COMMITTEE FOR HEALTH, SOCIAL SERVICES AND PUBLIC SAFETY
British Association for Counselling and Psychotherapy
2 July 2009
Members present for all or part of the proceedings:
Ms Sue Ramsey (Acting Chairperson)
Mr Thomas Buchanan
Mr Alex Easton
Mr Sam Gardiner
Mrs Carmel Hanna
Mr John McCallister
Ms Claire McGill
Witnesses:
Ms Sally Aldridge )
Ms Cathy Bell ) British Association for Counselling and Psychotherapy
Ms Jean McMinn )
The Acting Chairperson (Ms S Ramsey):
Thank you for attending the Committee.
Ms Sally Aldridge (British Association for Counselling and Psychotherapy):
I am Sally Aldridge, the director of regulatory policy in the British Association for Counselling and Psychotherapy (BACP). First, I apologise on behalf of our chief executive, Laurie Clarke, who is unable to be here. He was on his way to the airport this morning when 15 miles of the M6 were closed, so he was unable to get his flight or to find an alternative flight. He is really very upset, and he hopes that you do not take that as a lack of respect to the Committee; those are the vagaries of English motorways.
I have worked for the BACP for 10 years, first in developing professional standards, and now my role is to deal with statutory regulation. We welcome the strategy for improving access to therapies in Northern Ireland, and we really want to make it work. We think it wonderful that the Government are investing money in mental health and are taking a lot of time and trouble to develop a strategy. A strategy is particularly important at this time, given that statutory regulation of the professions that deliver psychological therapies is happening. The psychologists go on to the Health Professions Council (HPC) register on 1 July, and counsellors and psychotherapists are in line to be regulated, probably in 2011. However, that depends on what happens in Westminster in the meantime.
The BACP is a very large professional association for counsellors and psychotherapists. It has over 30,000 members, almost 1,000 of whom are in Northern Ireland. In Northern Ireland we have worked collaboratively with the Irish Association for Counselling and Psychotherapy (IACT) for the past 20 years. We meet regularly and share all our initiatives and objectives. We have a long history of collaborating with the Department, going back to John Park’s report on counselling in Northern Ireland, which was published in 2002. We wrote leaflets for the Department on counselling and how to employ counsellors, and we were also part of the group that was successful in obtaining funding to run two cohorts of an accredited training course in Derry. However, unfortunately, the money for that dried up after four years.
We have a history of collaboration, and we would really like to collaborate and work at making the strategy a success in Northern Ireland. However, we have some serious concerns about it. That is all that I will say, because I am not from Northern Ireland. I will now hand over to my two colleagues who represent the BACP in Northern Ireland.
Ms Cathy Bell (British Association for Counselling and Psychotherapy):
Good afternoon; my name is Cathy Bell. I am involved in counselling, and I trained originally as a social worker. I have a lot of experience in health, education and social services across all your constituencies. I speak with experience of many health issues, including emotional health and well-being. I am here today as a member of the BACP, but also as a taxpayer and a constituent of MLAs. I make no apology for saying that.
I agree with what Sally said; it is great to have an opportunity to comment on the strategy. I heard members say already that they have had no time to read the papers, so they have probably not had a chance to read the briefing paper, although it is short. That is fine. We will not have time to read every line, but we will highlight some elements of the paper. It contains a list of six concerns of the Northern Irish members of the BACP, and I will highlight one. However, I realise that your time is very limited.
To emphasise, the points that I am making do not represent those of an organisation with an English executive and English heads of departments; I am speaking on behalf of over 1,000 members in Northern Ireland. I must be honest and say that it grieves me that, in the document ‘A Strategy for the Development of Psychological Therapies in Northern Ireland’, there is no reference to or acknowledgement of the existing workforce of counsellors and services that are in place already in this country.
I know that the Committee has been well briefed. Members have heard various individuals speak from different groups, including families who have been bereaved by suicide. They have spoken about the input that counselling has to communities in their areas. They are not talking about when the doctors’ surgeries are open, but 24/7. It grieves me that the majority of the workforce in that area in this country was not mentioned in the document, and that is a real issue.
You can do whatever you want with numbers, but over 700 individuals have been trained through courses that the BACP has accredited across the country. The Belfast Cognitive Therapy Centre ran a course at Queen’s University in Belfast and another course in Derry. That course was supported with money from the victims’ fund.
