Gone are the days when psychotherapy was just for the rich and privileged. From next year clinical psychologists will be providing free mental health care to disadvantaged communities as part of their compulsory community service.
For the past decade mental health practitioners have been calling for psychologists to be integrated into community health systems, and to work with traditional healers where appropriate. In most rural communities traditional healers play the role of psychiatrists and counsellors, while the Western notion of psychology is considered alien.
In 1998 the Department of Health announced that clinical psychologists would join doctors, dentists and pharmacists in having to complete 12 months of compulsory community service in order to qualify.
This year the department included seven more categories of medical practitioners required to begin community service: they include clinical psychology, dietetics, environmental health, occupational health, physiotherapy, radiography, and speech, language and hearing therapy.
But with the first intake of community service psychologists just a few months away, students complain that the health department is unable to provide clarity on the process or adequately prepare them for what lies ahead. While academics have welcomed the idea of providing therapy to the poorest in the country, they say the process of implementation has been flawed.
”We know nothing of the process,” said Professor Gertie Pretorius of the psychology department at Rand Afrikaans University (RAU). She said they were not consulted during the decision-making process. And the only information she has about placements is what she has heard from her students.
”I am positive about the need for community service and we feel that our students will cope in rural communities because we have brought in the African paradigm and promote indigenous knowledge [in our courses],” she said.
She is confident that RAU students are equipped to work in a range of fields but believes it is a mistake to exclude psychologists who work in the educational, correctional and social-service fields from community service.
Only clinical psychologists are required to do community service at this stage because of funding constraints, Mohammed Seedat, director of Unisa’s Social and Health Science Institute, told the M&G.
He welcomes the community service initiative but said that funding has to be allocated to include all types of psychologists, and that all students need to be trained to communicate in African languages.
The increase in HIV/Aids has led to many communities being exposed to and learning to appreciate the services of clinical psychologists, said Harry Mchunu, communications director for the Department of Health. So far 116 clinical psychologists have been placed in community-service positions, with the majority based in KwaZulu-Natal.
Acceptance of psychology by the general public remains one of the greatest challenges facing the profession, according to Oscar Modipa, a lecturer at the University of the Witwatersrand.
He believes psychologists need to leave their offices and go out to communities and work through issues affecting their daily lives. This interaction will force psychology out of the affluent urban areas and into rural communities.
”South Africa is still recovering from a past that was characterised by bloodshed, brutality and psychological mutilation, where some groups were made to feel less of a people,” said Modipa.
He said all these had serious psychological consequences for communities and psychology can play a ”valuable role in regenerating a sense of community, fostering a sense of self-belief and empowering communities with skills to negotiate the challenges brought about by this transition”.
”The main concern for a number of students has been their anxieties about what to expect,” said Modipa. ”Students are worried about where they are to be placed.
”For example, some white students who have never been to rural areas worry about how they are to survive there, and [about] dealing with communication barriers such as language.”
Students at the University of the Witwatersrand are not opposed to working in rural areas, although they are confused about procedures. They say the department did not formally consult them, and most are uncertain about what kind of support they will receive out in the field.
”I think we’re well equipped to handle community work through modules we did on community psychology, which enabled us to work in community projects for one year,” said psychology student Sumayya Bhorat.
”I don’t mind working there, but the thought of having to work with people who do not understand your language can be frustrating,” she continued.
Malose Langa, another student at Wits, said language barriers pose the greatest challenge to providing mental health service — psychology is, by its nature, about talking.
But, according to Langa, language is not the only issue: ”People have not been familiar with psychologists in their communities. The profession is still considered to be for white people.” He said much time is spent translating for his colleagues as well as explaining to communities how psychologists can assist them.
He said the solution would be to ensure that more black psychologists are trained. Currently they are still in the minority.
Most students agree that community service will provide them with valuable experience, but some are alarmed at the prospect of giving up another year before they qualify.
The process is long overdue, said Anneline Mordaunt, a masters student at RAU.
”Going to a psychologist is not about sitting on a couch and talking about your childhood, but getting out into the communities.” She said community service may redefine the role of psychologists as ”experts” who have all the answers.
”Psychologists and those from social sciences need to come out of their ivory towers,” she said.
In her view, many students receive bursaries and community service is an opportunity to give something back to the country.
”The challenge would be to work together with traditional healers, faith-based leaders and community workers so we can provide a service to the community and go beyond a Eurocentric textbook approach.”