Counselors as social justice advocates

For anyone with aspirations of making a difference in the field of mental health, there is no time like the present. We live in a golden age of mental health–a time of awakening to the importance of emotional and social development and psychological well-being, as well as a growing understanding of the value of clinical therapy and the elimination of stigma around mental health treatment.

One of the most important developments in modern clinical mental health counseling has been the widespread realization of a pressing need for social justice advocacy on the topics of representation, inclusion and specific programming for underrepresented populations and underserved communities. Racial and ethnic disparities in the U.S. healthcare system have been widely acknowledged among experts,¹ and those disparities are not only reflected in the mental health space but may also be exacerbated by a growing shortage of counselors and therapists² amid a mental health crisis.³

At the same time the COVID-19 pandemic was fueling heightened levels of anxiety and depression across the globe,⁴ it also revealed alarming holes in the safety nets and support systems designed to address the mental health needs of the public. According to research from Mental Health America, although the percentage of adults in the U.S. who received mental health treatment rose from 19.2% in 2019 to 21.6% in 2021, more than half of adults with a mental illness did not receive treatment.⁵ Meanwhile, copious research indicates that disadvantaged and vulnerable groups have been disproportionately affected by this public health emergency.

Fortunately, there’s a movement underway that recognizes and has begun responding to the need for mental health workers and counselors to act not only as therapeutic advisors to their patients, but also as social justice advocates.

The roots of the social justice movement can be traced back to Industrial Revolution-era Europe, where entrenched class and social stratification prevented equal access to opportunity and resources (such as education) that are key to individual social mobility.⁶ It could be argued, however, that the concepts of fairness, equality and empowerment embodied by that movement are as old as–and are even a defining characteristic of–humanity itself. As we understand the term in its broadest sense today, social justice simply refers to the belief that a society should be committed to equal rights and opportunities for all.

The field of clinical counseling, guided by endemic professional principles of empathy and well-being, has been a leader in this regard. “There is a clear relationship between social injustice and the mental health of groups upon which the injustices are perpetrated,” wrote Hugh C. Crethar and Manivong J. Ratts in a 2008 article in Counseling Today.⁷ “The 2001 U.S. Surgeon General’s report highlighted the relationship between mental health and discrimination, oppression and poverty. Issues of social justice are integral to counseling because our clients do not exist as individuals independent of society, culture and context.”

Viewed through the lens of mental health, social justice in clinical counseling may be best defined as 1) an understanding that the denial of equal rights and opportunities can have a detrimental effect on a patient’s mental health and 2) a commitment to promoting equity in access to mental health care.

Many people spend a portion, if not all, of their lives as a part of a disadvantaged or vulnerable group — whether that group is defined by class, race, gender, ability, sexual orientation, age, religion, or other traits. Furthermore, these identifications are compounded by the concept of intersectionality, in which people may belong to multiple disadvantaged groups (e.g. being a person who is a woman and a person of color). It is important to recognize that the commitment to social justice should be embraced by all, including those of privilege. Our society can only benefit in and find value in promoting equity for all individuals and communities.

According to the United Nations, “Social justice makes societies and economies function better and reduces poverty, inequalities and social tensions.”⁸ Imbalances in social justice create complex detrimental social issues with ripple effects that leave no one untouched.

Still, you might ask: Why is social justice important in a counseling setting, specifically? We’ve established that a relationship exists between social and political injustices and the mental health of those at whom they’re directed. Just a slice of the available evidence reveals the depth of the problem:

● Among adults who reported experiencing 14 or more mentally unhealthy days each month, 22.9% were not able to see a doctor due to costs⁹

● In one study, the percentage of racial and ethnic minority patients who remained on buprenorphine, the gold standard for addiction treatment, for more than 180 days (the minimum recommended duration) is significantly below that of white patients¹⁰

● While 22.8% of U.S. adults experienced mental illness in 2021, the cohort of lesbian, gay and bisexual individuals was more than twice as likely (50.2%) to suffer from a mental disorder¹¹

Closing the gap on disparities in how mental health affects vulnerable and underserved communities, as well as their access to and quality of treatment, can help build stronger, more inclusive and productive communities.

Developed in 1992, the Multicultural Counseling Competencies were a guiding framework designed to help those in the counseling profession better meet the needs of diverse clients. Revised in 2014, this framework became the Multicultural and Social Justice Counseling Competencies (MSJCC), endorsed a year later by the Association for Multicultural Counseling and Development (AMCD) and the American Counseling Association (ACA).¹²

The MSJCC, according to the American Counseling Association, “offers counselors a framework to implement multicultural and social justice competencies into counseling theories, practices and research.”¹³ Built on four developmental domains–counselor self-awareness, client worldview, counseling relationship and counseling and advocacy interventions–the MSJCC provides a roadmap to help counselors navigate the relationships between privilege and marginalization that act on both their clients and themselves. It may not be possible to strictly codify a best-practices approach to social justice counseling, but the MSJCC is a valuable tool for clinical mental health counselors committed to becoming social justice advocates and serving clients of all backgrounds.

Courses like Marquette’s Multicultural Counseling are also helpful for preparing students for these experiences (as well as the rest of their careers). Master’s level courses such as these teach contemporary approaches to multicultural counseling and its unique legal and ethical issues and understand and identify historical and societal influences, including privilege and power that serve as barriers to mental health treatment for culturally diverse groups. The course also imparts critical self-reflective lessons to help students learn to articulate how cultural background, personal values and biases may affect their counseling practice and cultural competence and how to implement a social justice advocacy activity to address a counseling-related problem or behavior. In addition to the Multiculural Counseling course, at Marquette university, multicultural humility and competency is interwoven throughout all course work, as we believe that each and every class should consider the importance of diversity and uphold our commitment to social and racial justice.

As the general population’s need for more–and more diverse¹⁴–clinical mental health counselors grows, the field is experiencing a talent drain due to an aging workforce and low retention numbers.¹⁵ This trend has been a source of concern in healthcare circles, but it also represents an opportunity for aspiring mental health professionals.

An online M.S. in Clinical Mental Health Counseling from Marquette University can provide a platform to help people change their futures and better connect with diverse populations of patients in need. “Our program is firmly rooted in the values and work of social and racial justice,” said Marquette University Assistant Professor of Counselor Education and Counseling Psychology, Alexandra Kriofske Mainella, Ph.D. “We, as a faculty, work together on a regular basis to improve and consider equity and inclusion. We also have a dedicated department racial justice committee, comprised of faculty, staff and students of all levels that work together on these issues.” Marquette’s commitment to social justice is built into the counseling program with a sincere intent to shape students into highly capable counselors that will close the gaps in access and quality of mental health care. According to Kriofske Mainella, students are encouraged to and assisted in finding ways to work with underserved groups through their internships and practicum hours as well.

Grounded in the Jesuit tradition of intellectual inquiry and service, Marquette University’s online mental health counseling program is designed to foster personal and professional excellence among students and promote social justice in the mental health space. Contact an admissions outreach advisor today to learn more about taking your first step toward a career of leadership in social justice counseling.