An Ethicist Speaks out II -- AWARE’s Counselling and Social Service Arm: Why we need to care

Recent events at AWARE have raised serious concerns about the ethics of leadership change and about the nature of civic space and renewal in Singapore. Relatively little, however, has been said about the implications of the recent events on its social service and counselling arms.

AWARE has had a long history of providing social services and support for some of the most vulnerable members of society in Singapore - women who are struggling with abuse, with rape, living in fear for their lives. They run a helpline for women in distress and also a befrienders' service for women at risk where a trained counsellor escorts women under threat to the police, hospitals, courts and help centres.

One of the great virtues of AWARE was the professionalism of the counselling staff that worked there and the fact that AWARE invested heavily in training for all their volunteer helpliners and befrienders. There was a commitment to ensuring that the professional expertise and independence of their counselling and social work staff were respected.

In this context, I am deeply concerned about the recent change of leadership in AWARE and about the ability of AWARE’s counselling arm to continue providing professional help and support for women in need.

Any organisation providing mental health or social services is expected to uphold standards of neutrality, care and professionalism in line with internationally recognised standards for care. At minimum, this requires:
a) that counsellors and social workers need to adhere to standards for definition of mental illness and pathology as delineated by the relevant medical authorities and professional bodies, and not by religious institutions which are unqualified to make such assessments
b) that clients need to be assured of the neutrality, the impartiality of the care they will be given when they sign up for counselling services. As the Code of Professional Ethics for the Singapore Association of Social Workers states, social workers in Singapore are obliged to “avoid discrimination and prejudice, respect individual differences and accept that professional responsibility must take precedence over personal aims and views” and that “Social workers affirm the right to client self determination” and that their role is to “provide all relevant information that would allow the client to make an informed decision.”
c) that counsellors and social workers have a fundamental obligation to safeguard the rights of their clients and their confidentiality

Because women seeking help are fragile, psychologically vulnerable and in need, particular care needs to be exercised to ensure that their sense of self and effective agency is protected and respected by those who counsel and support them. AWARE has had a long track record of upholding these standards of care in their counselling and befrienders’ services. This type of non-judgmental care cannot be provided by individuals with beliefs that lead them to condemn particular forms of life (homosexuality) as sinful and deviant, and certain practices (abortion, safe sex) as fundamentally mistaken.

Rather unfortunately, it is clearly documented in the press that members of the new executive committee of AWARE do hold on to some of these views, and that they intend to enforce them on AWARE – indeed it is presented as the raison d’être for their recent takeover. For example, Dr Thio Su Mien explicitly stated that she was instrumental in bringing about the change in leadership in AWARE because she was motivated by concerns that in AWARE’s sexual education programme, “homosexuality is regarded as a neutral word, not a negative word.” Dr Thio makes it clear at various points in her interview that she regards homosexuality as an aberrant and deviant form of behaviour.

While Dr Thio and other members of the new Executive Committee are entitled to their opinions on homosexuality, there is a clear conflict of interest when they have said that they intend to use their new-found positions of influence to steer AWARE away from its existing position of protection and provision of care and support for all women regardless of their race, religion, sexuality or beliefs about more controversial issues, such as abortion. In so acting, they are endorsing positions running counter to the professional standards of internationally recognized mental health associations. For example, homosexuality is not listed as a disorder in the classic reference text for the delineation of mental disorders for psychiatrists -- the DSM-IV: The Diagnostic and Statistical Manual of Mental Disorders IV. This text is the standard reference for all mental health professionals working within the field and their position on homosexuality is one also endorsed by the American Psychiatric Association (APA), American Psychological Association, The Royal College of Psychiatrists in the UK, The World Heath Organisation, and the Chinese Psychiatric Association amongst others. These professional mental health associations have clearly and unequivocally stated that homosexuality is not a pathology, nor an aberrant or deviant behavioural set.

This is not an argument in favour of or against homosexuality. It is purely an argument that social support services for women at risk must be run by professionals trained to do so and that their professional independence and neutrality must be ensured if they are to serve their clients with the conscientiousness their clients deserve.

Secondly, it is worth noting that neutrality and the provision of information with respect to a lifestyle is not equivalent to the endorsement or promotion of that lifestyle. If I attend a suicide awareness forum, it does not imply that the professionals speaking at the forum are thereby promoting suicide or endorsing it or encouraging the participants to kill themselves. Similarly, informing the public of the existence of homosexuals and of the very often traumatic prejudice they face when coming to terms with their sexuality is neither an endorsement nor promotion of homosexuality. AWARE is well within its ambit of educating the public concerning the substantial discrimination faced by a group of women in speaking of homosexuality. This is true also of the other issues old Aware has spoken of on behalf of other minorities, such as the discrimination faced by migrant workers, single unwed mothers, raped woman etc.

The new Executive Committee of AWARE does not appear to understand the ethical significance of the need to:
a) respect the capacities of women for self-determination,
b) respect the independence and neutrality of counsellors working at AWARE
c) maintain a separation of their personal convictions from the provision of public services for women.

I was deeply troubled to learn of events at AWARE’s centre at Dover Road on 23 April 2009 where burly locksmiths and security personnel attempted to force their way into AWARE’s premises and other male associates of the new executive committee turned up with recording devices. AWARE’s centre at Dover Road is supposed to be a safe haven for women – it is the place of last resort for women who have been threatened, abused, raped and who have, at times, turned up in distress in the immediate aftermath of a traumatic personal tragedy. Can you imagine what might have transpired had a woman needing crisis support and care turned up at AWARE’s premises on that day? Not only would she have felt threatened and afraid by the presence of so many men and by the conflictual nature of the interactions going on in the centre but she would have had serious and legitimate concerns as to whether her confidentiality and privacy would be respected in a place where male members of the association can turn up with recording devices and challenge existing staff with the comment that, “if you’ve got nothing to hide, why are you afraid of being recorded?”

The lifeblood of any organisation providing vital counselling and care services is trust – trust in the integrity of the organisation and the people leading it, trust in the professionalism and impartiality of the counsellors staffing it and trust that the rights of clients to self-determination and confidentiality will be protected. The women seeking help at AWARE are trusting their counsellors and befrienders sometimes with their lives. The conduct of the new Executive Committee of AWARE -- the fog of secrecy and duplicity concerning their religious affiliations and whether the takeover was orchestrated in advance, and the tactics they have employed in the takeover of AWARE and since coming into leadership -- have left many doubts in the minds of concerned observers as to their integrity, honour and good intentions. At heart, there are serious doubts about whether the new Executive Committee is a body we can trust to uphold the standards of care that women in distress need and deserve.

In writing this open letter, I hope to highlight these issues so as to:
a) provide some insulation from interference for counsellors and helpliners working at AWARE. Their professional integrity and independence need to be respected.
b) ensure that the new Executive Committee needs to understand that the public cares for the most vulnerable members of society who seek help at AWARE and that we will be monitoring developments in the counselling arm closely.

Alexandra Serrenti
Research specialisation – Ethics, Continental European Philosophy.
Email – alex.serrenti@gmail.com