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.
- 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.
- 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?
- 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.