Question for Short Debate (Lords) on Mental Health: Unregulated Treatment - Mar 2

Asked by

Baroness Jolly

To ask Her Majesty’s Government what assessment they have made of the impact of treatment by unregulated and unregistered persons offering psychotherapy or counselling services upon the mental health and wellbeing of their clients.

Baroness Jolly (LD)

My Lords, I thank my noble friend Lord Marks for bringing this issue to my attention and for introducing me to someone whose family had been turned upside down as a result of the “treatment” of a member of it—I have used inverted commas, as it is was not treatment recognised as such by any professional body. I am also grateful to noble Lords who will speak in this debate, bringing both professional and personal experience. I hope that the Minister or one of his colleagues will be able to meet me and the family member to understand to some extent the harms that came from unregulated counselling.

I want to touch on what it takes to be a professional counsellor; the importance of registration, regulation and protected terms; online and face-to-face counselling, and the research about harms done to individuals by unregulated counsellors. Of course, I will expect the Minister to clarify the role of the NHS in the world of counselling.

The terms “counsellor” and “therapist” are not protected. All of us could call ourselves such. While the number of unregistered therapists is low, the expectation is that clients or patients working with unregistered counsellors and psychotherapists are more vulnerable to the possibility of harm. This is because they have no assurance of the level of training or competence of the practitioner nor a redress system to access should something go wrong. A register of qualified counsellors is held by the Health and Care Professions Council, and I would not wish there to be any confusion between these perfectly legitimate individuals and others who are not. The register protects the public from the harm that could be caused by people practising in a profession when they are not qualified.

Let me be clear: it takes many years to train to be a psychiatrist. One has to qualify as a doctor, undergo the extra qualification in psychiatry and then work under supervision until ready to practise. Training as a psychotherapist takes 400 hours over several years and, in most cases, this is paid for by the individual, as are their own therapy sessions which are a prerequisite for qualification. Counsellors have a shorter timescale but, typically, they would have a relevant degree and then several years in training before they qualify. They can work in both the NHS and the private sector.

If they are not on the register, they are not qualified. If they are using one of the terms on the register to describe what they do, without qualification, they are breaking the law. Article 39(1) of the Health Professions Order 2001 makes it a criminal offence for a person, with intent to deceive—whether clearly or by implication—to say that they are on the register of the Health and Care Professions Council, or use a designated title to which they are not entitled, or say falsely that they have qualifications in a profession regulated by the HCPC. In times past, they would just have been called quacks.

To demonstrate how easy this is, a BBC journalist, Jordan Dunbar, recently obtained a counsellor qualification certificate online for the price of £12.99—the cost of a session in a 24-hour gym or a wind-proof umbrella. At present, it is up to patients to make sure that counsellors are qualified and registered with an accredited body. The onus is on the patient, not the provider. A well mocked-up certificate, accompanied by a brass plaque, offers confidence to an anxious and vulnerable member of the public looking for someone to share their confidence with. However, practitioners interact with people at some of the most distressing times in their lives, leaving them vulnerable or worse. Research has shown that fewer than two-thirds of patients are aware of whether their therapist is a member of a professional body.

Many people who use private services do so because the NHS service is hard to access and there is a waiting time. A quick look at the NHS website does not mention waits and these may be quite short if access is via your GP. The NHS website also has an online assessment tool called “Mood self-assessment” which takes a very top-line look at depression and anxiety and makes sensible recommendations based on the results. I used it this morning; it was time not terribly well spent. The NHS Long Term Plan promises to

“deliver the fastest expansion in mental health services in the NHS’s history, with thousands more adults being able to access talking therapies for common disorders and better support being off ered to children and young people.”

When he sums up, will the Minister tell the House where the progress is with this ambitious claim since the publication of the NHS Long Term Plan?

This issue is only becoming more urgent. Waiting lists for non-primary care NHS mental health services are long, and patients are turning to private healthcare solutions which are less likely to be affiliated to voluntary regulators. Also becoming more common are online treatments, where there is little accountability for any harms caused, making it easier than ever for patients to be exploited. Online counselling is a different matter altogether, as there are no boundaries. Mobile phone apps abound to increase well-being, gain confidence and sort personal problems. But there is not a lot of research on this. We know there is no regulation, no way of knowing where the site is based, or the qualifications of the counsellor, or a guarantee that you will be connected to the same person each time. The risk is real. Without protecting these terms, we leave the profession open to abuse by those who practise pseudoscientific therapies with the outcome of doing harm to their clients.

It is vital that the Government assess the impact of these harms. I have been contacted by individuals whose stories, although anecdotal, paint a picture of a real risk to their mental health and safety. The stories are extremely distressing. They tell the tale of vulnerable people putting their trust in therapists only to be exploited and isolated from their loved ones. It is no exaggeration to say that lives have been ruined. It is essential that these harms are documented so that we can find solutions. One possible solution, which I favour, is statutory regulation. This has been debated before in this House, largely driven by my noble friend Lord Alderdice. Unfortunately, the issue has been pushed off the agenda in recent years, but now is the time to revisit it. The Government have previously stated that statutory regulation may be introduced if harms to the public can be demonstrated and this risk cannot be addressed through other means. Will the Minister give some indication of what the department might do to help with the issue of assessment of harms?

