Evolution of Counseling in Jamaica: Past, Present, and Future Trends
Abstract
Counseling maintains a small yet growing presence in Jamaica as a profession. Practitioners are confronted with several societal problems. The authors provide a historical overview of Jamaica and a synopsis of the development of counseling. The emergence of counseling services through the limitations of psychiatry and psychology sets the stage for current practices and notable involvement of guidance counselors. It is concluded that the continued growth and effectiveness of counseling is dependent on overcoming negative attitudes and economic barriers.
The launch of cross-cultural research investigating multicultural issues in the United States has forced mental health practitioners to recognize an existing void in the profession. In Western cultures, there is a tendency to apply counseling theories and techniques to populations having diverse backgrounds that are not represented in the mainstream literature. The people of Jamaica are not exempt from this exclusionary oversight that is present in today's research literature (G. J. Palmer, 2009). Regardless of the representation of Jamaica in the mental health services literature, the practice of counseling is now present within that Caribbean country. The introduction of counseling services is limited, with the majority of professionals being employed in the school systems as guidance counselors. Although the majority of counselors are found in Jamaica's public schools, there is also an effort to provide counseling within community settings, such as local churches (Copeland, 1992), and through student affair divisions of colleges and universities. Among the helping professionals are a small number of mental health care providers in private practice. Counseling delivered in this manner faces a multitude of challenges that stem from economic and social constraints.
The purpose of this article is to provide an overview of counseling services in Jamaica. The evolution of counseling is discussed by reviewing past practices, the present state of counselors in the field, and implications for future trends. This synopsis of Jamaica's development in counseling also has implications for the services provided to Jamaicans now living in the United States.
Historical Overview and State of the Nation: Jamaica
Jamaica achieved its political independence from Great Britain in 1962 amid high hopes for growth and development. For large numbers of Jamaicans, the realization of these hopes was possible only by moving to the urban areas, especially the metropolitan area of Kingston, the capital. Many of these individuals were formerly engaged in agricultural activities that added only marginally to the total output of the economy. The late economist W. Arthur Lewis (1954) described them as surplus labor that could be absorbed only in low-wage urban jobs. In 1960, there was considerable room for improvement in citizens’ level of education. Only 43% of the high school age population actually attended secondary school and only 2% of individuals between the ages of 20 and 24 years were enrolled in tertiary education. Over the past 5 decades, these percentages have improved to 66% and 6%, respectively, as a result of greater investment in education and an increase in the demand for skilled workers (R. W. Palmer, 2009). When compared with universal access to secondary education in small developing countries such as Singapore and South Korea, these increases have been modest.
In addition to the limited availability of skilled workers, strong labor unions have kept labor costs high, placing Jamaica at a competitive disadvantage with other countries in the region. Today, the major share of employment is provided by the service sector, which includes government, wholesale and retail, and financial and tourism services.
In the 1970s, the politics of nationalism limited the capacity of employment growth in the private sector as the socialist government sought to capture the economy, which at that time meant control of the bauxite industry. In the process, the strategy scared off needed foreign private capital investment to such a degree that subsequent pro-private-sector governments were unable to stimulate growth beyond the anemic rate of 1% from 1975 to 2005. At the same time during this period, the rate of emigration to the United States rose, draining away valuable skilled labor, including future educators and mental health practitioners.
As the economy stagnated, graduation from high school no longer guaranteed a job. Consequently, an urban informal economy began to flourish around the buying and selling of drugs, an illegal business controlled by an informal government of drug dealers called dons, who operate with a wink-and-a-nod from the elected representatives in the more economically desperate constituencies of Kingston. The informal government of the dons exercises its own justice to those who break their rules and dispenses their welfare benefits to loyal followers. The existence of this informal government was a clear manifestation of the inability of the legitimate government to meet the needs of the people. In the summer of 2010, the situation erupted when the government moved in on the dons to restore some semblance of law and order. A small part of the government's response included sending guidance counselors to troubled areas to address the needs of school children who may have been affected.
In a country where tourism is the major source of foreign exchange, urban violence, even if it occurs outside the so-called tourist areas, takes its toll on foreign exchange earnings. As a consequence, the Jamaican government has devoted a disproportionate amount of security resources to isolate tourists from the violent consequences of unemployment and income inequality.
