...protection apply to all mental healthcare practitioners.

**********

A significant proportion of mental health practitioners in Australia offering counselling services are only subject to voluntary participation within self-regulatory framework. The main exceptions are psychiatrists, psychologists and nurses, who are subject to statutory registration requirements. Australian law does not restrict the use of the title 'counsellor' or other professional titles adopted in this field such as 'psychotherapist', leaving the market open to anyone to 'put out a shingle' and offer these services. Consumers are left to determine the competency of a counselling practitioner with often little understanding of the varied levels of training and expertise among practitioners. It is arguable that the law has failed to protect consumers by neglecting to implement an adequate comprehensive regulatory framework.

Many jurisdictions around the world are reviewing their regulatory models for mental healthcare providers, including counselling and psychotherapy services. In Canada, the Ontario Health Professions Regulatory Advisory Council undertook an extensive review of all unregulated healthcare groups, including counselling and psychotherapy, and recommended regulating the practice of 'psychotherapy'. (1) Alberta has restricted psycho-social interventions according to the severity of the condition being addressed, rather than the nature of the intervention being employed. (2) Thus, only six statutorily regulated health professions can provide psycho-social intervention to persons with substantial thought, mood, perception, orientation or memory disorder that grossly impairs judgment. Quebec has formally regulated a number of professions offering counselling and psychotherapy services such as those provided by psychologists, psycho-educators and social workers, but is still undecided on the broader regulation of these activities. (3) British Columbia is also considering the regulation of psychotherapy and/or clinical counselling as a subset of the service provision of counselling. (4)

At present, the United Kingdom has a system of voluntary self-regulation, under the umbrella of the United Kingdom Council for Psychotherapy, which represents 80 voluntary associations. (5) A review by the Department of Health has recommended mandatory registration for psychotherapists. (6) In the United States, many states restrict the practice of psychotherapy and counselling through a range of approaches, from voluntary registration with a state board to formal licensing. Using Washington as an example, there are three forms of 'credentialling' available, with only the first two levels applicable to counselling under the State's legislation. (7) The first level is called 'registration' and requires the health practitioner to be identified to the department (that is, registered) and does not require a qualifying examination. (8) The second level, 'certification', is a process by which the state grants recognition to an individual who has qualified by examination and met established educational prerequisites. (9) The third level, 'licensure', is a method of regulation by which the state grants permission to persons who meet predetermined qualifications to engage in a health profession that would otherwise be unlawful in the absence of the permission. (10)

These overseas inquiries and models for the regulation of mental health practitioners highlight the need to consider what should be a workable regulatory framework for all mental health practitioners in the Australian context. The Council of Australian Governments has agreed to establish a national professional registration scheme for health practitioners already subject to statutory registration. (11) The Council has indicated that due consideration will be given to incorporating new professions. This provides the impetus to work towards a nationally consolidated and coherent framework for accrediting courses, institutions and registering health practitioners providing mental healthcare services who are currently self-regulated.

As the parameters of 'counselling' can vary between practitioners, an understanding of the term's boundaries is necessary when considering the regulation of mental healthcare practitioners delivering such services. This is no simple task, given the term 'counselling' lacks clear definition. For example, Irvine Epstein, David MacAulay and James Chisholm describe 'counselling' as representing 'a wide range of services', including 'interviewing, assessing, behaviour therapy, behaviour modification, hypnosis and research'. (12) The issue is further complicated by the unresolved debate over whether 'counselling' is an activity performed by many health practitioners or whether it constitutes a profession in itself. Epstein, MacAulay and Chisholm point out that counselling may he classified as a function rather than a profession. (13) That is, 'counselling' can be viewed as an intervention technique used by a range of professionals and non-professionals including social workers, psychologists, doctors, lawyers, members of the clergy, and others. (14)

Regardless of the difficulty in identifying a broadly accepted core activity in the practice of counselling, this article argues that it is necessary to regulate all mental healthcare practitioners, given the inherent power imbalance in the therapeutic relationship between the practitioner and patient.

The next section outlines current regulatory frameworks for health practitioners in general and is followed by an overview of the current self-regulation framework for counsellors and the problems associated with this. The article then turns to a consideration of the options for the regulation of currently unregistered mental health practitioners and argues that a title protection framework should be adequate and workable.

Current Regulatory Frameworks

Six general models of occupational regulation of the health workforce can be demarcated, from least restrictive to most restrictive as follows: self-regulation, negative licensing, co-regulation, reservation of title, reservation of title and core practice restriction, and reservation of title and whole-of-practice restriction. (15)

The 'self-regulation' model is the least restrictive. Health practitioners falling into this mode may voluntarily choose to maintain membership of a professional organisation and are said to be self-regulating. They are not governed by occupational registration laws. (16)

The second type, 'negative licensing, allows a practitioner to practise in a self-regulated profession unless listed on a register of persons who are ineligible to practise because of a tribunal or court finding of poor practice. (17)

'Co-regulation' refers to members of a professional association being regulated by that association in conjunction with government. For example, the professional association will undertake its usual duties, such as setting membership requirements...

NOTE: All illustrations and photos have been removed from this article.



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