Back in 2016, the Department of Health decided to define a framework for several unregulated professions*. Even if voluntary organisation-based registration exists, the government wanted to harmonize the practice of such disciplines. Clinical psychology is now being discussed and it raises some concerns, especially for practitioners trained overseas.
It is our mission at Healthy Matters to empower you with trusted health information. This article aims at shedding light on a highly politicized issue – and one that may affect your access to clinical psychologists in the future.
The indirect exclusion of non-Cantonese psychologists could have a big impact on the 6.1% of the Hong Kong population that doesn’t speak Cantonese. Language and culture are an essential part of the relationship between a psychologist and patient. Any obstacle in their communication has the potential to impair the ability to diagnose and effectively treat, as well as the ability to form a trusting relationship with your therapist.
What is a psychologist?
A clinical psychologist is a mental health professional with highly specialized training in the diagnosis and treatment of mental illness. They observe and listen to patients, and make interpretations based on conduct and how people interact with their environment. Clinical Psychologists treat emotional, mental and behavioural problems. Unlike psychiatrists, psychologists cannot prescribe drugs.
What is the current legal framework for psychologists in Hong Kong?
Currently, there is no official regulation in Hong Kong for psychologists. Any person can use the title “clinical psychologist” without proving their qualifications. Psychologists are under no obligation to be licensed or registered with a professional board of government agency in order to practice here in Hong Kong.
Which organizations are involved?
Organizations have been created to attempt to set up a framework and regulatory standards. Their goal is to ensure professional ethical treatment. There are two main organisations: The Hong Kong Psychological Society’s Division of Clinical Psychology (DCP) and the Hong Kong Association of Doctors in Clinical Psychology (HKADCP). For both organisations, criteria for the members were set up with the help of public authorities such as the Social Welfare Department, Department of Health and the Hospital Authority.
On one hand, the Hong Kong Psychological Society represents around 500 practitioners, since 1982, who mainly graduated from the University of Hong Kong and Chinese University. On the other hand, the Hong Kong Association of Doctors in Clinical Psychology, created in 2011, has fewer members and its psychologists mainly graduated from a self-financed program at City University.
What about overseas clinical psychologists working in Hong Kong
Clinical psychologists trained overseas can also be a part of those organisations upon submitting necessary documentation and with proof of training.
Why does the Government want more regulation for psychologists in Hong Kong?
The Department of Health wants to promote good service standards and provide reliable information. With this decision, the Government recognizes “the importance and effectiveness of voluntary society-based registration” but aims at enhancing it. They want the public to be able to make more informed decisions.
In December 2016, the Department of Health implemented the Accredited Registers Scheme for Healthcare Professions. Its principle is “one profession, one professional body, one register“.
The Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong (SPHPC-CUHK) has been appointed by the government as the Accreditation Agent. Its role is to elect through an objective process the independent body that will be in charge of the registration, administration of the profession and the establishment of the professional standards.
Why does this process stir controversy?
When the Department of Health stated that clinical psychology was among the list of professions to be regulated, some disagreements and rivalry rose from the announcement. The Division of Clinical Psychology (DCP) declared that among the Hong Kong Association of Doctors in Clinical Psychology, around 100 members had differing standards. This had a big impact because it put in jeopardy those 100 members already having patients and clinics running. This stressed again the need for regulation, as both bodies cannot agree upon a consensus.
In June 2018, the Division of Clinical Psychology (DCP) made a proposal of accreditation standards for the Accredited Registers Pilot scheme. However, even after three rounds of consultations, the proposition is far from bringing a consensus in the community.
Overseas trained psychologists working in Hong Kong are in jeopardy
The proposal submitted by the DCP raises questions, especially among clinical psychologists trained overseas. According to the proposal, there are 6 cumulative criteria to become a registered clinical psychologist in Hong Kong.
Among them, some are particularly worrisome:
On top of a master’s degree or a doctoral degree in Psychology, a bachelor’s degree is required. However, this is not a mandatory requirement in every country, such as the US.
The proposal asks for professional knowledge and skills in local psychological testing and inventories. However, overseas psychologists are not trained in local assessments.
During the training, the clinical placement must include on-site supervision for all three major clinical population (adults, children, adolescents with psychological problems and individuals with medical or mental conditions). However, this is not a requirement elsewhere.
The proposal includes a waiver for psychologists who would not fit the criteria, but the waiver is very restrictive. An “under exceptional circumstances” clause has been established but it leaves a very broad discretionary power to the accreditation body.
What do psychologists who treat expats think about this?
We asked Hong Kong born Dr. Sharmeen Shroff who completed her PsyD in the US and has been practicing in the field of Psychology for 14 years, what she thinks of the latest proposal.
While Dr. Shroff fully supports the decision to regulate the professional body of Clinical Psychologists, she is simply asking to be included and to be allowed to provide the services for which she was trained for and for the benefit of her patients.
Dr. Shroff who is also the Founder of Central Minds, a private psychology practice, explains that “psychotherapeutic treatment relies predominantly on verbal exchange as well as a deep knowledge of cultural competency and language proficiency necessary to treat an individual. If the current proposal is enacted without change, expatriates in Hong Kong will have limited access to a psychologist that has the cultural competency and language proficiency to provide them with effective treatment.
Without language proficient and culturally competent services, I fear that our patients would not be able to access the services they need. By taking away an individual’s choice to see a clinical psychologist who speaks the same native language and understands the intricacies of their culture, we could potentially have a mental health crisis on our hands.”
Doubts concerning the independence of the process
During the last round of consultations, the DCP changed its name to “Hong Kong Institute of Clinical psychologists” (HKICP) and claimed to have been appointed by the SPHPC-CUHK as the accredited professional body. Yet, this seems impossible given the lack of consensus still ongoing.
The SPHPC-CUHK declared that the DCP changing its name was not a problem and this made the psychologist community question its integrity and independence. To protest, those bodies are willing to “fully boycott the so-called “HKICP” consultation process”. They are asking for an independent third party to assess the proposals. They reminded the SPHPC-CUHK that every organisation is entitled to make a proposition and that the advanced designation of the DCP without reaching a consensus seems unfair and premature.
Even if there is a clear need for regulation and that the policy towards regulation is well-intended, it is to be hoped that the process will be clarified by the SPHPC-CUHK in order to shake the feeling of biased procedure.
If you wish to support clinical psychologists trained overseas, you may find here a petition asking for a more inclusive proposal.
*Other than clinical psychologists, these professions are also targeted: audiologists, audiology technicians, chiropodists / podiatrists, dental surgery assistants, dental technicians / technologists, dental therapists, dietitians, dispensers, educational psychologists, mould laboratory technicians, orthoptists, prosthetists/orthotists, scientific officers (medical) and speech therapists.