As the contribution of mining (bauxite) and agriculture to the country's gross domestic product declined over the last 2 decades, tourism and remittances sent back to the country by emigrants abroad have loomed larger as sources of foreign exchange. The fact that the most important flow of foreign exchange now came from two types of travel, tourism and emigration, has led one economist to designate the Jamaican economy as a travel economy (R. W. Palmer, 2009, p. 69).
Past Mental Health Practices
Early Forms of Therapeutic Care
Within Jamaica, the presence of professional counselors has been limited and counseling services are still in the early stages of development. The need for mental health care existed long before counseling arrived on Jamaica's shores, and there have been methods of providing treatment that have not been recognized by Western scholars. Before the age of counselors, there were highly respected members of the community who helped individuals in need of mental health care. G. J. Palmer (2009) recognized the presence of mental health care in Jamaica well before counseling was established as a profession:
Jamaican channels for receiving help for issues pertaining to personal problems, family matters, and community relations have existed in Jamaica for hundreds of years. Throughout the generations, Jamaicans have relied on family members, church leaders, and community elders to resolves issues contributing to psychological stress. (p. 2)
Prior to Spanish colonization and instigation of the British transatlantic slave trade, the original natives of Jamaica were the Arawak Indians. Historical observations in the 1600s provide insight into the care that those with mental disorders received. Treatment included support from the social structure within the community and early forms of pharmacology (Hickling, 1988). This treatment did not involve restraints (Hickling, 1988) and was considered humane.
Counseling's Relationship to Psychiatry and Psychology
The arrival of psychiatry through European colonization lacked humanitarian compassion and there was little advocacy for individuals experiencing a mental illness. British-trained psychiatrists influenced Jamaica's first asylum in the early 1860s. In 1862, the Lunatic Asylum was constructed, and a decade later British governance supported the medical model principles of psychiatry with the 1873 Lunatic Asylum Law. This legislation allowed for the imprisonment of individuals suffering from mental illness (Robertson-Hickling & Hickling, 2002).
By this time, the transatlantic slave trade from Africa had ceased, forever changing the demographics of Jamaica and most of the Caribbean. The end of the 1800s and the beginning of the 20th century witnessed continued segregation among individuals providing treatment and those receiving mental health care. British-trained psychotherapists reserved therapy for the White upper class, while the Jamaican Black community was cared for by indigenous healers. The British did not support this traditional form of care by local preachers and respected community members who had the knowledge of folk healing, and many efforts were made to eliminate this practice (Robertson-Hickling & Hickling, 2002). These attempts by the British colonialists to abolish traditional forms of mental health care were efforts of oppression. Burke (1979) suggested that native healers have greater prominence in Jamaica than do Western practitioners because of their numbers in the community, understanding of societal factors, and social acceptance by the public.
The history of mental health care in Jamaica was heavily influenced by psychiatric services. However, in the 1950s, social work and other interpersonal approaches to wellness began to accompany treatment in the renamed and deteriorating Bellevue Mental Hospital (Robertson-Hickling & Hickling, 2002). The introduction of psychotherapy provided patients with individualized treatment plans that focused on overall wellness. The wellness model is in contrast to psychiatry's medical perspective with which psychologists also identify. Although psychiatry began to specialize with populations such as children in the 1960s, counseling's potential influence and professional presence with this demographic did not emerge until the mid-1980s.
Before the popularization of guidance counselors in Jamaica, events of the 1960s raised individuals’ consciousness of mental health through the launching of Community Mental Health Services. This project received psychiatry supervision from the University of the West Indies at Mona. The Community Mental Health Services project introduced two mental health officers (MHOs; Robertson-Hickling & Hickling, 2002), which the Pan American Health Organization also referred to as consultants (Collis & Green, 1976). The primary responsibility of the MHOs was to identify members in the community who may have been in need of mental health services and to have these persons transported to a local hospital. The MHOs had the authority to have potential patients taken from their homes, an act that was authorized by the 1974 amendment of the Mental Health Act. In addition, the 1974 revision of the 1930 Mental Health Act amendments required family members and others living with those believed to have a mental illness to assist MHOs (McKenzie, 2008; Robertson-Hickling & Hickling, 2002). The Mental Health Act was amended again in 1997. This latest revision included sections concerning compulsory detention, appeal process, and duration of detention (McKenzie, 2008). With the authority of the law and the support of Pan American Health Organization, the number of MHOs grew steadily to 41 by 2008 (McKenzie, 2008).
