Institute of Clinical Psychology (ICP) and Australian Clinical Psychology Association (ACPA) Position Paper in response to calls for the development of the role of Psychology Assistants within Australia’s mental health services.
This Position paper was prepared by Dr Marjorie Collins and Professor Caroline Hunt.
The high need for mental health care and the shortage of psychologists in Australia is a matter of concern and requires effective solutions. However, including Psychology Assistants in the mix of psychology practitioners would compromise the quality of mental health care provided. There is already confusion among the public and non-psychologist health professionals regarding the different types of psychology registration and the varying training pathways that can lead to registration. We argue that adding a further level of psychology practitioner, one which does not match current standards, would add to this confusion, as well as creating several negative outcomes. We also argue that there exist a range of solutions to the shortage of psychology services that sit within the current regulatory system that is in place to protect the Australian public.
It is likely that calls for the development of the role of Psychology Assistants within Australia’s mental health services has their origin in the role of the Psychology Assistant within the UK’s National Health Service (NHS). Graduates who have completed a degree in psychology are eligible to apply for a paid position as a Psychology Assistants within the NHS where they have a support role in a multidisciplinary team, conducting specified assessment or intervention activities, under the supervision of a registered psychologist who carries overall clinical responsibility for the work (see https://www.healthcareers.nhs.uk/exploreroles/psychological–therapies/roles/assistant–clinical–psychologist). A Psychology Assistant in the NHS is seen as a temporary and transitional role whereby an individual can gain experience before commencing training to become a registered psychologist. They operate like a research assistant, being paid a low wage to undertake simple and assisting work under direction. There was never any intention that they would meet a service need.
ACAP and ICP do not support the introduction of Psychology Assistants into the workforce in Australia particularly in the absence of a very carefully articulated scope of practice. There would need to be significant work required as to how psychology assistants would complement other mental health workers with similarly low levels of mental health training (e.g., peer workers, Positive Behaviour Support practitioners in NDIS). This ‘solution’ does not address the federal health department’s request for more psychologists who are “job ready” with shorter and clearer training pathways nor does it increase the public sector workforce. Psychology Assistants are not Psychologists.
Implementation issues in the Australian context
The proposal in the absence of a detailed scope of practice and clearly developed supervision model is dangerous from a public safety perspective given the low level of mental health training and appraisal of personal suitability to work with vulnerable groups. There is no regulatory system currently in place that ensures appropriate referral pathways, scope of practice, or oversight. Identifying an appropriate working and training environment poses a challenge. The Australian public sector, characterised by patient acuity, clinical governance requirements, and a shortage of psychology supervisors, appears unlikely to serve as an optimal workplace. Conversely, the private sector, which constitutes most of the Australian psychology workforce, lacks an appropriate funding system, clinical governance, or suitable work tasks. The PHN system, comprising intricate networks of very small, commissioned services, lacks both clinical governance structures, funding levers and adequate psychology supervisory resources. We understand that government favours the PHN system for the expansion of psychology services, but it would benefit far more from targeted psychology intern (student) placements and registrar positions.
The current psychology undergraduate course content, grounded in psychological science, is not geared to the development of appropriate skills. Opening avenues for Psychology Assistants requires the introduction of skills-based training and simulated practice in the undergraduate psychology curriculum via: i) more clinical and skills-based content; ii) earlier separation of Research and Professional/Applied pathways; and iii) supervision after graduation with a 3 or 4 year degree. The introduction of more applied units will increase costs to university programs in the form of additional supervision in skills development and put the concept of a liberal arts or science degree at risk. The undergraduate psychology degree is a critical generic base for further training a specialisation for careers in research and education as well as professional psychology. Any changes to the undergraduate curriculum would take many, many years to flow through, not only the governance processes of the PsyBA and APAC, but also to the first graduates of such new programs.
Unintended negative consequences
The limited availability of placements and supervisors is a very significant challenge in the field of psychology, and a contributor to the current training bottlenecks. If these resources are redirected towards supporting Psychology Assistants, there is a significant risk of reducing the number of available placements for trainee psychologists on the path to registration. This, in turn, could impact the number of graduating psychologists and potentially create further bottlenecks in the workforce.
Mental health care is complex, and patients seeking psychological therapy are often dealing with sensitive and challenging issues. Without the rigorous training and supervision required in the final stages of psychology training, there is an increased risk of inadequate assessments, incorrect diagnoses, and suboptimal treatment plans. Patient safety could be compromised, leading to harm to patients’ mental health and well-being.
With a significant increase in the mental health workforce, it would be difficult to ensure that all Psychology Assistants adhere to high professional standards, undergo regular supervision, and maintain ongoing professional development. This could lead to discrepancies in the quality of services provided and undermine public trust in the mental health system.
Furthermore, will insurance companies allow such people to practice when in fact they have not yet completed their requirements for full registration? Will a new registration category need to be established? Will employing agencies be required to provide indemnity insurance as well if Psychology Assistants are practising in a private practice setting?
Alternative solutions to grow the psychology workforce
There are alternative and simple solutions to quickly growing the psychology workforce, available within the current regulatory system, that will provide effective and safe psychology service and maintain training standards.
An alternate job-ready workforce is available now, is supervised, and would be a far more appropriate, and safe, prospect – that is, provisional psychologists. The most efficient solution is to increase places in postgraduate programs by increasing government support for the programs and for placement opportunities, one of the key limits on postgraduate training. It is well established that there is huge demand for all postgraduate psychology programs, and many who are worthy of entry do not get a place. This workforce is guaranteed to be job-ready in one to two years, has the capacity to work far more competently and independently, and will be working under the current regulatory system.
Another potential solution is to invest in retraining people with existing bachelor degrees from an non-psychology discipline. Many universities allow undergraduate psychology units of study to be completed in an accredited 1-year degree such as a graduate diploma. Therefore, within current regulatory structures an individual with a bachelor degree in another discipline can complete Level 1, 2, and 3 competencies in 3 to 3.5 years. This route does not compromise current standards, yet is currently underutilised. This route can more quickly graduate more work ready psychologists than the current 5 years required to train a high school graduate from scratch.
The current accreditation standards for psychology allow the development of 1-year programs that provide a bridge between general and speciality skills. The existing one-year courses for AoPE have already led to the development of new courses like the UNSW neuropsychology course and the University of Tasmania’s Education and Developmental course. These accredited “standalone” programs provide a bridging pathway between general registration and an AoPE while maintaining standards. As demand rises for “standalone” programs and the new government funding accelerates 5th and 6th year options, we are well-positioned for growth within the current system.
Another proposal is to pilot psychology clinics embedded within the PHN system. The program could accept university 5th and 6th year interns and provide no cost services to the public for short term group programs with individual therapy support as required. Alternatively, a PHN grant system allowing commissioned service providers to provide psychology supervision workforce programs could also work.
