Mick Clifford: 'Irish Examiner' and RTÉ revealed lax regulation of mental health professionals

For all the current emphasis on wellbeing, the State's primitive approach to regulation shows what a low priority it really is

'RTÉ Investigates' reporter Barry Kelly showed how easily he obtained fake qualifications and set up as 'psychologist' with a brass plate on the door of his fake practice. Picture: RTÉ

Picture the scene. You are new to an area, a recent arrival, and you are experiencing some physical pain that you believe to be serious. You go in search of a doctor and find one down the road, his GP practice advertised on the door.

The doctor examines you and diagnoses your illness. Much later it turns out the diagnosis was all wrong and, in fact, the individual was not a qualified GP at all, but some chancer.

The wrongful diagnosis led to your condition worsening and now you have a very serious health problem.

The fake GP would be investigated, quite possibly arrested, and prosecuted. Not that this helps your current condition but at least he could not do further harm to others.

Now substitute the physical ailment for a psychological one. 

Wild west of regulation

The fake psychologist can diagnose and treat until your money and patience run out and you realise that you are not getting any better. There is no consequence for this chancer because he is operating in an area that is a wild west of regulation.

Last Monday, RTÉ reporter Barry Kelly demonstrated on RTÉ Investigates how he was able to set himself up as psychologist, obtain fake qualifications, and put the brass plate on the door of his fake practice.

The programme transmitted was a fine example of public service broadcasting. It showed how the whole area of psychologists is totally unregulated. 

While the report was very well executed, the bones of the story is not new. Others, including the Irish Examiner, have over the years highlighted this shocking lacuna.

Anybody can set up as a psychologist and do a hell of a lot of harm. There is a grift involved in taking money from vulnerable people under false pretences, but the bigger issue is the damage that can be done, and is done, by this dereliction of duty on the part of the State.

Prioritising mental health

Today, mental health is a buzz phrase right across society, from employment to the rearing of children.

On one level, this is highly progressive in that it represents a belated recognition of the impact that psychological disorders or illnesses can have on a person’s ability to function.

The word “trauma” is now frequently invoked in all sorts of situations.

Some would say that it is overused, but at least now there is an awareness of the damage, often hidden from a person’s public demeanour, that can be done to mental health by events, experiences, and upbringing.

Yet one of the main disciplines designed to address psychological conditions has the potential to do much further harm.

There are many fine psychologists at work today, who are fully qualified and imbued with proper ethics and standards.

The problem is that accessing one is, to the greatest extent, down to word of mouth. One can check organisations such as the Psychological Society of Ireland and research whether the individual is accredited to any professional bodies, but, understandably, this tends to be done in a small minority of cases.

Assessment of needs logjam

Take one area where damage can and is done thought lack of proper regulation. In recent years, the plight of families which include one or more children with autism has been highlighted repeatedly. 

The first step on the journey that a parent or family takes in addressing such a condition is to get an assessment of the child’s needs.

The urgency is acquiring an assessment of needs for a child in order to begin treatment as fast as possible is recognised in legislation.

The 2005 Disability Act stipulates that an assessment of needs must be completed within 90 days of applying to the HSE and treatment is to begin within another 90 days.

This has never been properly observed by the HSE, mainly due to a dearth of resources. As such, any parent who can afford it goes to the private sector in order to get the assessment.

Enter the psychologist.

For sure, many deal with their clients with the utmost professionalism, but there is also the reality that most who do an assessment of needs are aware that the applicants want an outcome that will provide them with a result that can be furnished to the HSE in order to begin treatment.

In such a milieu, there is undoubtedly pressure on the psychologist to come up with the preferred result.

Box-ticking culture

What can, and certainly does, occur in some circumstances then becomes a box-ticking exercise. Guarding against such a culture is not easy and would be a challenge even in a scenario where psychologists were properly regulated. 

In an environment where they are not, there is a far greater chance of an assessment being conducted for a pre-determined outcome that ill serves the child and the health authorities. All of this is well known to anybody with any knowledge of this area. Despite that, there is still no regulation.

Proper psychologists deal with their clients with the utmost professionalism, but the logjam in the HSE assessment of needs system creates circumstances that could be exploited by unscrupulous individuals. Stock picture

The Government’s response to this has been much the same as it has been to the disability sector. Just as the Disability Act came into being in 2005, so also in the same year did legislation to regulate psychologists, the Health and Social Care Professionals Act. 

It’s as if the government of the day simply makes the law and walks away, leaving other arms of the State to sort out how exactly they will comply with the law.

The Disability Act, 18 years on 

In 2016, nine years after the act came into being, Coru — the regulator of health and social care professionals — was due to begin the establishment of a Psychologists Registration Board. The following year it had still not happened and the Irish Examiner reported that the department had confirmed that it would be established “in the coming months”.

This would only be the start of the process of full registration, the report stated, but added that the department’s position was “the worst case scenario would effectively mean that anyone could call themselves a psychologist until 2021, regardless of their level of training or qualification”.

The board was established in 2017 but is still not ready to impose full regulation. A spokesperson for Coru told this column that no date has yet been set for the opening of the psychology register.

Barry Kelly's demonstration of how easy it is to pretend to be a qualified psychologist echoes the work six years ago of then 'Irish Examiner' reporter Joe Leogue. Picture: RTÉ

“This cannot happen until all the standards and requirements of a statutorily-regulated body have been established. However, Coru and the board are fully committed to delivering regulation to this very important profession,” they said.

The process of doing so is not easy and full of complications. But 18 years after the law was passed and six after a board was established, there is still no sign of a proper register to protect the public.

For decades, until recently, mental health was described as the “Cinderella” of the health sector. 

Today, with the awareness, the rhetoric, the apparent empathy with children in particular who require treatment, mental health is constantly referenced as a high priority for the general wellbeing of society. 

And yet, when it comes down to the nuts and bolts of providing a service to match the rhetoric, the State, in some respects, is as primitive and negligent as ever.