Current Status of Counseling in Jamaica
Although there is evidence that the number of MHOs has increased (McKenzie, 2008), there is a scarcity of data on the practice of professional counseling and current trends in Jamaica. There are few official figures on the number of trained counselors and the credentialing procedures that they undergo. However, there is solid evidence of three major factors contributing to the emergence of counseling in Jamaica: (a) spiritual support of the church, (b) introduction of the Ministry of Education's Prevention Education Program, and (c) the establishment of counseling training programs.
First, Jamaican churches began to provide counseling services in combination with nonemergency general health care. During the mid-1980s, counseling services began to materialize as a small, but meaningful presence in Jamaica. This was an effort to provide more holistic care to members of the community. By the early 1990s, counseling services were incorporated in 72% of churches, using this holistic model, within the areas of Kingston and St. Andrew (Copeland, 1992). The introduction of therapeutic care within the church provided an outlet for community members to seek psychosocial help. During the early 1990s, this network of counseling ministries was supported through 29 churches (Copeland, 1992).
Second, in 1985 the Jamaican Ministry of Education initiated the Prevention Education Program (PEP; Ministry of Education, 2011). The PEP focus was a response to the nation's growing drug problem. Substance abuse during the mid-1980s increased reflecting a slowing economy and high unemployment, particularly among young, work-eligible men. In 1997, the PEP's mission was further defined when the Youth and Culture Division of the Ministry of Health created policies concerning substance abuse within schools (Ministry of Education, 2011). The PEP approach was to stem the tide of many societal problems through various forms of education for primary and secondary students. The incorporation of guidance counselors was one of PEP's educational strategies to combat drug abuse. The PEP received support from the European Union and the National Council on Drug Abuse; by 2000, there were 75 guidance counselors receiving training in substance abuse counseling and management in order to operate related projects (Ministry of Education, 2011). During the following year, 25 guidance counselors were prepared to work with students of all educational levels, and 50 students received training to become peer counselors (Ministry of Education, 2011).
A pinnacle year for counseling as a profession in Jamaica was 1985. Not only did the Ministry of Education (2011) launch the PEP, which implemented a plan to train guidance counselors in the area of substance abuse, but the development of the first counselor preparation program also took place in 1985 (Stupart, Rehfuss, & Parks-Savage, 2010). Within the last 10 years, the number of counseling programs at colleges and universities in Jamaica has grown to four with a total of 16 supervisors providing supervision for advancing practicum students (Stupart et al., 2010).
The National Board for Certified Counselors (NBCC; 2008) reported that the NBCC, in conjunction with the Jamaica Association of Guidance Counsellors in Education, established NBCC-Jamaica. The purpose of this agreement was to create and maintain a counselor certification program that was to be governed by NBCC-Jamaica. According to the NBCC, the Jamaican branch has awarded the newly installed certificate, the NCC-Jamaica (NBCC, 2008). The NBCC- Jamaica is a three-tier credentialing system, with a reported 449 counselors registered at the first level (NBCC, 2008). Despite the early success of the collaborative effort, Jamaica is no longer represented as an NBCC international field and regional office (NBCC, 2011).
Future Trends
Attitudes Toward Seeking Mental Health Services
Within Jamaican culture, there is a stigma surrounding mental illness. Individuals living with or caring for family members with a disability or mental health disorder are reluctant to share this information (Statistical Institute of Jamaica, 2004). As has been found in other Afro-Caribbean populations, Jamaicans who need mental health care do not typically seek help from someone outside the family or community social network. Seeking outside help is regarded as sharing personal issues with a stranger, with the potential consequence of placing the family at risk of being stigmatized by the community. Counselors must not underestimate the importance of understanding help-seeking attitudes. In order for counseling to continue developing, the public's attitudes toward seeking mental health services will have to change. The future of counseling as a profession in Jamaica would benefit from efforts to raise awareness. Education is one of the best strategies that can be used to curb the entrenched stigma surrounding mental illness.
