Global Impact

By Lisa R. Rhodes

November 2024

In April of this year, Gregory Kimble, DMin, LPC-S, went on a mission trip to Highgate, a rural town in Jamaica. Kimble traveled as part of an annual medical mission trip to Jamaica organized by Women at Real Risk and Hands For A Cause. The two nonprofits work to provide health care in underserved communities in Jamaica and around the world.

While volunteering at the Highgate health clinic, Kimble met a 17-year-old girl who had been raped and now had a child from that sexual assault. She said she had been waiting three years to speak to a counselor about her experience.

Quality and timely mental health services are in dire need throughout the world. Mental health problems, such as anxiety and depressive disorders, are the most prevalent psychological challenges. The Institute for Health Metrics and Evaluation, a public health agency based at the University of Washington in Seattle, reports that 1 in 8 people across the globe — or 970 million individuals — were living with a mental health condition in 2019.

Counselors and counselor educators are doing their part to tackle the problem. They are volunteering and working to bring counseling to regions where there is no health insurance, no licensing or practice standards, few professionally trained mental health providers and long waiting lists of people who urgently need care.

Ukraine

In 2016, Joshua Kreimeyer, PhD, LPC, LMFT, was studying for his doctorate degree at Regent University in Virginia Beach, Virginia. He was invited by Olya Zaporozhets, PhD, LPC, his professor, mentor and eventual dissertation chair, to travel to Ukraine to help establish a post-baccalaureate certificate in trauma therapy.

Zaporozhets was working in Ukraine with a local church group to create an infrastructure for counseling education and mental health services. Churches were struggling to provide mental health aid after the 2014 revolution. With help from teams of counselors from Regent University, Zaporozhets stepped in to fill the gap and created the International Institute for Postgraduate Education in Kyiv in 2019 to oversee the development of counselor education.

The institute now provides a master’s-level degree in mental health and counseling with a specialization in trauma therapy. The Center for Psychological Counseling and Trauma Therapy, known as Open Doors, is a mental health clinic that is part of the institute and provides in-person and telehealth outpatient therapy services.

When Kreimeyer, who speaks Russian, traveled to the region in 2016, he taught Ukrainian general psychologists basic counseling skills, such as bearing witness, validation, reflection and basic ethics. Mental health education was new to the students, most of whom had only a bachelor’s degree in psychology and had learned the discipline primarily from books, without a practicum or supervision, says Kreimeyer, now an associate professor of counseling in the School of Counseling at Colorado Christian University in Lakewood, Colorado.

One-on-one treatment for mental health problems is culturally frowned upon due to years of political oppression, which taught the Ukrainian people to repress their emotions and to be “stone faced,” according to Kreimeyer. He says the country places a high value on being tough and “sucking it up” during adversity. Furthermore, Ukrainians who seek mental health services must pay out of pocket.

In 2020, the master’s-level mental health counseling program was approved by the International Registry of Counsellor Education Programs and meets the Council for Accreditation of Counseling and Related Educational Programs (CACREP) equivalency standards. Ukrainian students who earn the degree are called psychological consultants or trauma therapists. There are more than 250 graduates of the program, and 60 are practicing at the Open Doors clinic, supervised by American and Ukrainian counselor educators.

The team at the Open Doors clinic completed a code of ethics for trauma therapy in 2021, a year before the Russian invasion, and are working with the Ukrainian government to create licensing standards.

“We built this program from the ground up,” Kreimeyer says. “We currently have about 180 students in our program and provide around 1,500 direct client hours a month. Our therapists are really helping people. Especially during wartime, people really, really need help.”

South Africa

Shannon Hodges, PhD, LMHC, has volunteered at eight orphanages in South Africa, located mostly in the Western Cape and KwaZulu-Natal provinces, during the mid-2000s. He and his wife, a former counselor, often traveled to remote underserved regions as part of volunteer service projects.