I could speak for a long time about the issue. You may think that it is not a great concern, but it is such to the members — your constituents — who, day in day out, are involved. People’s problems do not happen only when the statutory agencies are open; they happen around the clock.
I am voluntarily involved with the faith communities, and we are aware of how much time counsellors give voluntarily so that they can be available 24/7. That is a really big issue, but I do not want to hammer the point.
Some of you may or may not have read ‘A Strategy for the Development of Psychological Therapies in Northern Ireland’. However, it is sad that I, and another professional counselling body to which I belong, got that document only because the BACP found it by chance on a website. I met my colleague Ms McMinn at a meeting, and she asked me about it. However, I had not seen it, so she gave it to me. It is really sad that a document about emotional health and well-being and psychological therapies in this country, which is a post-conflict society, was compiled without anyone bothering to consult or talk to the biggest workforce that we have. We were left out. However, it is not all bad, because, in the past 48 or 72 hours — if I am being generous — Jean McMinn was asked to join the psychological therapies steering group. That offer might be late, but it is great that it was made, and that is the one matter that I wanted to raise. All six points in the briefing paper are important, so I ask you to please take them on board, because they are essential if we are to achieve cradle-to-the-grave care in this country.
Ms Jean McMinn (British Association for Counselling and Psychotherapy):
My name is Jean McMinn, and I am a member of the BACP. I am a senior accredited counsellor, meaning that I am a practitioner. In the past 13 years, I have managed three counselling services in Northern Ireland, two in the community sector and the other for Queen’s University Belfast, which has a student population of 25,000, which is equivalent to that of a small town.
I have taught counselling at the University of Ulster, and presently I teach it at Queen’s University Belfast, where I am responsible for the undergraduate programme. That is one of two British Association of Counselling and Psychotherapy accredited courses in Northern Ireland. In addition, I was on one of the expert working groups in the Bamford Review. Therefore, I have been involved in the field for quite a while.
The point that I want to raise with the Committee is about the single point of access, which is mentioned in the strategy document. It has been suggested that there is a single point of access to psychological therapy for citizens, for you and me, in Northern Ireland. For instance, if one has a mental-health issue, is depressed, anxious or suicidal or has suffered bereavement, one goes to primary care, from where one is referred on.
We know that, and Cathy Bell mentioned this, people’s difficulties do not occur between 9.00 am and 5.00 pm, and, rightly or wrongly, we do not always think to go to our GP or the statutory sector for support. We also know that, in this post-conflict society in Northern Ireland, community is terribly important. We gain access and support from family, neighbours and the community in which we are steeped.
Northern Ireland has many voluntary community counselling services, and earlier, when discussing the Committee’s minutes, members mentioned some of them, including Aware Defeat Depression, in relation to the suicide strategy. Many people who are involved in providing those services are doing incredibly good work; however, at the moment, many of them are, arguably, being excluded from the strategy. Therefore, although vulnerable adults and children are attending counselling services, under the strategy document, there is a real question mark about what will happen to those services. That means that we are asking for the single point of access to be reviewed.
I am behind the strategy fully, and I want to recognise clearly that integrated services are very important. As head of the Queen’s counselling service, I work closely with primary and secondary care, and we need an integrated service, not one single point of access. I am also very willing to acknowledge that there is a variety of standards and practices in the community sector, which is the third sector. That provision must be mapped so that we can see the standards and practices in that sector.
That links into training, and we ask for an investment in training in counselling to equip counsellors with the appropriate skills so that they can work with our allied professionals. I work very hard at Queen’s with our BACP-accredited course. I am acutely aware of the different courses and different standards of counselling training courses in Northern Ireland. Undoubtedly, the standards must be raised and brought into line with those for allied professionals such as clinical psychologists. I am not saying that one needs a doctorate to be a counsellor, but minimum standards must be set, and investment must be made in counselling training and counselling-supervision training. That point is mentioned in the briefing paper.
Ultimately, the issue is one of public protection. We want to ensure that if a vulnerable child or adult were to walk into their community counselling service or into Aware Defeat Depression needing support, they would be able to sit in front of someone who has the appropriate skills, knowledge and experience to respond to their dilemma.
Along with the other concerns that we raised in the briefing paper, we ask the Committee to consider with purpose the need for a single point of access and to recognise the arguably varied practices but high-quality provision in the community and the third sector.
