How will 3000 counsellors fit into a new National Mental Health System in NZ?

There is a new pathway for about 3000 counsellors to be accredited to work in publicly funded mental health and addiction roles. Until now, counsellors haven’t been able to work in publicly funded clinical roles, because it’s a self-regulated profession in New Zealand. A new accreditation pathway has addressed this concern. This has raised hopes that the shortfall in capacity to tackle mental health service demand in the public system.

But I wonder how this will be achieved. Here’s why.

  1. What incentive is there for Counsellors to enter the public health system? Salary stability and regular hours might be one reason, but the caseload would need to be carefully managed, in terms of both case numbers and case complexity. If this move is to enable work with people earlier in the trajectory of their mental health difficulties before it gets too entrenched, then case assessment and allocation will be critical.. Otherwise, it will be a case of revolving doors as people enter the system, get overwhelmed, and decide they prefer working outside the public mental health system after all. Counselling services are inundated outside the public health system, as well as inside it. But working privately, counsellors can take charge of their own caseload. Management, as well as counsellor capacity, would also need to be strengthened. Maybe that’s happening already – I don’t know.
  2. What happens to clinical psychologists?

Under the new pathway, NZCA counsellors would be able to work as health improvement practitioners, health coaches or publicly funded counsellors in their community, GP clinics, in kaupapa Māori, Pacific, and youth settings and in schools, Minister of Health Andrew Little said. “They could join a therapeutic multidisciplinary mental health team in a specialist hospital environment which could free up other specialists, such as psychologists and psychiatrists, to focus on the most acute cases and presentations.”

This is a good move, but the addition of a large number of counsellors to the public mental health system will have a knock -on effect on how teams function, and the work that other professions will be asked to focus on. If this means that clinical psychologists will take more responsibility in management and in working with complex cases, are they being trained to do this? At the moment, there seems to be a problem with many junior clinical psychologists leaving the public mental health system because they become overloaded with cases. Taking some of this load from them is a good move, but what will be left? And is there adequate training and supervision for this work to take place safely and effectively? And will this still be an attractive proposition for potential clinical psychologists to work in the public mental health system?

  1. How is this being coordinated? These are early days for Health NZ, after amalgamating the previous DHB system. Not much has been said about how a new National Mental Health System may emerge from this, or even if there is going to be one. More information on this would be really helpful.

I’d love for this to work. But if we are not careful, we will end up with revolving doors as people enter the system, and then exit straight back out again. We need a focus on why counsellors may be attracted to this work, and encouraging them to develop their skills while they embark on a career in the public mental health system. Pay attention to professional development and building all tiers of management and supervision to ensure support while working. Build for the long term, as well as dealing with mental health service demand.

Make it sticky.

Build a National Mental Health Service professionals want to work in.

Make them proud that they work there.

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2 thoughts on “How will 3000 counsellors fit into a new National Mental Health System in NZ?

  1. Hilary Stace says:

    Two points: 1. Many NZAC accredited counsellors already work in multi-disciplinary teams, eg with social workers, psychologists, educationalists and health practitioners, and manage often heavy workloads. Many are self-employed but still manage these relationships well. Most counsellors are women for whom life generally requires much negotiation and balancing of time and workloads. This change means that they can now apply for positions that require HPCA accreditation and such accreditation is what many have been seeking for years. This is a Government response that short-circuits that requirement.
    2. This change requires counsellors to have NZAC registration which is a very rigorous and ongoing process including frequent re-registration, a high level of professional supervision etc. I would even suggest that some counsellors are better prepared than some who already work in the mental health system.

    It is important to note and critique this change which got very little media coverage at the time. But It is not helpful when the media picks up on comments such as in this post to cast doubt on the profession of counselling or the recent significant changes, without any context.

    • Dr. Sarb Johal says:

      Hi Hilary. Thanks for this. That helps with some information and is reassuring in some part. I know the value of counsellors and they work they do through my experience of working with them in Canterbury post 2010-11 earthquake sequence. The system could not have worked without them. Nevertheless, my post comes from the point of view of curiosity and concern. I may be wrong, but asking around there appears to have been no consultation with clinical psychologists on the impact of this change on their role in the system. Though counsellors have been working in MDTs ’til now, I am unsure how the system will adopt this practice more widely – though it has been said it will. I’m not sure where in my post it says anything about casting doubt on the profession of counselling. There are a valued part of the mental health system. My concern is lack of transparency on how more counsellors in the system changes how services will be organised and delivered. I’d like to see more information and thinking about that from those who designed these changes.

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