Dan Neville (Limerick West, Fine Gael)

I second the amendment and echo Deputy McManus's comments. The amendment recognises the difficulties surrounding the area of regulating counsellors and therapists in that it allows a period of 12 months to elapse before the present and totally unacceptable situation is regularised. It gives space to do so and does not insist the situation should be corrected as of now. I have been of the opinion for some time that there is a need to establish a national competent authority to regulate the area of psychotherapy and counselling. The State must ensure that those who offer a service for a fee and have the trust of service users have recognised competencies coming from approved training programmes. I further believe that those who do not have such training should not be allowed to operate.

Psychotherapy and counselling have important roles to play in many areas of life. In respect of mental illness, it is repeatedly highlighted that multidisciplinary community based psychiatric teams, including psychoanalysts and counsellors, is the accepted formula for delivering services but such teams are sadly lacking. There is ignorance and not a little confusion among the general public as to what psychotherapy and counselling are and what the difference is. This is compounded by the fact that there are over an estimated 400 different named therapies, which are used to tackle many medical and social problems, including marriage and family difficulties, anxiety, depression, addiction, sexual abuse, rape, psycho-sexual difficulties, eating disorders, bereavement, adolescent difficulties, AIDS, HIV and many more. In other medical professions, there is a requirement for a basic qualification in medicine and professionals continue to specialise.

A rhetorical question is are there 400 specialist qualifications in psychotherapy or counselling? The absence of clear roles and dedicated skills for those roles fuels confusion and the absence of regulation allows for a situation where many calling themselves counsellors in the community and private practice do not warrant professional recognition. One does not need a recognised qualification or skill base to call oneself a psychoanalyst or counsellor. All that is required are premises, a gold plaque outside the door and the neck to charge a fee.

There are no means to monitor the present unregulated situation and the opportunity for untrained people acting as psychotherapists or counsellors to do damage is frightening. Vulnerable people in crises who need professional help can be destroyed. This situation has been exposed by some practising alternative medicines where people have been duped out of life savings. Is the same happening in the area of psychotherapy and counselling? It is not alarmist to assume there are instances of it. How much is there and what damage is being done? The stigma that persists in respect of mental, emotional and personal problems prevent the exposure of these issues. Those damaged in such a way may not be in a position to recognise their abuse. Do those who are severely damaged die by suicide? There are no psychological autopsies on those who die by suicide. I am convinced of the need to do such autopsies to determine the psychological difficulties and where the services failed. Such information made available without identifying the victim is vital for research into why so many take their lives and is invaluable in formulating suicide prevention programmes.

Clients, often in severe distress, make major investments in therapy and have a right to know that the therapy they are engaged in is safe and effective. For this reason, the development of practice standards for accreditation and training is essential. The recent report of the working group on the role of psychotherapy within the health service states the requirements of the various accrediting bodies can differ significantly. The situation is problematic as, given the lack of clarity regarding agreed criteria for training and qualifications, both the health service as an employer and the general public have difficulty in making judgments as to the equivalence of one qualification against another. This is why confusion arises and Deputy McManus's amendment, which would give 12 months and space to all those concerned, including the Government, aims to correct the situation. The professional group strengthened its regulation arrangements. The Government's position, through not accepting this amendment, is to stay on the fence until the various professional groups strengthen their regulation arrangements. I accept they have an onus to do so as a matter of urgency and appreciate that is the Minister of State's difficulty. However, they should have 12 months to do so. If there is no will to do so within that time, the Government must move towards statutory regulation. Only five professions are subject to this, medicine, dentistry, nursing, optometry and pharmacy. As the Minister of State pointed out, there can be only one registration board per professional grouping. A difficulty arises in conferring powers of statutory registration on a professional body where more than one body represents the profession, as is the position in the case of counselling and therapy.

We should strongly urge the groups to come to a consensus, which is lacking, on basic definitions, training and accreditation. The professional bodies have a responsibility to ensure the public can have the same confidence in the professionalism of psychotherapists and counsellors as they do in doctors, dentists and pharmacists. This would enable them to supervise the delivery of a safe, high quality service to clients. The role of supervision is becoming increasingly valuable as it enables professionals to maintain good standards of practice and to develop responsive services to meet the needs of clients. Supervision also has a key function in fulfilling an employer's duty of care to staff under the Safety, Health and Welfare at Work Act 1989, as employers may not be covered under the Act if employees are not qualified.

By accepting Deputy McManus's amendment the Minister of State would accept that there is a difficulty and challenge for the four bodies to come to an agreement within the next 12 months on the criteria for membership of their organisations. The ideal way to do so would be through amalgamating the organisations. If that cannot occur, the organisations should come to an understanding on the criteria, training and qualifications required to ensure those who provide counselling and psychotherapy services have the necessary skills and qualifications. That would also ensure those whom we and medical professionals advise to go to counsellors and those whom psychiatric professionals advise to go to psychotherapists can be confident that persons calling themselves psychotherapists and counsellors are at a level and standard to meet the criteria acceptable under the Bill.

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