Health & Social Care 2012

Health and Social Care Professionals (Amendment) Bill 2012

Dáil Éireann 3rd October 2012

Deputy Dan Neville

I welcome this technical Bill, which is quite comprehensive in respect of the 2005 legislation. Difficulties were identified early on and it is surprising that it has taken seven years for it to be corrected. The Minister for Health and Children at the time, Mary Harney, informed me about this in 2006 or 2007.

I will address a proposal that psychotherapy and counselling be included as designated professions. At present, there is no regulation Ireland for the registration of psychotherapists and counsellors and no State control over the qualifications held by those practising in the area. It is dangerous for untrained and unskilled people to probe a person’s unconscious. They are dealing with human vulnerability and serious damage can be done to such delicate people. The Act provides for the registration of persons qualifying under the title of a designated profession for the determination of complaints relating to their fitness to practise. Some 12 professions are listed as designated professions under the Act. The professions of psychotherapy and counselling are not included. When I challenged the former Minister of State, Tim O’Malley, who dealt with the Bill in 2004, he stated that the professions included in the legislation had become so regulated by a process of discussion and consensus. However, the psychotherapists and counsellors group failed at that time to agree an approach to such registration. The Minister of State stated that statutory regulation in such circumstances would have serious legal implications. He accepted the principle that all psychotherapists and councillors should be properly qualified and pointed out that, in consultation with the professional groups involved, he was unable to obtain agreement on the criteria.

In response to the position of the Minister of State, 22 organisations established a psychological therapies forum for counselling and psychotherapy. The forum accepted that it was imperative that the public is protected by the promotion of high standards of conduct, education, training and competence among the professionals of counselling and psychotherapy. The forum pointed out that all bodies involved in the forum provided a code of ethics by which their members must abide. The forum stated that while this form of self-regulation provides protection to clients of these organisations, if falls short of optimal protection as, under our common law system, it is possible for any person to take the title of councillor or psychotherapist and practise accordingly, without training or competence. Any person can put up a sign to say that he or she is a counsellor or psychotherapist and charge €80 an hour to perform psychotherapy and counselling. It is extremely dangerous for such untrained people do so.

I am also aware of courses being provided. One course ran for eight weekends leading to a diploma in eating disorders. One should be a professional to deal with that but I tested the system a number of years ago. A secretary, who had no qualifications or interest in any clinical, medical or psychological area, applied and was immediately welcomed on to the course and provided with a handwritten note inviting her to commence the course on the following Saturday. A course covering a number of weekends also led to a higher diploma in suicide studies. It is highly dangerous for people to counsel those who have suicidal ideations after such a short course, when they are not fully trained. My objective is to include psychotherapy and counselling in this Bill.

The current position does not lend itself to good clinical governance and the maintenance of high standards of patient care. The Health and Social Care Professionals Act provides a mechanism to drive forward the clinical governance agenda. It creates a framework through which practitioners are accountable for continually improving the quality of their service and safeguarding high standards of care by creating an environment in which excellence will flourish and optimal protection is offered to members of the public who access psychotherapy and counselling. The psychological therapies forum made a proposal for statutory regulation of councillors and psychotherapists. We have been informed that the 12 organisations already designated must have full recognition of designation before counsellors and psychotherapists are included in the Act. This is critical to vulnerable people in crisis, who will be damaged by councillors and psychotherapists who are not properly trained qualified, some of whom are mavericks. The issue of their designation should be given priority.

I do not have confidence of an early introduction of this point. On 17 November 2009, the former Minister for Health and Children, Mary Harney, informed me:

While the proposed system of statutory registration applies, in the first instance to twelve 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 by regulation over time, as appropriate. However, the priority for the Health and Social Care Professionals Council is to establish statutory registration for the 12 designated health and social care professions in the first instance. It is not envisaged that additional structures will be considered for inclusion within the scope of the system until the registration boards for the existing 12 professions are established. The issue of inclusion of other grades, such as Psychotherapists and Counsellors, within the scope of statutory registration will be considered after the initial designated 12 professional grades have been dealt with.

After seven years, only two of the 12 bodies are close to registration. How long must we wait until the 12 bodies are registered so that they can make additions?

The Council has undertaken an enormous amount of preparatory work to date in readiness for the establishment for the first 13 person Registration Board, The Social Work Registration Board, by the end of this month [in May 2010] It has done excellent work on developing governance arrangements, financial management systems, fitness to practise procedures, ICT requirements and other such issues that will be needed to support the establishment and functioning of all registration boards. As you will appreciate, it is essential that the first registration board, later this month, is established with great care as it will serve as a model for all 13 registration boards to follow.

More than two years later, nothing has happened. The Bill will facilitate this.

Yesterday, the Minister confirmed that we will have to wait a considerable time before action is taken on the registration of psychotherapists and counsellors. The Minister said:

Under the Act, I, as the Minister for Health, may designate other social care professions if I consider that it is in the public interest to do so and if the specified criteria have been met. I am conscious that some professions, currently not designated, have made a case to be regulated under the Act. My immediate priority, however, is to proceed with the establishment of the registration boards for the professions designated under the 2005 legislation. Then and only then, can consideration be given to the registration of other professions.