Ms Bell:
The issue should not be seen in isolation; it must be considered alongside the Bamford Review and the strategy for children and young people. I am not sure that the mental-health strategy includes joined-up, integrated thinking. That is dangerous, especially when it comes to public protection.
The Acting Chairperson:
I think that you are right. You said that late in the day you were asked to join the steering group. Is that group the same as the reference group?
Ms McMinn:
I believe that it is.
Ms Aldridge:
We think that the steering group wrote the strategy and that that group is being transformed into the implementation strategy group. Until Jean attends tomorrow’s meeting, we will not be absolutely clear on that.
Ms McMinn:
We lack information about that.
The Acting Chairperson:
We shall try to find out about that. Was the BACP not contacted when the strategy went out for consultation? Was your organisation not included on the stakeholder list?
Ms Aldridge:
We were on the stakeholder list, but we found the consultation document only by searching websites, which is what we do to check what is happening.
The Acting Chairperson:
Does that mean that, although you have over 1,000 members in the North, your organisation was not contacted?
Ms Aldridge:
Yes, and before the strategy group was convened, I asked the Department to include a representative from counselling services on the group. However, that did not happen.
Ms Bell:
The issue is not about who is on a committee; it is about ensuring that whatever we do in this country is the best. Part of the workforce doing that work is made up of volunteers, most of whom pay for their own training.
The Acting Chairperson:
Whenever a document goes out to consultation, the experts who know the issues should be part of the process. There is no point in going out to consultation for the sake of it. The fact that an organisation with over 1,000 members was not contacted shows that, whatever the issues, there is a problem in the system.
Mrs Hanna:
I accept that you need minimum standards of data accreditation. Do the volunteers that you mentioned go on to qualify?
Ms Bell:
Some of them have qualified already and are working in faith communities or in the community. They pay for themselves, but no reference was made to that in the document.
Mrs Hanna:
I take that on board; I cannot understand how you were left out. You said that people often need you out of hours. How do people know how to contact you, if, for example, something happens in the evening?
Ms McMinn:
Mapping provision and assessing need in communities in Northern Ireland is important. Many of our community counselling services are open in the evening. That is standard practice, and in some of the centres, helplines are available as a point of referral. Therefore, the hours are not 9.00 am to 5.00 pm.
Mrs Hanna:
I understand that such services are often required in the evening or at weekends.
To me, the Department’s December 2008 consultation document focuses a great deal on psychology, almost to the exclusion of counsellors such as yourselves. Do you agree? I have only had a quick look through the document, but the words “psychological” or “psychology” are mentioned on most pages. Do you feel that the focus is too much on that form of treatment, and that that, in itself, excludes some people?
Ms Aldridge:
I think that you are absolutely right. When you look at the membership of the strategy group —
Mrs Hanna:
I have examined that.
Ms Aldridge:
When you look at the membership of the strategy group, the emphasis on psychology becomes clear. Some of that has come across from the English Department of Health’s improving access to psychological therapies programme, which is very much dominated by clinical psychology. Often models get picked up and copied.
It is true that the strategy in that document also struck us as being very much in secondary care, with a statutory mentality. To my knowledge, whenever most clinical counselling psychologists are employed, they do not work for free, and they are more often employed in the statutory sector than in the voluntary sector. That has steered the document.
Mrs Hanna:
That must be addressed, as must setting minimum standards. We must create one standard so that when people visit a counsellor they can have confidence in that counsellor, because they are experienced and will deal with their problems with confidentiality.
The creation of one reference point that patients can go through is also important. The BACP is not that well known, and although most people would all know counsellors, they would probably not know what the BACP is. I am not sure what would be the best way for patients to contact the BACP. A referral from a GP is a fairly regular way of accessing health-related services.
Ms McMinn:
The issue is about ownership in communities and how we live our lives. There is a perception, and I suggest that it is a reality, that the statutory sector has more power and the community sector is the Cinderella. We must examine how we can best integrate the services that both provide. If someone’s preferred option is to present at a community counselling service such as Shankill Stress and Trauma Centre, Corpus Christi Services, New Life Counselling Service or the Aisling Centre, they should be supported so that they get the best care.
Mrs Hanna:
That could well be the case, because we are talking very much about community-based services. However, how do you do that, and how do you regulate those services?
Ms McMinn:
The state regulation of counselling and psychotherapy is to be welcomed, and we are undergoing that process. Indeed, I sit on the Health Professions Council’s psychotherapists and counsellors liaison group, which is making recommendations to the Department on that regulation. That process will begin to set a minimum standard.
