Lay Counselling In Ghana: Ethical Dilemmas and Ethical Challenges in Practice

Abstract

Lay counsellors play critical roles in mental health service delivery in Ghana. There is a shortage of professionally trained mental health practitioners. Lay counsellors deliver basic counselling and psychoeducation services in schools, churches, health settings and communities. Given the critical role of lay counsellors in mental health delivery in Ghana, it is imperative to understand how these lay counsellors deal with ethical dilemmas in their everyday practice. Unfortunately, there have been limited studies focusing on this group of counsellors. This qualitative study explored the ethical dilemmas experienced by a conveniently selected sample of 27 lay counsellors in Ghana and investigated how these dilemmas were resolved. Data were gathered using in-depth individual interviews and vignettes; and analysed using thematic analysis. Findings showed five thematic domains of ethical challenges faced by the lay counsellors: (1) difficulties negotiating rights and confidentiality; (2) competency issues relating to working on cases they are not trained for; (3) difficulty managing multiple relationships; (4) dealing with conflicting values; (5) and issues relating to gifts. Four thematic resolution strategies were identified: (1) referrals; (2) personal discretion; (3) consultation; and (4) use of codes of conduct. More so, three challenges were identified in terms of resolving ethical challenges: lack of continuous training; challenges religious values; and challenges with cultural values. The findings are discussed in relation to improving lay counselling practice in Ghana.