Migration Influences on Counseling Services
The future of counseling in Jamaica can potentially benefit from the ongoing migration of citizens to countries such as Britain and the United States due to research conducted in the new host countries. Mental health investigators can identify the counseling practices and treatment plans that are the most effective for Jamaicans. Future research findings can yield implications that are more culturally appropriate not only for Jamaicans living abroad, but for those living in Jamaica as well. An example of this is Payne's (2006, p. 93) qualitative research with a Jamaican American sample. This study identified a three-dimensional phenomenon called “being in control,” which is a basic social process to sustain, improve, or resolve mental health issues, sometimes evident as a false sense of confidence and self-imposed limitations to seeking professional help. Jamaicans who have migrated to the United States to seek greater economic opportunities are faced with a multitude of psychological stressors. In addition to acculturation, many Jamaican migrants are faced with the dilemma of being separated from their families. This problem becomes more complex when children are involved. Future research on Caribbean migrants’ children would directly benefit family members who are in need of care in Jamaica.
The separation between children and their parents who have moved abroad places the children at a higher risk of poor performance in school (Pottinger, 2005) and to experiencing psychological stress (Sankey, 2010). For Jamaican family members who intend to stay and become established in the United States, there usually is a plan to later reunite with children and other relatives in their new host country (R. W. Palmer, 1998; Pottinger, 2005). Typically, the time from the beginning of the separation to the reuniting of the family causes the greatest amount of stress for children. The future of counseling as a profession and the welfare of children experiencing even the temporary loss of family members would benefit significantly from research addressing this problem.
Economic Barriers to Receiving Services
The cost of providing counseling services has been a deterrent for government agencies, community organizations, and private practices in Jamaica. There are several economic barriers that could interfere with the development of a network of helping professionals. Mental health services in Jamaica are threatened by the high cost of counselor education training programs and credentialing. Many counselors in Jamaica have received their education in the United States. During this process, many of these individuals incur considerable debts from both education and consumer loans. They return to Jamaica with large debts for their education, possibly sizable credit card debt, and the expectation that they will get high paying government jobs. However, the Ministry of Health may not view counseling services as an affordable or necessary expense. In addition to the high cost of educating therapists, counseling credentialing has also been viewed as an economic barrier. When properly designed and managed, credentialing has major benefits to both the public and the profession. However, credentialing needs to be affordable for counselors in Jamaica and not based on the U.S. economy. If this does not happen, the high cost of credentialing will be passed on to the client.
Despite potential economic barriers, the Jamaican government has taken steps to help reduce the cost of mental health care and related human services, which have not been a public priority in many Caribbean countries, including Jamaica. However, with the realization that community mental health care is more effective and cheaper to provide than institutional services, the Jamaica cabinet approved the 2006 development of the Mental Health Services and Deinstitutionalization Plan (Jamaica Information Service, 2008). Emerging from that approval was the 2008–2012 Mental Health Strategic Plan. This plan mirrored the World Health Organization's recommendation for the development of community-based services to reduce stigma and to provide the best clinical approaches (Jamaica Information Service, 2008). The strategic plan foresees the availability of all necessary mental health services, including counseling. Programs stemming from the Mental Health Strategic Plan can help spread awareness of counseling as a growing profession and help keep costs affordable for community agencies and future clients.
Summary and Conclusion
Societal problems concerning high unemployment, substance abuse, and urban violence are just a few of the major issues challenging the growing profession of counseling in Jamaica. Issues in society alone will not promote the use of counseling services. Education, particularly in the primary schools, is seen as the key to the future progression of the counseling profession. Help-seeking attitudes need to be understood by practicing clinicians in order to curb stigma surrounding mental health services. As the profession continues to develop, steps must be taken to ensure that counseling is accessible for every individual who needs it. Access for all is largely dependent on the government's ability to recognize the need for mental wellness and its ability to maintain affordable counseling services. The expense of investing in Jamaica's counselors to become qualified to serve must stay within reach to avoid having future clients shoulder the burden of inheriting a high cost for mental health services.
