Tuesday, 11 May 2010
Mental Health Services
I thank the Ceann Comhairle for letting me raise again the issue of regulation of the professions of psychotherapy and counselling. At present, they are not regulated. There is no criteria by which one may gauge the standard of psychotherapy and counselling services. Anybody can set up a counselling or psychotherapy service without qualifications and charge a fee to vulnerable people whose lives may be in danger from suicide.
I will give two examples of short courses that allow, facilitate or encourage people to do that. The first is a course to gain a diploma in skills for counselling eating disorders, which is granted to people after fewer than 50 hours' tuition. One could do eight modules over eight weekends and obtain a diploma in counselling for eating disorders. There is no basic qualification required to enter this course. Eating disorders are extremely complex and have emotional, psychological, psychiatric and physical health implications. They have the highest mortality rate of any mental health condition. A counsellor with training of less than 50 hours does not have the range of skills to even understand the issues involved and is not qualified to probe the unconscious. He or she is dealing with human vulnerability and serious damage can de done to very delicate people
The second example I have concerns an advanced diploma in suicide studies that consists of less than 100 hours of tuition. This is marketed as providing people with skills to counsel people at risk of suicide and the bereaved of suicide. Modules include suicide prevention, suicide intervention and suicide postvention, each of which is completed in just two weekends, yet one receives an advanced diploma in suicide studies.
Those who are at risk of suicide, attempted suicide and self-harming require detailed psychiatric diagnosis. This cannot be done with training over three weekends. Some 80% of those who take their lives are suffering from a psychiatric disorder. A bereavement by suicide falls outside the normal range of human experience. It is an overwhelming loss that leaves the bereaved confused and helpless, overwhelmed by many emotions and many unanswered questions.
The two examples show the need to fully regulate the professions of psychotherapy and counselling, which are so essential to dealing with all areas of mental health and emotional difficulties and assisting in many varied areas of counselling, including marriage counselling, family counselling, sex and sexuality counselling, sexual abuse counselling, occupational counselling, bereavement counselling, addiction counselling, long-term illness counselling, and post-traumatic stress counselling. These involve very delicate areas of human vulnerability requiring the highest level of professional assistance. They should be included under the Health and Social Care Professionals Act 2005, which was introduced to regulate 12 professions. The areas to which I refer are not regulated under it because of issues that arose at the time regarding agreement between various groups. Disagreement has now featured for two years.
The psychological forum has criteria setting out the skills required of staff working in these areas. One does not allow doctors and nurses the freedom to walk in and out of each other's profession but it is allowed in respect of psychotherapy and counselling. The forum recommends that the baseline academic qualification for entry to training is a degree or equivalent in human sciences, be it medical, psychological, social or educational. For registration as a psychotherapist, the forum specifies a minimum of four years' training in specific psychotherapy modality at Master's level, which involves 1,400 hours.
With regard to entry for training for counselling, the forum requires that one have a leaving certificate or equivalent qualification, or a relevant degree, while equivalent accredited prior learning is considered. An interview is required to enter training for both counselling and psychotherapy to determine whether one is suitable. The baseline qualification and experience for registration as a counsellor is a minimum of four years' training in specific counselling and psychotherapy modality, involving a minimum of 1,250 hours. This is what is required, not a few weekends of training.
I tabled a parliamentary question asking the professions that have completed registration on the Health and Social Care Professionals Council and the reply stated, "Arrangements for the establishment of the first of these registration boards are currently being finalised". Can I take it that none of the 12 grades has been regulated since 2005 despite the high profile of the Bill which was intended for this purpose? The Minister has informed me that it is not until the 12 grades are dealt with that the areas I am addressing will be considered.
Áine Brady (Minister of State with special responsibility for Older People and Health Promotion, Department of Health and Children; Minister of State, Department of Environment, Heritage and Local Government; Minister of State, Department of Social and Family Affairs; Kildare North, Fianna Fail)
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I am responding to this matter on behalf of the Minister for Health and Children, Deputy Harney. I thank the Deputy for raising this issue and for giving me the opportunity to update the House on the ongoing regulatory programme undertaken by the Department of Health and Children.
The Health and Social Care Professionals Act was passed by the Oireachtas in 2005. The Act provides for the establishment of a system of statutory registration for 12 health and social care professions. The 12 professions to be regulated under the Act are clinical biochemists, dieticians, medical scientists, occupational therapists, orthoptists, physiotherapists, podiatrists, psychologists, radiographers, social care workers, social workers, and speech and language therapists.
The structure of the system of statutory registration will comprise a registration board for each of the professions to be registered, a health and social care professionals council with overall responsibility for the regulatory system and a committee to deal with disciplinary matters.
As a first step in the implementation of the system of statutory registration, the Minister for Health and Children launched the Health & Social Care Professionals Council in March 2007. The chief executive officer of the council was appointed in 2008 and additional senior administrative staff took up duty with the council in late 2009. The council must establish a registration board for each of the 12 professions currently covered by the Act. These appointments, and further progress in the establishment of a suitable organisational structure, will greatly assist the council in its ongoing work in preparing for the establishment of the individual registration boards. Arrangements for the establishment of the first of these registration boards are currently being finalised. The council is currently working to put in place the necessary structures for registration, education and fitness to practise for the 12 health and social care professions designated in the Act and it is hoped to bring additional registration boards on stream in late 2010.
The Health & Social Care Professionals Council will enable health and social care professionals to practice in a regulated, controlled and safe environment and in a manner which will ensure the provision of high-quality interventions, meeting the challenges of increasingly complex and evolving care for service users. Health and social care professionals will be facilitated in ensuring responsible and accountable practices while providing the highest level of patient care and service.
While the proposed system of statutory registration applies, in the first instance, to 12 health and social care professions, the legislation empowers the Minister for Health and Children to include, on the basis of specific criteria, additional health and social care professions in the regulatory system over time, as appropriate.
A detailed examination is required of the degree to which such groups conform to the criteria included in section 4 of the 2005 Act governing the addition of further professions into the system, including the extent to which the profession has a defined scope of practice and applies a distinct body of knowledge; the extent to which the profession has established itself, including whether there is at least one professional body representing a significant proportion of the profession's practitioners; the existence of defined routes of entry into the profession and of independently assessed entry qualifications; the profession's commitment to continuous professional development; the degree of risk to the health, safety or welfare of the public from incompetent, unethical or impaired practice of the profession; and any other factors that the Minister for Health and Children considers relevant.
The priority for the Health & Social Care Professionals Council is to establish statutory registration for the 12 designated health and social care professions in the first instance. The issue of inclusion of other grades, such as psychotherapist and counsellor, within the scope of statutory registration will be considered after the initial designated 12 professional grades have been fully dealt with.