance, state sector counselors play a critical role in addressing the needs of communities. But until recently, counselors have lacked the tools and training to help them professionalize their skills and draw emotional support and guidance to do their jobs effectively.

In 2013, The Asia Foundation conducted a mapping study of 315 psychosocial counselors to identify their key needs, which included: increased technical knowledge, greater career progression pathways, greater clinical and practice supervision, and a stronger peer support mechanism. Counselors reported that in the absence of such a mechanism, they drew emotional support and guidance from informal sources such as former university colleagues, friends, and family.

Shanika Heiyanthuduwa, a counseling assistant from the Ministry of Women and Child Affairs based in Narammala Divisional Secretariat, in front of a client family. “My initial judgment of counseling was that it is a subject based on theories that are limited to textbooks with no practical use. However, since I started treating clients and resolving issues it was obvious that this is a very practical subject” she said. Photo by Gemunu Amarasinghe

In 2014, The Asia Foundation began working with the government’s counseling and psychosocial service providers to improve service quality and professional competency, and to introduce and equip point persons involved in the provision of counseling services with the knowledge and skills to train their teams and facilitate regular peer support mechanisms within their districts. As part of this effort, we developed an eight-step peer support model through a series of monthly training workshops to create an opportunity for counselors to learn from each other’s practical experience and challenges. In January 2015 and March 2016, the Ministry of Social Empowerment and Welfare and the Ministry of Women and Child Affairs mandated that this peer support methodology be practiced at their monthly review meetings.

A counseling cadre from the Ministry of Women and Child Affairs of Kurunegala district share a meal during a visit to a Buddhist temple ahead of a group meeting. Photo by Gemunu Amarasinghe

When the peer program was initially introduced, counselors said they were challenged by the limited colloquial words that could be used to describe complex emotions in local languages. In the absence of local terminology (for example the word sathuta which translates to happiness conveys a range of emotions from being pleased, satisfied or agreeable, similarly, the word duka which translates to sadness also conveys disappointment or sympathy), most counselors learned that clients often explain emotion through descriptions and expressions rather than single words. By presenting case examples to each other, the support mechanism enables the peer group members to empathize with the counselor who is supporting a client. As a result, they are more able to recognize their own emotions which could influence them while supporting a client.

Counselors reported having not been accustomed to reflecting on their own emotions and were entirely focused on their clients’ situations, sometimes with too much emotional entanglement. With practice and technical guidance, participating counselors began to recognize how their emotions were also activated in their work with clients. These reflections also enabled counselors to recognize, validate, and respond to emotions expressed by their clients and colleagues. In monthly meetings with their peer support groups, counselors were able to identify the positive or effective interventions and responses made by a peer. Each member of the peer group then offered an idea or suggestion of what strategies or actions they would explore going forward if they were working with that client.

Jaffna district counseling assistants from the Ministry of Social Empowerment and Welfare role play in pairs on gathering data during a workshop introducing them to the Client Screening Form (CSF) and the Client Intake Form (CIF). The Foundation facilitated workshops that created assessment tools for counselors to gather accurate data. Photo by Gemunu Amarasinghe

For counselors, the structured monthly meetings provide an open space to discuss their work and to benefit from input within peer groups to share both their experiences with what worked, but also what they felt fell short. At the end of a peer supervision session, counselors often reported gaining new ideas and approaches which they had not considered or explored. Following the workshops, each Ministry nominated trainers based on their experience and competency, and following refresher training programs, the model was introduced to counselors across all of Sri Lanka’s districts.

The peer support model for the first time provides an avenue for counselors to share their work within a safe space with reflective review and practice which are key ingredients of accountability and good practice in mental health provision. As Sri Lanka rebuilds, this type of model will be critical to a holistic recovery.

Mihiri Ferdinando is a program manager for The Asia Foundation in Sri Lanka. The views and opinions expressed here are those of the individual author and not those of The Asia Foundation or its funders.

Related locations: Sri Lanka
Related programs: Conflict and Fragile Conditions


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