Does psychological counseling need to be delivered by a psychologist to be effective?
Not necessarily, according to a provocative new line of research involving CU Boulder psychology professor Sona Dimidjian that suggests an army of trained “lay counselors” could someday provide a solution to the global mental health treatment gap.
A key paper, co-authored by Dimidjian with famed Indian psychiatrist Vikram Patel and published Thursday in The Lancet journal, explored whether lay counselors – community members who got three weeks of intensive training plus follow-up supervision – could effectively counsel people with depression.
Of 500 subjects recruited from medical centers in Goa, India, the 245 seen by lay counselors for three months had significantly lower symptom severity and fewer days of missed work than those who did not receive the counseling. Sixty-four percent experienced remission from depression.
A second paper, also released this week in The Lancet, showed lay counselors can be effective in curbing alcohol abuse too.
“Some women may prefer to get initial care from another mom who has experienced what they have and can help combat the shame and stigma associated with getting depressed during pregnancy and postpartum,” says Dimidjian.
Dimidjian is now testing the concept locally, working with Kaiser Permanente Colorado Institute for Health Research in Denver, the Valley Settlement Project in the Roaring Fork Valley, and the National Behavioral Health Innovation Center on the CU Anschutz Medical Campus to develop two pilot programs in which “peers” – mothers who have experienced depression and come through it – support moms experiencing depression during pregnancy or early parenting.
“Lay or peer counseling is not likely to be the recommended intervention for all depressed people. Some people will need more or something different,” stresses Dimidjian, an associate professor in the Department of Psychology and Neuroscience. “But do we need psychologists to deliver all psychological treatments? The answer, in general, is no. This study shows that a 6 to 8 session protocol can be delivered by trained and supervised individuals with no formal mental health expertise – and it works.”
Nearly 8 percent of adults in the U.S. suffer from depression. Globally, the number hovers between 4 and 7 percent. But in low and middle-income countries like India, as many as 90 percent of people who require treatment can’t get it, largely due to lack of affordable care providers. In the U.S., 57 percent of people with a mental illness go untreated. Half say it is because they lack affordable options.
Patel was recognized by Time magazine in 2015 as one of the 100 most influential people in the world for his pioneering work looking at low-cost effective treatment options for people with mental illness.
“These robust studies prove there are cost-effective solutions to the shortage of trained mental health specialists in low resource settings,” said Mary DeSilva, head of population, environment and health at Wellcome, a charitable foundation which funded the studies. “They also provide food for thought for high-income countries, where, despite their affluence, mental health service provision is frequently sub-optimal.”
Dimidjian traveled to India to work with Patel and his team teaching lay counselors an approach called “behavioral activation.” It hinges on the notion that identifying and intentionally scheduling activities which bring pleasure or accomplishment – be it exercise, art, or time with friends – is key to battling depression. “It’s using activity as a pathway out of depression,” she explains.
She believes the lay counseling model could be an ideal fit for some mothers with depression, which impacts about 20 percent of women during pregnancy and postpartum.
“Some women may prefer to get initial care from another mom who has experienced what they have and can help combat the shame and stigma associated with getting depressed during pregnancy and postpartum,” she says.
Will she get push back from mental health professionals who, like herself, spent years to get their degrees? Maybe, she acknowledges, but the existing system isn’t working.
“We need more intensive, professional care for some, but we also need innovative solutions so that, overall, effective care is more widely available. Not everyone who needs treatment for depression needs to see someone with a PhD.”