In Low-Income Communities, Trained Lay Counselors Prevent Depression

By: Erin Hare

In disadvantaged communities, where credentialed mental health professionals are scarce, training local lay counselors, chosen from the very communities they serve, offers an effective, boots-on-the-ground approach to preventing depression among older adults.

University of Pittsburgh psychiatrists, led by Professor Emeritus Dr. Charles Reynolds III, in collaboration with researchers from Goa, India, trained lay health counselors in Goa to help at-risk residents avoid depression. Lay counselors provide problem-solving therapy and act as mentors, many having beaten depression themselves. The results of this randomized, clinical trial were recently published in JAMA Psychiatry.

“There’s a real shortage of trained mental health professionals – psychiatrists and the like – whereas it’s relatively easy to train lay counselors and then provide ongoing oversight,” Reynolds said. “That allows the expertise of people like me to be multiplied so we can reach out to far greater numbers of people than would otherwise be possible.”

Among the residents of Goa who engaged with the program, 95 percent remained depression-free in the following year. Only 87 percent of the control group avoided depression over the same time frame.

What makes the program work is that lay counselors help community members build resilience. Participants learn active coping skills to confront problems and bounce back from challenges, rather than succumbing to despondency.

Reynolds originally tried out this problem-solving approach to depression prevention among the African-American population of Pittsburgh’s East Liberty neighborhood, with great success. Next, he plans to train lay health counselors both within the Hispanic community of Mission Hills, Los Angeles, as well as in rural communities in northern New England.

But he stressed that the training program must be adapted to each patient population for it to be effective. For instance, in Goa, limited literacy of some participants necessitated the use of visual aids. And in East Liberty, there was a strong interest in education specific to healthy food choices and managing chronic illnesses.

“It’s important to spend time in the community to learn what residents find important so the program can be adapted to suit their needs,” Reynolds said. “One size does not necessarily fit all. You have to learn to speak their language, to engage them so they can take ownership and really run with it.”