Mechanisms Linking Counselling Psychology Access to Household Welfare in Kenya: Multilevel Causal Mediation Analysis

Counselling psychology services are expanding across Kenya, yet evidence linking their uptake to household welfare remains largely associational and atheoretical. Moving beyond a generic treatment-effect question, the proposed framework distinguishes between a psychological rehabilitation pathway, in which symptom reduction and improved cognitive function restore labour market participation, and a family-systems pathway, in which relational repair reduces conflict-driven expenditure and stabilises household composition. The analysis integrates the capability approach with stress process theory to explain why conventional single-level estimators are unlikely to recover unbiased effects in Kenya's decentralised health and education governance structure. A formal multilevel mediation model is presented, with identification assumptions articulated for the estimand of interest. The article argues that the welfare effects of counselling access are probably heterogeneous across counties and household types, and that policy evaluation must therefore attend to mediator-by-context interactions rather than average effects alone. The framework generates testable propositions and specifies the data architecture required for credible causal inference, including repeated measures of mediators and outcomes, instrumental variables for service access, and multilevel structural equation modelling. The contribution is a theoretically grounded, methodologically explicit template for evaluating counselling psychology's welfare returns in low- and middle-income country settings.