The other point that is worth mentioning is that we have particular needs in the field of mental health in Northern Ireland, due to the fact that we are living in a post-conflict society. That has consequences for the training of counsellors, psychotherapists and doctors.
Although it is important to link in with developments that are happening further away, it is also crucial that we recognise our own context. Again, community services are very important in that people may choose not to access their GPs because they do not want mental-health issues to be on their medical records or to be disclosed to their employers. The question is how to integrate and bring in what serves many people on the ground already. How do we bring that forward so that it is part of the investment?
Mrs Hanna:
That is a key issue. However, it is a conundrum: you want to give the community aspect its place, although, at the same time, it needs to be linked to the statutory sector. Did you say that you have an affiliation to an Irish association? Will that continue?
Ms Aldridge:
The British Association for Counselling and Psychotherapy works collaboratively with the Irish Association for Counselling and Psychotherapy. At present, our counsellors and psychotherapists have reciprocal accreditation. However, that will cease with statutory regulation. When the regulation is introduced, the Republic of Ireland will be considered a foreign country. Therefore, anyone who has been trained there will not have their training recognised in the United Kingdom. That means that the regulation will change the entire picture. We will still work together as professional organisations, but the close collaborative and reciprocal arrangement that we have now will legally end because the Republic is an EU country.
Ms Bell:
That perplexes our members, some of whom are also members of the IACP. Questions have been asked about that, but we are having difficulty getting answers.
Mrs Hanna:
You say that you have asked questions about that — it all seems a bit strange.
The Acting Chairperson:
I do not claim to speak for the Minister or the Department, but in his foreword to the consultation, the Minister welcomes responses from the community, voluntary and private sectors. You might find that there is a blockage in the system. It is ironic that you have over 1,000 members, but none of you was aware of that document.
For members’ information, the meeting is being recorded by Hansard. I propose that we send a copy of the Hansard report to the Minister, and he can respond to queries that have been raised during the meeting. We will stay in touch with you about that. Are members agreed?
Members indicated assent.
Mr Gardiner:
Jean, I believe that you said that more investment is needed in postgraduate training and courses for counsellors in particular. I am trying to get my head around which Department would deliver that training: would it be an education Department or the Health Department? Would that require joined-up effort by two Departments?
Ms McMinn:
It would require joined-up effort —
Mr Gardiner:
The Committee can take the matter only so far. We can make a recommendation to the Minister to consider that matter seriously and to see what funding is available. I am sure that you understand that health funding is limited, so an education Department would have to be involved as well.
Ms Bell:
It would require involvement from the Department for Employment and Learning (DEL), which deals with the education of the over 18s. Another important point is that school counselling is delivered by the Department of Education. It works towards standards, BACP guidelines, and so on. Joined-up thinking is missing from the strategy. All those Departments need to make joined-up efforts on training.
Mr Gardiner:
Therefore, Departments other than the Health Department must be involved in training.
Ms Bell:
Yes.
Mr Gardiner:
You have got to get on your bike, as the saying goes.
Ms McMinn:
Members may not be aware of the actual form that counselling training takes at present. It is self-funded, meaning that individuals fund their own training. That raises an equality issue as regards who can afford to pay for training, and questions as to whether there is diversity in the profession. For other models of training for allied professionals, such as social workers, nurses, physiotherapists, occupational health therapists, and so on, places are funded. Therefore, at present, counselling does not have that parity with other professionals, even though, arguably, we do highly skilled work that is of equal value to that which is done by those professionals.
Mr Gardiner:
I congratulate you on your efforts. I am sure that members want to help and encourage you, and we record our appreciation for the work that you have done for people who need counselling. However, the matter goes beyond the Health Department; we have no jurisdiction over any other Department. We must cast the net wider. We must pull every string and knock on every door to get that help. You do a good job, but you need financial help.
Ms Bell:
Although I am involved in counselling, I have also used the services as a survivor of sexual abuse. That counselling was not arranged through a GP or a single point of access; it was arranged through the community, and I saw a trained professional in the community who did not charge me any money. If I had have been charged money, I would not be sitting here today. That illustrates that the Department of Health, Social Services and Public Safety must address the workforce issues.