In many Indigenous areas, mental health concerns are couched as “spiritual, cultural and health concerns,” Hodges says, and are tended to by community elders and healers. “Black South Africans have a well-earned mistrust of European people, especially white Afrikaners,” he explains. “Interestingly, as a guest, many South Africans — Zulus, Xhosa and even Afrikaners — would come talk with me, likely because I was not South African.”

Hodges spent up to four to six weeks at the orphanages. He met with children who were open to sharing stories of early emotional abuse and with adult staffers who needed training on how to address trauma and conflict in clients and how to handle the stress from their jobs.

There was no infrastructure for counseling services in South Africa at the time, Hodges says, and there was a lack of mental health providers. Providers were mostly psychologists and social workers who had earned a bachelor’s degree in psychology with little or no additional training.

“The several decades of long racist apartheid policies hover over the country in this post-apartheid recovery,” he says. “Part of the lack of services in South Africa is corruption, inefficient government bureaucrats, post-apartheid recovery, racism and a fundamental misunderstanding of what counseling is about.”

Hodges, a professor emeritus at Niagara University and now an associate professor of counseling at the University of the Sunshine Coast in Australia, says he is hopeful a counseling presence can be established in southern Africa. One of his students, a social worker in the master’s counseling degree program at the University of the Sunshine Coast, wants to help bolster counseling services in Zimbabwe. When she earns her degree, she plans to return to Zimbabwe and work with the Zimbabwe Association of Family Therapists and Professional Counsellors, the country’s national counseling organization, to expand the profession.

Jamaica

When Kimble, a Baptist minister with a private practice in Dallas, met with the teen mother at the health clinic in Jamaica, he had only about 30 minutes to provide a listening ear and person-centered therapy.

“I allowed her to talk and express her feelings and let her know someone cared enough to hear her crisis event,” he says. “I spoke to her about how to move forward with her life, in spite of what had occurred. … She was grateful she finally had someone to talk with.”

Kimble also met two inmates from a jail in the region who were brought to the health clinic to receive medication. He spoke to them about the importance of medication compliance so they could live a stable life in the community.

The clinic’s Mental Health Day is held on Thursdays, but there are no counselors or psychologists to treat clients. About 35 to 40 people were waiting in line for mental health services when Kimble was there. Mental health providers are hard to come by in rural areas, where extreme poverty is rampant, he says. Private health insurance is available in Jamaica for people who are employed and for those who can afford to pay for it.

During his trip, Kimble met the only psychiatrist and two nurse practitioners who manage medications, as well as the only social worker, in the area. “Most mental health providers are located in Kingston and charge an equivalent of $100 to $150 per hour session, similar to the United States,” he says. People who rely on the public health system for mental health services may experience long waits and limited access to treatment.

South Korea

In South Korea, the use of digital technology in the delivery of mental health services is growing at a “remarkable pace,” says Nanseol Heo, PhD, a professor in the Department of Youth Counseling and Education at Soonchunhyang University in Asan, South Korea.

“For example, all students in Seoul can currently apply for school counseling in the metaverse, and students nationwide can access chat counseling through an app operated by the Ministry of Education,” she says.

Yet despite these advances, the country’s network of public and private agencies that provide mental health services, particularly counseling, can make the process of seeking treatment confusing and time consuming.

“The general public often doesn’t fully understand the complex service system,” says Heo, director of the Soonchunhyang Psychological Counseling Training Center. “The manpower and resources of public counseling institutions are certainly not flexible enough to accommodate the entire demand, and their capacity has clear limits.”

There are four mental health delivery systems in South Korea: in-patient hospitals, run by psychiatrists; school counseling, provided through the Ministry of Education; private psychological counseling centers operated by counselors or clinical psychologists; and the public counseling and mental health service system. That last system offers free counseling through two separate agencies — one that provides counseling for teens and young adults ages 10 to 25 and another that provides case management and community living assistance for people of all ages who have been diagnosed with severe mental health disorders.

