Regulating psychologists a good step but unlikely to curb unethical practices: Forum

As an advocate of greater regulation of mental health services in Singapore, I find the recent proposal requiring psychologists to be registered before practising represents a significant step towards ensuring ethical and competent provision of mental health services (Singapore to register psychologists to safeguard patient safety, boost public confidence, March 7).

However, I have several concerns based on the information provided thus far.  

For starters, focusing solely on the psychologist profession and a risk-based approach to regulation may be insufficient, and could create a regulatory blind spot that exacerbates or makes it more difficult to weed out unethical practices in the future. 

After all, the “psychologist” title implies a certain level of expertise and adherence to established ethical principles and professional practice.

However, not all psychologists work with high-risk mental health populations or mental health populations at all. Yet, in Singapore, to a layperson, psychologists are mainly understood to be individuals who work with people with mental illness.  

For example, if specific titles such as clinical psychologist, counselling psychologist and forensic psychologist are to be regulated, and non-clinical or applied psychologists are still allowed to use the general title of psychologist, it could, at best, create further confusion among laypersons, or at worst, allow bad actors to circumvent the regulatory policies. 

Another inherent risk is that other unregulated professionals may continue to practise unethically without accountability, taking advantage of the significant help-seeking literacy gap in the public or finding loopholes in the limited regulations to continue marketing their services. 

This disparity creates a significant vulnerability for those seeking mental health support, and leaves a substantial portion of the population exposed to potentially harmful or ineffective interventions, with no avenues for remedy available.

For example, the recent debacle regarding Carousell “counsellors” was over individuals who operate under the title of “counsellor” instead of “psychologist”, and regulating the title of “psychologist” would be unlikely to stop them from providing their services (Counsellors alarmed by unqualified people offering mental health services on Carousell, Feb 25).

Far more professionals offer services outside the high-risk range and psychology discipline than those within them. 

Considering that we are shifting to a tiered model of care, this would be an opportune moment to lay out regulations for all formal mental health services within the model instead of just those at a high-risk tier.

After all, psychological damage can often lay dormant and surface only later on, which is why regulation is needed, regardless of the risk of harm occurring.

Nevertheless, I am also cautiously optimistic that these baby steps will lead to systemic changes that provide greater protections, accountability and transparency, and result in higher-quality mental health services for people accessing them across the ever-growing plethora of mental health professionals.

Jonathan Kuek

Source: The Straits Times © SPH Media Limited. Permission required for reproduction.

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