Reaching out: Mental Health Delivery Outside the Box

Mental health does not exist in a vacuum. Indeed, a person's mental health can be influenced by sociocultural, political, and economic forces (Blustein, McWhirter, & Perry, 2005). For this reason, scholars in the mental health field have been increasingly calling for more systematic social justice work and for mental health professionals to identify and operate as social change agents (e.g., Blustein, Elman, & Gerstein, 2002; Fouad et al., 2004; Herr & Niles, 1998; Ivey & Collins, 2003; Kiselica & Robinson, 2001; Speight & Vera, 2004; Toporek, Gerstein, Fouad, Roysircar-Sodowsky, & Israel, in press; Vera & Speight, 2004). When discussing such social change agents, Goodman, Liang, Helms, Latta, Sparks and Weintraub (2004) conceptualized mental health delivery as occurring at three levels: micro, meso, and macro. At the macro level, individuals and families are the target and the mental health practitioners derive their work from traditional counseling theories where the main focus is on promoting the self. Changing individual and family functioning for better mental health is the focus. At the meso level, communities and organizations are the target. Here, the emphasis is on programs in the community geared at improving the mental health and quality of life of citizens. Finally, at the macro level, social structures, ideologies and policies are the target. Here, mental health practitioners' work involves educating policy makers about psychological principles and the importance of incorporating such knowledge into organizational and societal policies (e.g., Goodman et al.). The April 2005 special issue of the Journal of Mental Health Counseling (JMHC) entitled, Counseling Around the World (Gerstein & AEgisdottir, 2005a), was designed to share information with mental health counselors, researchers, and educators about counseling outside of the United States, and in so doing, potentially influence various meso and macro levels of the delivery of mental health services. In this JMHC issue, international scholars discussed the application and unique characteristics of counseling in their home country (Auxier, Forster, & Kuruleca, 2005; Gemignani & Giliberto, 2005; Chang, Tong, Shi, & Zeng, 2005; Iwasaki, 2005; Lo & Dzokoto, 2005; Raney & Cinarbas, 2005; Yakushko, 2005). The countries represented in these articles were Ukraine, Fiji, Italy, The Peoples Republic of China, Taiwan, Ghana, Turkey, India, and Japan. A common theme among these publications was a need for the counseling profession in these countries to incorporate indigenous philosophies into the delivery of mental health services to successfully address the unique concerns of the particular country's population (Gerstein & AEgisdottir, 2005b). A number of these articles also discussed the role and impact of changes in the society of interest and the importance of understanding the effect of political and sociopolitical forces on mental health. The articles in this special section of the JMHC entitled, Counseling Outside of the United States: Looking in and Reaching out!, provide further elaboration on the themes just mentioned, namely the importance of reaching out of the box and intervening at the community level when addressing societal challenges faced in countries outside of the United States. In the first article, Soresi, Nota, and Ferrari discuss the difficulties experienced by Italian adolescents in today's Italy, and they describe a preventative program to assist with these difficulties. More specifically, Soresi et al. introduce a training program aimed at improving the adjustment and mental health of Italian at-risk youth, while at the same time reducing their dependence on outside experts. This social justice intervention also focuses on the role of the mental health counselor as a social change agent by training teachers and parents to intervene at the community level. …