Thursday, 16 April 2015
Topical Issue Debate
Regulation of Health and Social Care Professions
I thank the Ceann Comhairle for selecting this matter as we have discussed the need to regulate psychotherapy and counselling over the past ten years. There is no regulation at present in Ireland for the registration of psychotherapists or counsellors. There is no requirement for a qualification to practise in these areas. It is dangerous for untrained and unskilled people to probe a person's unconsciousness. We are dealing with extreme human vulnerability and serious damage can be done to such delicate people. We have seen it.
The eating disorder organisation, Bodywhys, has been discussing this for a number of years. It has quite extensive complaints about treatment by unregulated counsellors. Back in 2005 the Health and Social Care Professionals Act, which provides for the registration of persons qualifying under the title of a designated profession, was enacted. This is for the determination of complaints concerning the fitness to practise of professionals named under the legislation. Psychotherapy and counselling were not included as the various organisations could not agree. Subsequently, 22 of them made a presentation to the then Minister at his request, and produced the Psychological Therapies Forum report, Submission on the statutory registration of counsellors and psychotherapists in Ireland.
On 20 March, 2014, the former Minister wrote to me saying he intended in the public interest to designate by regulation the professions of counselling and psychotherapy under section 4(2) of the Health and Social Care Professionals Act 2005. The Minister informed me he was obliged to consult the council in the first instance and give interested persons, organisations and bodies an opportunity to make representations to him concerning the proposed designation. The Minister also informed me he had requested that his officials put the necessary arrangements in place to initiate this consultation process as soon as possible.
On 20 February of the same year, the director of the National Office for Suicide Prevention of the HSE, Mr. Gerry Raleigh, stated that people in distress should avoid these services because counsellors may not be fully trained and may not be basing their counselling on best advice. He said it was important that a person seeking psychotherapy and counselling identifies professionals who are members of the Psychological Therapies Forum, which I already mentioned and which encompasses 22 professional organisations. This forum said it provides protection to clients but falls short of optional protection, as under the common law system it is possible for any person to take the title of counsellor or psychotherapist and to practise accordingly without training or competence. Any person can put up a sign and say he or she is a counsellor or psychotherapist and charge the usual fee of around €80 an hour to perform psychotherapy and counselling. The previous Minister accepted that it was extremely dangerous for such untrained people to do so and that regulation should take place.
I have two leaflets here - I have about a dozen more as well - one of which is advertising a so-called advanced diploma in suicide studies. It is a course taking place over seven weekends. There are two weeks for suicide prevention, two weeks for suicide intervention and two weeks for post-intervention. That makes up an advanced diploma in suicide studies. Bodywhys informed me of another diploma programme from the eating disorder resource centre of Ireland, with a certified trainer in practitioner skills for eating disorders and obesity. The diploma is granted over an eight-weekend period. The cost of that is €370 per module, which makes it up to €3,000 for the eight-week programme to obtain the diploma. As the Minister, a qualified professional himself, knows, eating disorders are psychological, psychiatric and physical. It is a very complex area. I got somebody who has no interest whatsoever in eating disorders or any area of psychotherapy and counselling to apply for this diploma, and they got a reply back - I have it here - saying they could start the course the following weekend, without any background whatsoever in any branch of medicine.
As such, I would welcome an update from the Minister on the current situation in respect of the regulation of psychotherapy and counselling.
I thank Deputy Dan Neville for raising the issue and giving me an opportunity to update the House on the ongoing programme of regulation of health and social care professionals being undertaken by the Department of Health. The regulation of the 14 professions currently designated under the Health and Social Care Professionals Act 2005, including the optical professions, is being implemented on a phased basis as the registration board and register for each profession is established. To date, eight registration boards have been set up. The registration boards for the remaining designated professions will be established between now and 2016. In addition, the regulation of the optical professions will transfer from the Opticians Act 1956 to the Health and Social Care Professionals Act 2005 before the end of this year.
Regulation under the 2005 Act is primarily by way of the statutory protection of professional titles, confining their use solely to persons granted registration. The structure of the system of statutory regulation comprises registration boards for the professions to be regulated, a committee structure to deal with disciplinary matters and a Health and Social Care Professionals Council with overall responsibility for the regulatory system. From a public protection viewpoint, a crucial milestone in the regulation of health and social care professions in Ireland was the introduction on 31 December last of the 2005 Act's fitness to practice regime which is similar to that applicable to doctors, nurses and midwives.
In relation to the question of regulating counselling and psychotherapy, the current position is that, while the profession or professions of counsellor and psychotherapist are not specifically designated under the 2005 Act, there are various regulatory controls on many counsellors and psychotherapists operating in Ireland. The profession of psychologist, for example, is a designated profession under the 2005 Act, which means that those psychologists who are counsellors and-or psychotherapists will in time be regulated under the Act. A psychologist registration board is due to be established this year and will be an additional source of advice on the question of regulating counselling and psychotherapy in the interest of protecting the public. Psychiatrists, some of whom practice psychotherapy, are regulated under the Medical Practitioners Act 2007. Also, counsellor therapists working in the publicly funded health sector are required to have the minimum qualifications set by the Health Service Executive under the Health Act 2004.
The previous Minister for Health, Deputy James Reilly, wrote to the Health and Social Care Professionals Council last year seeking advice on the question of specifically designating counsellors and psychotherapists under the 2005 Act. A number of issues require clarification and there are strong differences of opinion on these issues among the various professional bodies representing counsellors and psychotherapists in Ireland. The main questions to be resolved include whether counselling and psychotherapy should be treated as one or two professions for the purposes of regulation, the title or titles of the profession or professions to be protected and the minimum qualifications that would be required. The readiness and compatibility of the professions for designation under the 2005 Act also need to be determined. The council's detailed report on the matter has been received in my Department in recent weeks and is being examined carefully by officials with a view to deciding the next steps.
I am pleased the detailed report is now with the Department. Hopefully, steps will be taken to progress matters as it is now 14 months since the previous Minister asked that this be done. There are professional bodies which do very good work on the requirements for entry on their registers, but these are not the problem. The problem is those people who practice without any training or supervision by a professional body. We appreciate the work done by the professional bodies to ensure there is a level of competence among their members, but these are not the issue. The problem is those people who are not members of any association and who are not subject to any regulation. As we know from the NGOs in the area, they can do serious damage to people who are suicidal, have eating disorders or many other psychiatric issues which would benefit greatly from professional psychotherapy and counselling. We look forward to information in the coming weeks on the report of CORU on the registration of psychotherapists and counsellors under the 2005 Act.
I understand the argument and case that Deputy Neville is making. He is absolutely right that there are a number of very strange people out there advertising their services as psychotherapists, counsellors and all sorts of other things. Not only may they not be very good, they can also do real harm in certain circumstances. If we are going to regulate the professions, we must ensure that we get it right. A number of issues need to be considered, including whether it will be one profession or two, which titles should be protected and which should not, given that people can always invent a new title and start to provide a service under it, what the qualifications should be and the readiness and compatibility of the professions as things stand. We must also look at grandparenting and the assessment of the qualifications and experience of good counsellors, particularly members of religious orders who have been providing a great service, including to my patients as a GP, but who may not fit the criteria. Further issues include the impact on psychology and social workers and international experience. I understand the experience in the UK has not been that good.
I assure the Deputy that the matter is not on the back burner. My officials will take a look at the document, on which I would be interested to hear the Deputy's views also. The next stage will be a further consultation once we know what direction we are going in.