Yesterday, the Minister confirmed that nothing will be done about psychotherapy and counselling until all the other professions have been registered.

The Minister then said:

The Bill has three main purposes. The first is to amend the Act to allow the Minister for Health to continue to appoint professional members to the council until each of the registration boards has been established in respect of the 12 professions designated under the Act, has held elections and is in a position to nominate one of their elected members.

The Minister said nothing about the Act catering for further nominations to the board. For that reason, I ask the Minister to add psychotherapy and counselling to the 12 designated professions, and make it the thirteenth.

I note from the Minister’s speech that the professions are not being taken in rotation. In fact, the second last one is being worked on at present. Psychotherapy and counselling could be prioritised under the Act.

I draw the Minister of State’s attention to some of the debates that have taken place on this issue. I refer to Report Stage of the 2005 Bill, on 2 November 2005. Deputy Liz McManus proposed an amendment to insert the following words:

and in particular shall, within the period of 12 months from the passing of this Act, so designated the profession of counsellor and therapist.

Deputy McManus stated:

Some people have been in therapy for many years. Many are vulnerable, perhaps going through crises in their lives and need expert and professional support for which they turn to counsellors and therapists. Regrettably, it is easy for a person to set up as a counsellor in Ireland. There is a wide range of standards in terms of types of counsellors people go to.

She asked what guarantee have we, and I quote:

…that counselling to such a vulnerable group of children is of the proper standard if there is no formal regulation. This question must be answered. People may have degrees in psychology, with at least some level of professional standard, but not every psychologist is a good or appropriate therapist while there are many excellent therapists who are not psychologists. We need regulation in this area.

Deputy McManus continued:

We have a duty to protect an abuse victim with a damaged psyche from meddling by people who guide and direct in a way they believe is appropriate simply because they have set themselves up as counsellors and therapists, done courses or may have strange ideas about what a counsellor or therapist is.

I supported Deputy McManus’s amendment. I referred to the 400 different named therapies that 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. I pointed out that in other medical professions there is a requirement for a basic qualification in medicine and professionals continue to specialise.

I asked the rhetorical question, 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 community and private practice do not warrant professional recognition. One does not need a recognised qualification or skill base to call oneself a psychotherapist or counsellor. All that is required are premises, a gold plate outside the door and the neck to charge a fee.

The Minister of State at the Department of Health and Children, Deputy Tim O’Malley, replied to the amendment on behalf of the Government. He said:

The concern of Deputies for the inclusion of counsellors and psychotherapists in the system of statutory registration being established has been made clear throughout the passage of the Bill. We are all conscious that the provision of counselling and psychotherapy services has increased in recent years and are agreed on the need for people to be confident that a counsellor or psychotherapist is qualified, competent and fit to practise.

I have already mentioned that section 4 of the Bill provides for the inclusion by regulation of additional professions in the proposed system of statutory registration. The section also sets out the criteria to which the Minister shall have regard in considering the designation of further professions. These criteria include 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 is established, including whether at least one professional body represents a significant proportion of the profession’s practice, and the existence of defined rules.

Various professional groups representing psychotherapists and counsellors have been encouraged to prepare for statutory registration by working to explore a common understanding on baseline qualifications and scope of practice. I also hope to see a further strengthening of voluntary regulations.

When the 2005 Bill was debated in the Seanad, Senator Brendan Ryan made a strong case for registration. He said:

Many people are concerned that some may claim to be psychotherapists who only have a six month diploma while other claim to be counsellors who have a diploma obtained following a 12 month part-time course. Many of these professionals probe deeply into vulnerable areas of people’s emotions and their personal lives. It is a profession that desperately needs to be regulated through the formal recognition of proper professional qualifications.

Senator Ryan said 12 designated professions were listed for the resolution, through guidance counselling or otherwise, of personal social and psychological problems but there were only two of the professions to which that could currently apply. He said much of what one might call the resolution, through guidance counselling or otherwise, of personal, social or psychological problems goes outside the profession of psychology and is practised by people who are not qualified as psychologists. The Minister of State, Deputy O’Malley, said he wanted to do what the Senator suggested but that it would be extremely difficult to do so at that time. He said one could end up with numerous court cases because many of the people involved had qualifications.

The Psychological Therapies Forum was formed by various organisations, which I do not have time to name. The forum includes Accord, the Catholic Marriage Care Service; the Association of Psychoanalysis and Psychotherapy in Ireland; the Association of Cognitive Analytic Therapy; the Irish Council for Psychotherapy; the Irish Association for Counselling and Psychotherapy; the Irish Association of Christian Counsellors; the Irish Gestalt Society; the Irish Institute of Counselling and Hypnotherapy; Marriage and Relationship Counselling and; the National Association of Pastoral Counsellors.

In a report entitled Public Protection, the forum made a recommendation to the Minister that psychological therapists be added to the list of registered professions. The forum proposed that there would be two grades: psychotherapist and counsellor.