A nervous disposition
Whilst Psychologists benefit from being regulated by a statutory scheme which protects their professional title, talking therapists do not. Protecting a title by statute means that only practitioners granted registration by a statutory body can use that title. That same statutory scheme usually also sets out the standards of training and qualifications that must be achieved in order to be admitted to the statutory register and granted registration to use that title.
There is a voluntary scheme of regulation and many qualified therapists sign up to one or more of those as they publish a register which patients often use to identify a therapist they wish to work with. Those voluntary bodies started out as professional associations and continue to campaign for better funding into mental health but they also investigate complaints made to them by patients and members of the public. As such, these voluntary bodies have the ability to make findings of misconduct and impose sanctions against members including removal from the register. Many of the voluntary bodies are ‘Accredited Registers’ who are themselves monitored by the Professional Standards Authority, which has required them to improve their complaints handling processes, although it is right to say that this is usually in favour of the complainant-patient rather than in support of due process for the member.
The lack of statutory regulation has two quite serious consequences for patients, some of whom may be extremely vulnerable. The first is that anyone can practise as a therapist whether or not they have any formal qualifications. The second is that even when findings of misconduct are made by a voluntary body against a member and they are removed from the register, that individual can continue to practise regardless of the sanction imposed on them. Although the decisions of the voluntary body may be publicly available on their website, it is possible that patients may never become aware of those findings and continue to use the services of that practitioner nonetheless. A report by Unsafe Spaces in 2016 found that one in four members struck off by the BACP or UKCP appeared to be still practising. In circumstances where a former member continues to practise and treat patients; these voluntary regulators are powerless to do anything about it, unlike statutory regulators, who usually have the option of prosecuting someone for illegal practice.
There have now been several previous attempts to change the status quo. In 2010 the then coalition government scrapped plans to bring psychotherapists and psychoanalysts under the scheme of an existing statutory regulator as they concluded it would be “disproportionate to the risks to the patients and the public”.
In 2013, several MP’s led by Geraint Davies MP supported a private members’ bill for the regulation of psychotherapists but it failed to win enough support. The following attempt also floundered in 2018 when the Counsellors and Psychotherapists (Regulation) and Conversion Therapy Bill 2017-2019 failed to complete its passage through Parliament before the end of the session.
The overwhelming majority of members of the talking therapy professions stand to benefit from statutory regulation because it should drive up standards and lead to greater confidence in the various titles that are protected. Those who lack adequate qualifications and expertise should not be able to share the same platform and title as those who are highly trained and skilled practitioners.
The voluntary bodies have struggled to adapt to their role in disciplining members for misconduct or poor practice. Unlike statutory regulators who have resources and experience behind them in order to run adjudication schemes fairly and apply effective sanctions, the voluntary bodies do not. In recent times, several of them have made improvements to their complaints processes to bring them into line with the schemes exercised by the statutory regulators. However, some oddities in complaints processes remain and there is still more work to be done to bring them in line with the statutory schemes. This is more likely to happen quickly if the regulation of talking therapists was transferred to an existing statutory regime. The alternative would be to create a new statutory body or promote one of the voluntary bodies but there would need to be an investment in improving the training and experience of investigators and decision-makers to bring them properly up to speed.
There are increasing numbers of practitioners joining the profession. In 2009 there were over 30,000 members of the BACP whereas now there are over 50,000 members.
There are also increasing numbers of referrals being made in the NHS to talking therapists. Particularly so recently as there have been many campaigns over the last few years in which people are being encouraged to talk more openly about mental health problems and seek help from a talking therapist. For example, according to a press release by NHS Digital in July 2019, there were 1.60 million referrals made to talking therapies for anxiety and depression in England during 2018-19 which was an 11.4% increase from the previous year.
Finally, the voluntary bodies are receiving an increasing number of complaints against members. In 2013 the UKCP received 156 against members whereas by 2017 those figures had increased to 203.
Many psychoanalysts, psychotherapist and counsellors that we look after are surprised to learn that they can continue to practise even if they are struck off the register by their voluntary body. Alongside their incredulity, they also reflect at how those disciplining them are actually relatively ‘toothless’ when it comes to public protection - which surely should be at the heart of their role. As a result, those bodies often lose credibility in the eyes of those they seek to regulate. We suspect that the voluntary bodies often receive complaints from aggrieved patients who learn that even though a member has been removed, they continue to practise without any hindrance at all. It could therefore be said that the benefits of statutory regulation extend to those that regulate as much as the practitioner and complainants.
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