The report says that in October 2008, 308 professionals were involved in a range of therapies across Northern Ireland in the health and social care trusts. That figure is much higher if one counts all the folk who work as counsellors day in, day out. Their pay is often nothing compared with that of psychologists. Therefore, equality issues exist.
Mr Buchanan:
Your comments are interesting. You said earlier that 1,000 counsellors work under the BACP. Did I pick that up right? Are they all self-funded? Do you not receive any funding from elsewhere? Do you work throughout all the health trusts in Northern Ireland? Moreover, as Carmel said, do GPs know about you in the sense that they can refer patients to you? How many patients have you seen in the past 12 months? Do they range from children to elderly people? I must confess that I have heard very little about the BACP; this information is new to me.
I am somewhat disappointed that, although you were on the stakeholder list, you were not notified about the consultation until you picked it up. However, that may have been an oversight, so I do not want to be too critical. There is a real need for a selling point for your work somewhere along the line to increase the help and assistance that you provide for people throughout Northern Ireland. I want to explore those issues through my questions.
Ms Aldridge:
The BACP has just under 1,000 members who work as counsellors in Northern Ireland, and 35 counselling organisations belong to us. They work across all sectors; some are employed in general practice, and an investment has been made in general practices this year to enable them to employ counsellors. They also work in schools and voluntary sector agencies. Some are paid and some are unpaid. They work with a range of problems, such as mental-health problems, relationship issues and drug, alcohol and substance abuse. They work with a wide age range, from children and young people to old-age pensioners. Therefore, they cover the spectrum of problems.
I will discuss the issue of a single access point again. There is a major stigma in declaring a mental illness. Some people may have lost their job in the recession, their relationship may be under threat because of it, and domestic violence, which we know is a common result of lost jobs and unemployment, may be present. Those people are unlikely to want to visit a doctor and be diagnosed with a mental-health problem on top of everything else that they are dealing with. Therefore, they need access that suits them.
Our members work in all areas, and we can collate information on that for the Committee. We have a big sheaf of information from our members about where they work and the area with which they work. If that would be useful to the Committee, I am sure that we can pull the information together into an easily digestible format for the next session.
Mr Buchanan:
It would be useful.
Mrs Hanna:
You said that there are more than 700 volunteers, most of whom are probably trained counsellors. However, counselling is almost a semi-private service in that people have to pay for it, which makes it more difficult for counsellors to be regarded as members of a professional body. You also help people in the community, and some of you do so simply out of the goodness of your heart. I understand the need for that service. However, a tension exists between being a professional body that is recognised, accountable and upholds standards for the protection of the public and being, in some ways, semi-private. How do you marry the two?
Ms McMinn:
You touched on the important issue of state regulation for counsellors and psychotherapists. That is a live issue right now, and we have held our final meeting on the subject. The UK Government have recognised the need to professionalise counselling, and they acknowledge that the myriad of scattered practice and different standards and knowledge must be formalised.
Mrs Hanna:
Sometimes people are concerned about whether a counsellor is qualified.
Ms McMinn:
As a trainer, never mind a practitioner, I have spent seven days in the past two weeks interviewing students for a BACP-accredited course. Many students apply because of their own needs. They want to receive personal therapy and development via a counselling course. Sadly, they apply for the course instead of going to see a counsellor. Therefore, a genuine need exists for what I will call screening, if that is not too technical a word. The qualities that people need to become a professional must be assessed appropriately.
Mrs Hanna:
That is exactly the point. There is a concern that people who are vulnerable themselves are counselling others.
Ms Bell:
That is why the BACP accreditation is important.
Mrs Hanna:
That gives people a better feel for what counselling entails.
Ms Aldridge:
Any member of the BACP is bound by an ethical framework and a conduct procedure, as are members of the Irish Association for Counselling and Psychotherapy. That means that there is an element of control. Jean and I are members of a group of the Health Professions Council. As she said, the process towards regulation is well advanced, and that will introduce a required standard of training for entry to the statutory register. The situation, therefore, will improve, but regulation will not help to fund that training; it will remain self-funded.
The Acting Chairperson:
No other member has indicated that they want to comment or ask a question. We have agreed that the Hansard report will be sent to the Minister and his officials. When we have received a response on the queries that have been raised, we will be back in touch. Perhaps we will continue the consultation process with you. On behalf of the Committee, thank you very much.
Ms Bell:
Please make use of us.
The Acting Chairperson:
Do not be saying that; there are not enough hours in the day.