Patients say that reporting harms through voluntary regulatory bodies can be an arduous process. This has been demonstrated in cases such as that of Patrick Strud. His therapist subjected him to so-called conversion therapy. Mr Strud had to wait two years for the BACP to withdraw her membership. The Government have indicated that they will outlaw conversion therapy. We all need to be comfortable with the way we are, and not feel that we are different. I hope that the Minister agrees that even one such case is too many and that our current system needs updating. When will the Government take action on those therapists who offer these services?

The most concerning issue is that, even if these regulatory bodies strike off a practitioner for misconduct, there is no legal requirement for that individual to stop practising. This includes those who are struck off for very serious allegations, including serious sexual misconduct. When I agreed to table this Question for Short Debate, I was surprised at the number of people who wrote to me with tales of family members who had been harmed through counselling, not helped or healed in the process. Although voluntary registers, such as the BACP and the UK Council for Psychotherapy, provide some safeguards, they are not enough, and they say that they would welcome regulation.

Given the experience and interest of all noble Lords, I am sure we are in for an excellent debate.

Lord Parkinson of Whitley Bay (Con)

My Lords, as this is a time-limited debate with a dozen speakers, I remind the House of the three-minute speech limit.

7.46 pm

Lord Giddens (Lab)

My Lords, I congratulate the noble Baroness, Lady Jolly, on introducing this debate so ably. We live in a world of dazzling change, in which the digital revolution and AI are among the major driving forces transforming our lives. This is new territory for all of us, but children and young adults are especially on the front line. The online world is almost wholly unregulated. Many traditional pathologies, such as addiction, appear in new forms. According to NHS estimates, 75% of people in England experiencing mental health problems get no treatment at all. It is not surprising, therefore, that the internet is awash with, in the words of the Question, “unregulated and unregistered persons” offering treatment for mental disorders, including in the shape of a swarm of apps offering counselling and therapy. Almost all of this is without any backup from registered healthcare professionals. Will the Minister update the House on the progress of the NHS’s Moodzone, which contains a directory of approved mental health apps? However, there is surely a need for a much more comprehensive strategy to deal with this new Wild West frontier.

The issues here for mental health are far-reaching indeed, since it is hard for any national Government to stamp their authority on the use of data that are in a large part global. Young people today spend a high proportion of their life online. Digital addiction is a huge issue in itself, with largely unknown consequences, since no previous generation has grown up in such a context. Have the Government set up any research projects on how to cope with its likely longer-term impact and its pathologies?

It is good to see that the Government are seeking at least to grapple with these issues, both in the context of the NHS and more widely. They have announced plans to upgrade the ways in which health apps and other digital technologies are reviewed and monitored by the NHS. To do so, it is said, Ministers are working with the digital corporations to try to establish proper standards of scrutiny and transparency—daunting though that is, given the speed with which the digital world Is evolving. A new digital health technology standard is being developed.

It is clear from ongoing research in this country, in the US and elsewhere that the selective use of Al could make a major contribution to diagnostics, which would mesh with the reforms that I believe are needed. As my final minute elapses, will the Minister say whether the Alan Turing Institute is at the forefront of such research?

7.50 pm

Lord Astor of Hever (Con)

My Lords, I have seen at first hand the devastating effect on a family whose lives have been turned upside down as they see a loved one being exploited and isolated from them by a bogus therapist, so I am delighted to support the noble Baroness, Lady Jolly. She has said everything that I would wish to have said and asked the questions that I would have asked.

I will make one further point: Section 76 of the Serious Crime Act covers domestic abuse. The Government accept that individuals can be coercively controlled, and they have rightly made it illegal for a spouse, partner or parent to coercively control somebody with whom they have a relationship—that is an imprisonable offence. However, in the case of coercive control, the law does not apply equally to everyone. A person coercively controlling their daughter would be breaking the law, but the same person coercively controlling someone else’s daughter is not covered by the law. There does appear to be a gap in the law, so will the Government look into this?

The noble Baroness, Lady Jolly, made the point that the terms “counsellor” and “therapist” are not protected—all of us could call ourselves such. I have been sent a list setting out some of the differences between healthy therapy with a trained professional and unhealthy therapy with an untrained person. A trained professional therapist is accountable and does not hide behind fronts, whereas an untrained person is not. Their qualifications are recognised by an outside body, whereas an untrained person is often self-appointed and usually hides behind fronts. Healthy therapy rehabilitates and is for the benefit of the client; unhealthy therapy debilitates and is often for the benefit of the therapist. A healthy therapist’s objectives are agreed with the client, as opposed to being the therapist’s own goals; they promote healthy relationships with others, as opposed to fostering alienation from others. A healthy therapist will aim for the independence of the client, as opposed to their dependence, and will psychologically enable the client and not disable him or her. In healthy therapy, questioning is encouraged, whereas a bogus therapist will discourage it.

The noble Baroness has raised a really important issue. 1 look forward to hearing the Minister’s ideas on how vulnerable people can be protected from unregistered and often very dangerous quack therapists.

7.53 pm

Lord Macpherson of Earlâ