Scope of Practice: CPF Statement

Clinical Psychology and other categories of psychologists as well as psychometrists and registered counsellors

Introduction

The Clinical Psychology Forum (CPF) wishes to inform its members of the following very important announcement regarding the scope of practice by the HPCSA and the Professional Board for Psychology (PBP). The CPF also wants to thank the PBP for issuing the communiqué as this is finalising the matter regarding SOP for psychology practitioners and should enable psychology practitioners, the health industry, the public at large and the media to differentiate and better understand the scope of practice of psychology practitioners. It creates more certainty for the future as well as supporting a vision for psychology practitioners when applying their skills and knowledge. Psychology practitioners play a critical role in the promotion and management of mental health as well as development of resilience to cope with life in general in various spheres. The CPF is supportive of outcomes based service delivery by psychology practitioners and urges its members to embrace the SOP for clinical psychology as announced by the PBP to guide them in their practice.

From the Health Professions Act  56 of 1974, its regulations, notices and rules, practitioners registered under the Health professions Act 56 of 1974, must follow and obey such as well as announcements, notices, letters and communication from the Professional Boards. In the case of psychology this would be the Professional Board for Psychology. Thus the latest determination via the overview of scope of practice from the PBP stands and should be implemented by CPF members and other psychology practitioners as it applies.

Scope of Practice

The Health Professions Council and the Professional Board for Psychology have sent out a communiqué to psychology practitioners with the heading: OUTCOME OF THE REVIEW OF THE SCOPE OF PRACTICE BY THE PROFESSIONAL BOARD FOR PSYCHOLOGY on Friday 15 November 2019 indicating that an announcement regarding the matter of SOP has been issued. On Monday 18 November 2019 the Professional Board for Psychology followed the initial announcement with a short message service (sms) to psychology practitioners to again alert them of the announcement. The website links to relevant documentation was included in the sms: http://bit.ly/PSBPage and select Announcements.

The following documentation is provided under that link and details the Regulations Defining  the Scope of Practice for Psychology. Other documents provided are:

Gov Gazette on Regulations no 1169 – Minister of Health – 2019 0913

Regulations defining the scope of profession of psychology (R993 Sept 2019)

Board statement on scope review process undertaken

 

In addition the same link provides documentation on regulations around the commencement of community service for clinical psychologists

A link in the initial email delivered on 15th November 2019 also provides a link to the Minimum standards for the education and training of psychology practitioners.

Accompanying the announcement on the SOP is a letter dated 7 November 2019 from the Professional Board for Psychology, signed by the chairperson of the board, Prof BJ Pillay, with the same heading: OUTCOME OF THE REVIEW OF THE SCOPE OF PRACTICE BY THE PROFESSIONAL BOARD FOR PSYCHOLOGY

From the communiqué it is clear that to understand the SOP all of these documents should be read in conjunction with each other in order to know what the outcome of the review of the scope of practice by the PBP is.

The executive of the CPF with this letter wants to highlight information as communicated by the PBP to aid members in their understanding of the SOP.

The previous SOP regulations, (R704 of 2 September 2011), has fallen away because it was declared invalid by the Western Cape High Court in November 2016, based on procedural grounds.

Regulation 993 of 16 September 2008 (regulations defining the scope of the profession of psychology) remain in force as indicated by a notice on 13 September 2019, issued by the minister of health; Dr ZL Mkhize. From the working group document the following is indicated: “These regulations were intended to delineate and protect the various acts of psychology from unregistered persons, though are often incorrectly thought to define the ‘core competencies’ of all psychologists.” (Page 8).

These regulations are very broad and do not mean that all psychology practitioners – including psychometrists and registered counsellors – should have all these core competencies.

On page 17 and 18 of the Working Group document, it was noted that: “There is much confusion about the purpose of the 2008 Scope of the Profession Regulations. While many interpret these to define the core competencies of all psychologists, their primary purpose is intended to rather protect an unsuspecting public from unregistered people – who fall outside the regulatory purview of the Board – from performing psychological acts that have serious consequences, and which are statutorily reserved for the psychology profession. To avoid this confusion, the new regulations should ideally incorporate and align the scope of the professions of psychology and the regulations defining the scopes of practices of the different categories in psychology and the psychometrist and registered counsellor professions.”

