Potential Risk, May/Can Cause Harm

By Barbara Dewar

Basis for Recommending to the Minister of Health that Psychotherapy be Regulated and/or a Controlled Act.

I have observed that the general public in Canada is aware of one prevailing approach for the treatment of mental health issues, one that is associated with the medical and psychiatric model. Alternative and complementary health care have always existed, side by side with ‘conventional’ medicine though mostly in silence, muffled for socio-political reasons, tending their own crops and establishing homesteads.

A recommendation was made to the Ontario Minister of Health in March 2001 that psychotherapy be regulated and that provision of any kind of emotional counseling be governed by the Regulated Health Professions Act because of the potential risk of harm that may/can happen by untrained health care workers. If this recommendation becomes law it will prevent a large number of health care providers like, palliative caregivers, grief counselors, priests, psychotherapists who are not psychologists or psychiatrists and possibly even social workers from doing mental health work. Many people living in Ontario could loose access to health care because the alternative or complementary services they know and rely on, that support the growth of our human potential would be required by law to join the existing regulated medical psychiatric model. In essence alternative and complementary health care would be eliminated. In all good conscience, a mammoth decision like this cannot be made on the words of a few who are stakeholders in the medical psychiatric model, and who do not substantiate their claims with solid, verifiable evidence.

Empirical studies are required to firmly establish whether certain mental health workers are actually causing harm. The Minister of Health has to study non-regulated workers to gain knowledge about their skills and training background to learn just how many consumers use their services and benefit, and how many of these services cause harm. This must be compared with how many people benefit from or are harmed by the regulated professions. Surveys, statistics and representative public consultations, should be the usual way for politicians to build support for their proposals for new legislation. Eliminating non-regulated health care workers without proper scrutiny in all likelihood could support a monocrop of health care professions that will have negative long-term side effects – much like how the long-term use of chemicals and pesticides reduces the fertility of the soil.

Before 1991, all of the health professions delineated their scope of practice including their norms, requirements, certification and techniques of practice, and most were subsidized financially by government insurance plans. In 1991, the Regulated Health Professions Act (RHPA) was passed, under the guise of protecting the public from potential harm by untrained persons. The Act governs the provision of care (delineates scope of practice) for twenty-three professions that must be accountable to the Minister of Health and Long Term Care. All other health care services remain in the public domain and may at this point in time be conducted by anyone. Every five years, the Health Professions Regulatory Advisory Council (HPRAC) conducts a review of the legislation. Its purpose is to hear submissions and make recommendations to the Minister of Health.

Before and after the Act (RHPA), alternative and complementary services, like psychotherapy, flourished in spite of name-calling due to protection by the Canadian Charter of Rights and Freedoms, a constitutional act as of 1982. This Act guarantees rights and freedoms only to such reasonable limits prescribed by law as can be demonstrably justified in a free and democratic society. Being called names is painful but like the old childhood rhyme “sticks and stones will break my bones, but names will never hurt me”.

We all know however that the nature of rumors is that if continuous and loud enough they will cause the Wolf “to huff and puff and blow your house down” in spite of your house being made of stone. Under the notion of “protecting the public from harm” we note that historically, without evidence, many have had their rights stripped and even have been murdered or maimed. The history of lynching African Americans in the United States is a case in point.

A consultation document for comments and submissions called Weighing the Balance was sent out from June to December 1999 by the HPRAC. It is worthy to note that this was a five-month survey, not long enough for anyone to catch their breath and was sent out mainly to medical model stakeholders. Of the 368 submissions received, only 59 were from individual members of the public. This, along with supplemental research consisting of two ministerial letters provided the substantive basis for the advice and recommendations that were put forward in the HPRAC report to the Minister. Many of the submissions – including those of several district health councils and health organizations, a number of individual health providers, the Psychiatric Patient Advocate office, the College of Psychologists, the Ontario Psychological Association, and a member of the public – requested that psychotherapy be added to the list of controlled professions. The primary reason given was that psychotherapy may be harmful to the public if not provided by an appropriately trained person. For instance, one health professional commented on the possible adverse consequences of misapplication of psychotherapy techniques for recovering memories of childhood sexual abuse.

The HPRAC document is structured in such a way that data is analyzed and then a recommendation is put out to the Minister of Health and Long Term Care. In an analysis for the Minister, we read: “HPRAC recognizes that psychotherapy done properly is a highly complex form of treatment and that this complexity requires corresponding expertise and skilled application of knowledge. The misapplication or misuse of psychotherapy can have serious effects on consumers”. Further, it recommends that “the risk of sexual/emotional/mental harm to patients must also be given due consideration. HPRAC concludes therefore that regulation of psychotherapists and/or making psychotherapy a controlled act should be reviewed with reference to the nature and extent of associated risk of emotional harm” (p. 21).

We see a serious flaw in the HPRAC document in that it appears to ignore its own analysis and puts forth the recommendation to regulate psychotherapy. The recommendation also states that “the Minister invite a request for a referral from appropriate psychotherapy groups on amending the RHPA to list the additional controlled act of psychotherapy” (p. 22). I am asking that the above analysis written in the document form the basis of the recommendation, before jumping to the conclusion that psychotherapy needs to be regulated.

The proposed statutory registration of psychotherapists would be based on the words “potential risk”, as defined loosely by the Act’s stakeholders. The onus is not put upon these stakeholders to substantiate their position. This means that alternative and complimentary health care workers will be violated, stripped of their rights and excluded without demonstratable limits from protection by the Charter of Rights and Freedoms.