Perceptions, attitudes, and knowledge of teachers serving as mental health lay counselors in a low and middle income country: a mixed methods pragmatic pilot study

Background Low and middle-income countries (LMICs) lack trained child mental health professionals. While teachers’ child development experience potentially positions them to fill the gap as lay mental health counselors, they have rarely delivered indicated child mental health care in LMICs. As part of assessing the feasibility of teachers serving as lay counselors, we explored teachers’ perceptions of serving as lay counselors and their mental health attitudes and knowledge. Methods In 2018, with training and supervision, 19 primary school teachers from five rural, low cost private schools in Darjeeling, India, served as lay counselors in their classrooms. Using mixed methods, we examined teacher perceptions of serving as lay counselor and mental health attitudes and knowledge through a survey (n = 15), a summative assessment (n = 14), and semi-structured interviews (n = 17). For the survey and summative assessment, pre-training, post-training, and post-intervention mean scores were compared using paired t tests. Post-intervention interviews were coded for teachers’ perceptions of serving as lay counselor and mental health attitudes and knowledge. Results Qualitatively, teachers expressed being willing to serve as lay counselor, having more inclusive mental health attitudes, and retaining mental health knowledge as applicable to use during instructional time or incorporation into the knowledge transfer process, their primary duty. By contrast, quantitatively, teachers’ attitudes appeared to become more inclusive on the study-specific survey pre versus post-training, but reverted to pre-training levels post-intervention. Teachers’ mental health knowledge on the summative assessment did not change pre-training versus post-training versus post-intervention. Conclusions Training, supervision, and serving as lay counselors led to teachers’ willingness to serve as lay counselors. Teachers served as lay counselors by utilizing therapeutic techniques during class time and incorporating them into their typical instruction, not through delivering traditional office-like care. Teacher practices may be pointing to the potential emergence of an “education as mental health therapy” system of care. Their changes in attitudes and knowledge reflected their emerging practices. Quantitative measures of knowledge and attitude changes did not capture these nuanced changes. Trial Registration The parent feasibility trial was registered on January 01, 2018 with Clinical Trials Registry – India (CTRI), reg. no. CTRI/2018/01/011471, ref. no. REF/2017/11/015895. http://ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=21129&EncHid=&modid=&compid=%27,%2721129det%27..

Perceptions, Attitudes, and Knowledge of Teachers Serving as Mental Health Lay Counselors in a Low and Middle Income Country: A Mixed Methods Pragmatic Pilot Study

Background: Low and middle-income countries (LMICs) have a dire need for trained mental health professionals, especially for children. While teachers’ child development expertise potentially positions them to serve as lay counselors, they have rarely delivered indicated child mental health care in LMICs. As part of assessing the feasibility of teachers serving as lay counselors, we explored teachers’ perceptions about serving as mental health lay counselors on top of typical professional duties and their attitudes towards and knowledge about mental health after serving as lay counselors.Methods: In 2018, 20 primary school teachers from five rural, low cost private schools in Darjeeling, India, received training and supervision to serve as lay mental health counselors in their classrooms. Using mixed methods, we measured teacher mental health attitudes and knowledge and perceptions of serving as lay counselor with study-specific assessments and through semi-structured interviews. Pre-training, post-training, and post-intervention mean scores were compared using paired t tests. Post-intervention interviews were coded for teachers’ mental health attitudes and knowledge and perceptions of serving as lay counselor. Results: Interviews revealed teachers qualitatively having more inclusive mental health attitudes, expressing a willingness to serve as lay counselor, and retaining mental health knowledge as applicable to what may be used during instructional time. By contrast, quantitatively, teachers’ attitudes appeared to become more inclusive on the study-specific survey pre versus post-training, but reverted to pre-training levels post-intervention. Teachers’ mental health counseling knowledge on the quantitative study-specific assessment did not change pre-training versus post-training versus post-intervention.Conclusions: Training, supervision, and serving as lay counselors led to teachers’ willingness to serve as lay counselors. Teachers served as lay counselors by incorporating therapeutic techniques into their student interactions during class time and as part of their typical instruction, not through delivering one-on-one office-like traditional care. Their changes in attitudes and knowledge reflected those expected within an “education as therapy” emerging system of care. Quantitative measures of knowledge and attitude changes did not capture these nuanced changes.Trial Registration: The parent feasibility trial was registered on January 01, 2018 with Clinical Trials Registry – India (CTRI), reg. no. CTRI/2018/01/011471, ref. no. REF/2017/11/015895. http://ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=21129&EncHid=&modid=&compid=%27,%2721129det%27

Association of Refugees’ Knowledge of Mental Illness and Their Attitudes Toward Mental Illness

The purpose of this study is to identify the level of mental health knowledge of defectors and to investigate the effect of sociodemographic characteristics and mental health knowledge level on mental health attitudes. We conducted a questionnaire survey of 150 people and analyzed the data of 138 people. The t test and one-way analysis of variance were used to analyze differences according to demographic characteristics. Hierarchical regression analysis was performed to measure the effect of mental illness knowledge on attitudes toward mental illness. The positive correlations between the mental health attitudes of North Korean defectors and the knowledge level were significant, and the knowledge level between final academic achievement in South Korea and the entry year into South Korea was also significant. The higher the knowledge of mental health, the more generous the minds of those with mental illness because they know better about it, and they have negative thoughts about regulating their lives.

Association of refugees’ knowledge of mental illness and their attitudes towards mental illness

The purpose of this study is to identify the level of mental health knowledge of defectors and to investigate the effect of sociodemographic characteristics and mental health knowledge level on mental health attitudes. We conducted a questionnaire survey of 150 people, and analyzed the data of 138 people. The t-test and one-way ANOVA were used to analyze differences according to demographic characteristics. Hierarchical regression analysis was performed to measure the effect of mental illness knowledge on attitudes toward mental illness. The positive correlations between the mental health attitudes of North Korean defectors and the knowledge level were significant, and the knowledge level between final academic achievement in South Korea and the entry year into South Korea was also significant. The higher the knowledge of mental health, the more generous the minds of the mentally illness because they know better about it, and they have negative thoughts about regulating their lives.

Stigma in Class: Mental Illness, Social Status, and Tokenism in Elite College Culture

The majority of mental illness on college campuses remains untreated, and mental illness stigma is the most common reason for not seeking mental health treatment. Compared with affluent students, working-class students are at greater risk of mental illness, are less likely to seek treatment, and hold more stigmatized views toward people with mental illness. Research on college culture suggests that elite contexts may be associated with greater stigmatization of illness. This study asks how social status and college context together predict students’ mental health attitudes. A survey of Ivy and non-Ivy League undergraduates ( n = 757) found that lower status students’ perceptions of themselves as status minorities may be responsible for greater stigmatization of mental illness in elite contexts. Elite academic institutions bolster cultures of individualism and perfectionism, which encourage students to adopt stigmatizing views. In addition, these processes may be even more harmful to lower status students who are underrepresented on their elite college campuses. Results suggest that elite colleges need to evaluate the negative effects their culture and norms have on students’ mental health attitudes, and that increasing socioeconomic diversity may improve lower status students’ mental health attitudes.