Safety of mental health clients at risk if psychologists remain unregulated

There is growing concern among mental health professionals of risks to client safety if psychologists remain unregulated in Singapore. 

The current absence of regulatory oversight, along with breaches of confidentiality and professional misconduct when these occur, can erode public trust and endanger vulnerable individuals, Mr Adrian Toh, president of lead professional body Singapore Psychological Society (SPS), told The Straits Times.

SPS is currently in discussions with the Ministry of Health on the possible regulation of the psychology sector.

The regulation of mental health professionals is gaining attention, as unqualified individuals have been found offering counselling services on online platform Carousell.

Professional counsellors say this is part of a broader trend of untrained help being offered on social media and messaging platforms.

Among mental health professionals in Singapore, only psychiatrists, who are medically trained doctors, are regulated by the Singapore Medical Council now. 

Other key practitioners such as psychologists and counsellors are not regulated. However, professional bodies such as SPS and Singapore Association for Counselling (SAC) provide guidance on the professional and ethical conduct for their members.

Psychiatrists are medical doctors who oversee interventions such as medication, hospitalisation and medical treatments.

While psychologists do not give medical advice or prescribe medication, they can provide diagnoses based on psychological assessment and evaluation tools.

Counsellors are trained to provide mental health support for clients with problems and struggles that are specific and current to their present realities, like stress or grief.

While SAC has called for regulatory oversight over counsellors, the association said there has been no formal response from government ministries so far.

The role of the psychologist

Psychologists are now moving beyond clinical settings and playing a broader and more proactive role in different sectors, said Mr Toh. 

In schools, they develop resilience-building programmes and provide early intervention for students. In the community, they work with vulnerable groups to offer preventative mental health support. 

While most psychologists maintain high professional standards, the absence of legal safeguards creates risks for clients, practitioners and the mental health sector, said Mr Toh. 

SPS oversees 700 practicing psychologists registered with the society. It receives an average of six complaints of unethical practice each year. These include overcharging and breach of confidentiality.

Even though the number of complaints is relatively small, it still highlights the importance of oversight, said Mr Toh. 

In the absence of regulation, the society has a disciplinary advisory committee that examines complaints filed against its members and works with the psychologist involved to address any breaches of standards. 

This is so the members of the society have the opportunity to learn and improve their practice, added Mr Toh. 

When engaging a psychologist, members of the public can check if the professional is registered with the SPS. Members of the association are required to adhere to a code of ethics and offer services within their area of competence. 

Serious consequences

One of the biggest concerns about the lack of regulation is anyone can claim to be a psychologist, regardless of training, qualifications, or supervision.

Using the example of a person with severe post-traumatic stress disorder who seeks therapy from someone who lacks formal training in trauma care, Mr Toh said if the purported psychologist uses ineffective or even harmful interventions, the client’s condition could worsen rather than improve. 

“In cases involving suicide risk, psychosis, or severe mental health condition, improper assessment or treatment can have devastating or even life-threatening consequences,” he added.

Mr Toh has heard of instances where practitioners without the requisite training had conducted assessments and subsequently diagnosed neurodevelopmental conditions such as autism and intellectual disability.

“These reports, which are supposed to draw a clear picture of a child for early intervention or to enter into a special school, may not clearly reflect a child’s abilities,” said Mr Toh. 

“Without regulation, there is no system in place to verify credentials, restrict unqualified individuals from practising, or hold them accountable for harm caused.” 

Regulation could also have the benefit of ensuring psychologists have high standards of practice if, for instance, they are required to undergo continual professional development, he added. 

Another pitfall of the lack of oversight is that there are no legal safeguards to ensure confidentiality is maintained.

Mr Toh has received informal feedback on such ethical breaches, such as a psychologist who had openly complained about a client during a dinner, revealing enough information that others could identify who it was. 

“Breaches of confidentiality can cause emotional distress, financial harm, or even social stigma. If a psychologist improperly shares a client’s personal details, it could jeopardise careers, family relationships, and overall mental well-being,” he said.

Other examples of potential unprofessional and unethical behaviour include financial exploitation, such as overcharging clients or recommending unnecessary therapy sessions, discrimination and inappropriate relationships with clients.

“For example, there was a psychologist who belittled a client’s cultural or religious background during therapy, causing significant emotional harm and making the client feel even more isolated,” Mr Toh said. 

In a regulated profession, breaches of confidentiality or instances of ethical behaviour would likely result in serious consequences, such as suspension or removal from practice.

Without statutory oversight, there is no formal recourse for clients.

Counsellors alarmed by unqualified people offering mental health services on Carousell

An ex-psychology undergraduate and a self-professed “ordinary teenager” are among unqualified individuals drawing upon their life experiences to offer counselling services on online marketplace Carousell.

Some of them offer their services for free, others charge between $1 and $70.

These offers of counselling services by the unqualified alarm mental health professionals, who say such individuals may cause more harm than good in people seeking help for their mental well-being.

In addition to concerns over the ethics and risks of improper treatment, the issue is complicated by the fact that the counselling sector is currently unregulated.

While there is a wide range of mental health professionals in Singapore, only psychiatrists, who are medically trained doctors, are regulated by the Singapore Medical Council now. 

