Mental health education in Pakistan is still a work in progress, to say the least. There are few universities offering degree programs in psychology, and even fewer offering specialised programs in psychotherapy, counselling and special needs. With increasing awareness for mental health, there has been an increase in the demand for mental health practitioners, but there is a dearth of state-regulated, licensed practitioners. This very gap between demand and supply has provided an opportunity for profit-making institutions to position themselves in this field, with little to no regard of the ethical and professional standards that are essential to operate in this space.
Over the last few years, a number of institutions in Pakistan have appeared which offer certificate and diploma courses in counseling and psychotherapy, accredited by various United Kingdom-based credentialing bodies. These adult education curricula are structured primarily for working adults, with the diploma course ranging between 8 months to a year, and the diploma plus certification course ranging up to 2.5 years.
Despite claiming to be accredited with international bodies, these institutions continue to operate in an unregulated fashion with minimal oversight, lacking ethical checks and balances and sustaining bare minimum standards, with their British counterparts having little to no avenue of redressal. Adult education courses count as tertiary qualifications internationally, which enable individuals to take up trade jobs such as mental health aids or psychiatric staff, differing between North America, the UK and Australia. However, to qualify as a mental health counselor, social workeror therapist, it is essential for individuals to hold at least a bachelor’s degree (and in many countries, also a master’s degree), prior to enrolment in such a diploma. In Pakistan, given the lack of regulations, there have been reports of individuals who have yet to complete high school (A-level students, for example) being enrolled in these mental health courses. There are no standards of intake, no minimum requirements set, and no screening completed prior to admitting (and eventually certifying) individuals as ‘mental health practitioners’. There have also been reports of individuals themselves battling addictions and personality disorders having graduated from these programs, and now practicing as therapists.
We have a chance to make amends before our streets are overcrowded with sub-par therapists and counselors; who have crossed a bar that has been set far too low, operating in a field that is far too sensitive
The courses internationally fall under ‘advanced learning’, yet the curriculums being disseminated in Pakistan do not follow through on the rigorous requirements of research methodology, use of assessments, cultural perspectives, and most importantly, ethical and professional values. The courses are taught by individuals who have previously graduated the very same course, with two to three years of experience, therefore not meeting the international standards of quality education internationally. In the US, UK and Australia, the courses must be taught by professionals with high levels of academic experience in the field (Masters or PhD), in addition to significant work experience.
The counselors being produced from these institutions may know the techniques, but are severely lacking when it comes to ethical, non-biased practice. While speaking to a number of therapists previously associated to these institutions, a high number of cases relating to breaches in confidentiality, ethical violations and misconduct were highlighted. Most of these cases went unreported (or misreported) as there is no regulatory authority, or mechanism for redressal when it comes to psychotherapy in Pakistan. Clients who have previously opted to seek therapy from graduates of these programs have reported feeling demoralised, felt shamed and judged for their life choices, were made to feel guilty for not being ‘good practicing Muslims’, and have heard their conversations with therapists ‘in confidence’ being repeated in social settings. The damage being caused by these therapists is far more dangerous than we think.
A mental health helpline operating in Pakistan reportedly prescribes medication to clients over the telephone. There are no checks and balances to ensure that the person on the other end of the phone call is a psychiatrist licensed to prescribe medication, nor is this practice ethical. There have also been cases of individuals starting their own counseling clinics with no academic background or license, but simply because they were encouraged by family and friends to turn their ‘compassion and approachability’ skills into a profit-generating mechanism.
Pakistan Medical and Dental Council regulates medical professionals, yet mental health professionals don’t seem to be on their radar. There is no equivalent licensing body for therapists and counselors. As the field of counseling and psychotherapy continues to be unregulated in Pakistan, the Higher Education Commission must enforce at the very least, a universal standard of minimal education requirements. In doing so, it is important for a grandfather clause to be included, to ensure that new and past graduates of such diploma and certification programs ensure they meet these requirements too.
A lot of damage has already been done. But we have a chance to make amends before our streets are overcrowded with sub-par therapists and counselors; who have crossed a bar that has been set far too low, operating in a field that is far too sensitive.
The writer is a human rights lawyer based in Islamabad
Published in Daily Times, February 13th 2019.