Although the services provided through the public agencies are free, Heo says the agencies need to be reformed so they can clearly define their roles and work together to be more effective. There also needs to be a mental health campaign to explain how the agencies operate and how to properly access services.

Other impediments to receiving quality mental health care are the absence of legal regulations for operating private psychological counseling centers, the high treatment rates they charge and the lack of curriculum standards, such as CACREP, for master’s-level counseling education programs.

The South Korean government provides health insurance to cover the costs of psychiatric diagnoses and medication management, but because there is no law regulating the operation of private psychological counseling centers, their services are not covered by insurance. However, because of the high suicide rates in South Korea, the government launched a special insurance program at the end of 2023 to subsidize the cost of up to eight sessions of psychological counseling at the private centers.

Overall, Heo says, South Korea is slowly working to improve its mental health care system. In the next five years, she hopes the country will develop requirements for opening private clinics and that there will be a licensing system for psychological counselors.

Guatemala

In 2003, Maria del Pilar Grazioso, PhD, then the director of the Department of Psychology at the Universidad del Valle de Guatemala (UVG) in Guatemala City, began to offer counseling courses as part of the department’s continuing education program.

Grazioso, a licensed psychologist, says she decided to offer the classes because “the increased and often unacknowledged urgent need to address the mental health of urban and rural communities, particularly the underserved, was unmet.”

There was no counseling higher education program in the country, and there weren’t enough mental health professionals to offer services. “I considered counseling a [suitable] opportunity to train professionals who could not only offer interventions but, most important, offer prevention efforts toward well-being in a culturally relevant manner,” she explains.

Today, more than 20 years later, the university offers a master’s degree in psychological counseling and mental health with a specialization in expressive arts and a master’s degree in psychological counseling with a specialization in families and couples. A master’s degree in community counseling is also available at UVG’s Altiplano campus in Sololá.

Edil Torres-Rivera, PhD, LPC, LCPC, immediate past president of ACA, has been a strong supporter of bringing counseling to Central America, particularly the master’s counseling education program at UVG.

Ana Cóbar Catalán, PhD, director of the Department of Psychological Counseling and Mental Health at UVG, says to earn a master’s degree in psychological counseling, students must first earn an undergrad degree degree in psychology or any other area related to health science, which is earned in five years. To get the master’s degree takes about three years, after completing 20 courses, a practicum and a graduation project.

More than 100 students have completed the master’s degree program in psychological counseling and mental health and are now working in schools, hospitals, human resources, private practice and government.

Grazioso, who has retired from the university, says one of her goals with the program was to train professionals from a counseling perspective so they could help reduce the significant gap between mental health and access to services.

Mental health services in Guatemala City are limited, Cóbar Catalán explains, and very few, if any, psychologists or counselors provide services in the small towns and rural areas outside the city. There is also no health insurance coverage for mental health treatment.

Grazioso and Cóbar Catalán hope that in five years there will be more counseling programs and an ACA affiliate in Guatemala.

Leading the Profession Abroad

As the largest counseling organization in the world, ACA and its members can play a pivotal role in establishing a counseling presence in regions of the world where it is most needed. For example, as a sponsor for the International Association for Counselling Conference this past June, ACA helped 15 counselors from low-income economy countries attend the event virtually.

ACA also has resources related to international counseling, including the book Counseling with Immigrants, Refugees, and Their Families from Social Justice Perspectives and the International Counseling Case Studies Handbook. ACA also offers the continuing education course “Crisis in Ukraine: What Counselors Need to Know.” (Access these resources at imis.counseling.org/store)

The investment of clinicians’ time and expertise abroad is necessary and rewarding. Hodges, who has also used his counseling skills to help Indigenous communities in Australia, says international counseling is “the next big frontier.”

“My experience in traveling across the globe is that counseling is spreading, but also is spotty, and thus the need for coordinated efforts,” he says. “We’re going to need more people from Indigenous cultures to come in and be counselors and psychologists and social workers. That’s what’s really going to make the difference.”