Qualified practitioners said they have seen a rise in untrained individuals offering such therapy services on social media and messaging platforms.

The Straits Times referred at least 16 listings of counselling services on Carousell to the Singapore Association for Counselling (SAC), which said it was concerned about the listings.

The listings either do not give clear assurances of proper qualifications, or have misrepresented their services as adequate counselling and mental health interventions and support to potential clients, said the association.

SAC provides guidance on the professional and ethical conduct for its over 2,000 members. It has reached out to Carousell to engage the platform on possible safeguards to protect consumers. 

Suggestions by SAC include creating a special category for services like counselling, where there would be mandatory fields like qualifications acquired that would need to be filled in before listing. 

This is important as Carousell users include “a wide demographic group where awareness and information may not always be readily available to them”, said SAC president Andy Lam.

In response to queries from ST, a Carousell spokesperson said that the company takes a serious view on the sale of prohibited items on the platform, but it is currently not aware of any local regulations regarding counselling services.

The spokesperson added that the company is in touch with SAC on how to better moderate such listings. 

As of Feb 25, 15 of the 16 listings ST referred to SAC were still active. 

What the listings say

About a third of the counselling service listings on Carousell emphasised their empathetic and non-judgmental personalities.

They also pointed out that their friends and family often turn to them for a listening ear. Some also said they are good at giving advice. 

Three listings were upfront that they are not professionals, but most of the others provided few details about their credentials and experience. 

When ST, in the role of a potential client, contacted the people behind the listings, some of them offered relationship, marriage or child counselling services even when they said that they had not undergone professional training for these purposes. 

Some of the services were offered for free, while others charged between $1 and $70. At social service agencies and in the private sector, counselling sessions range from around $100 to $300 an hour.

Potential damage

Dr Jonathan Kuek, adjunct lecturer at James Cook University, said it is a common misconception that people with plenty of life experience and empathy would make competent mental health professionals.

“Providing a formal service is more complicated than just knowing how to relate to people or provide advice. Most mental health professionals do not actively offer advice but seek to help people derive their own solutions or, in some cases, teach skills to help them manage various challenges they may be facing,” said Dr Kuek. 

SAC’s Mr Lam also pointed out that counsellors build ethical awareness and professional discipline to separate their personal feelings and agenda from the work they do.

“This ensures that all therapeutic engagements are conducted within clear ethical guidelines and through professional conduct,” said Mr Lam.

He added that professional training involves undergoing a wide range of rigorous academic studies to gain theoretical foundation, and receiving clinical supervision to translate that into practice. 

Ms Wong Wun Chee, assistant senior counsellor at Care Corner Counseling Centre said that unqualified help can do more harm than good.

“For example, in marital counselling, an untrained individual may fail to recognise signs of family violence, unintentionally validate toxic and dysfunctional dynamics, or give advice that worsens conflicts. In child counselling, they may misinterpret behavioural issues, fail to create a safe space for the child, or even risk breaching confidentiality,” said Ms Wong. 

She added: “These mistakes can have long-term emotional and psychological consequences for individuals and families.” 

ST also spotted one listing by a master’s student offering free counselling sessions to fulfil her practicum hours. 

Postgraduate programmes in counselling that are recognised by SAC require students to fulfil at least 100 practicum hours. 

Mr Lam said that fulfilling practicum hours on such online platforms are not allowed, regardless of the assessment and supervision structure.

This is because the Counsellors’ Education Board, which oversees the course recognition scheme at SAC, stipulates that practicum sites should be visited by the trainer at least once during the internship.

Mr Lam also said that trainee counsellors do not usually find their own clients but through the institutions that provide the training.

“SAC will take a strong stance against any institutions running a recognised programme that engage in such a practice,” said Mr Lam, adding that it had sent a reminder about this to programmes recognised by SAC on this matter in May 2024.

When approached by ST, the master’s student said that she did not know such a practice was not allowed and took down her listing. 

What to look out for in a counsellor

Those looking for a counsellor to help them should check if the practitioner has postgraduate qualifications such as master’s degrees conferred by nationally recognised universities. 

Practitioners should also provide information on their depth of experience in years or hours, and with the areas of their specialisation clearly listed and substantiated, said Mr Lam.

The public should also check if the provider is registered with SAC, he added.

Beware of purported counsellors who promise quick fixes.

Care Corner’s Ms Wong said red flags include assurances like “I can fix your trauma in one session”, and vague or misleading credentials.

For some years now, SAC has been calling for regulation for the sector, pointing out that it is a necessary step in enhancing mental healthcare for Singapore. 

The association said there has been no formal response from government ministries so far. 

With the Government making mental health and well-being a key priority on the national agenda, more people are encouraged to seek help. Mr Lam said it is important that help is rendered by qualified counselling professionals. 

“In the absence of regulation, the risk of engaging unqualified counsellors remains pronounced, which might result in more harm than good in the mental health recovery process,” said Mr Lam.

Dr Kuek concurred, saying: “My argument has always been, if you won’t see a doctor without a proper licence, why would you see a mental health professional without one?” 

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

Pofma orders issued to The Online Citizen, YouTube channel over Ridout Road property claims DMZ v DNA [2025] SGHC 31