Regarding Continuing Professional Development (CPD) the work group stated: “There is confusion about the purpose of Continuing professional Development (CPD). Viewed by some practitioners as a mechanism to acquire competencies in order to justify acting outside of one’s scope of practice, the actual purpose of CPD is to assist health professionals to maintain and acquire new and updated levels of knowledge, skills and ethical attitudes within their scopes of practice. Registration in any category is a matter of formal education and training and not CPD activities.” (Page 18 and 19)

The matter above talks to what is needed to get licensed (being registered) by the PBP to practice as a psychology practitioner, is formal education and training and as such education and training directly relates to the different categories of psychologists.

The Working Group document also mentions more than once that the different categories of psychologists remain relevant and should be maintained by the Board. Mention is also made of the possible new generalist category of psychologist in the future.

Due to the SOP regulations of 2 September 2011 being declared invalid by the Western Cape High Court, “The terms of the order have provided the Board a welcome opportunity to reconsider the regulations defining the different categories of psychology practitioners and the professions of registered counsellors and psychometrists…the Board had already for some years been working on a number of projects to inform the necessary revisions to the scopes of practice with a view to promulgating new regulations to ensure that the profession is better placed to serve the needs of the population of South Africa.” (Page 10, Working Group Document). The document describes in detail the process and investigations done as well as summarise the concerns of psychology practitioners. It is therefore critical that members should read the document to get the necessary background information regarding SOP for psychology practitioners.

The CPF has noted with concern the finding of the working group that: “In general, practitioners, associations and internship sites expressed a poor understanding of the scope and training of other categories.” In this regard, the executive wishes to encourage and urge members to become au fait with the documents regarding the SOP, also of other categories of psychologists, psychometrists and registered counsellors.

The letter dated 7 November 2019 from the PBP states: “Practitioners are still required to perform any psychological act and practice according to the specific category or level of qualification in which they are registered. Rule 21 of the Ethical Rules of Conduct for Practitioners registered under the Health Professions Act 56 of 1974 is used by practitioners to guide their professional acts in accordance with the education and training standards and competencies as contained in the Minimum Standards for the Education and Training of the different categories of psychological practitioners, which are reflected on the Website of the Board.

Thus practitioners should consult the booklets published in February 2019 (see the heading: “Policy and Guidelines” for links to relevant documents) detailing the minimum standards for the education and training for guidance regarding what the practitioner has been licensed by the PBP to practice. 

For our members the booklet on Minimum Standards for the Training of Clinical Psychology is of critical importance in this regard. On page 2 this document states: “In as much as there is common psychology practices that overlap, this competency document details the practitioner’s education and training and confines the scope specific to the category of Clinical Psychology. These competencies, as specified by Rule 21 of the Ethical Rules of Conduct for Practitioners Registered under the Health Professions Act 56 of 1974, confines the scope to areas of the profession to which clinical psychologists have knowledge, skills and experience to practice lawfully, safely and effectively, meeting specified standards.” It further indicates that accredited programmes in psychology should align with these specified education and training, competencies and skills and that joint teaching of different categories is not allowed to exceed 25 percent of the curriculum and time spent in the curriculum.

The document on minimum standards supplies the following definition of clinical psychology, that was also supported by the working group:

“Clinical psychology is a specialist category within professional psychology that provides continuing and comprehensive mental and behavioural healthcare to individuals and groups across the lifespan. This includes assessment, diagnosis, evaluation, and treatment of psychological and mental health disorders that range from mild to severe and complex. Psychological assessment, diagnosis and formulation are based on biological, social and psychological factors. Clinical psychologists deliver a range of high-intensity psychological interventions with demonstrated effectiveness in treating mental health disorders and psychological distress with medical conditions.

It further defines minimum standards for psychological assessment (including diagnosing a broad range of psychiatric disorders and psychological disorders), psychological interventions (in this regard it states interventions applied to people with psychiatric, medical and neuro-cognitive conditions), professional practice (practitioners should adhere to their scope of practice), research, policy development and programme design, training and supervision, ethics and legislation.

Thus the documents for minimum standards for the psychology practitioners of the different categories of psychologists, registered counsellors and psychometrists contain the legally and professionally appropriate (See Health Professions Act 56 of 1974 at the end of this document) required information that should be followed by practitioners in terms of their specific scope of practice.

Rule 21 of the ethical rules (Page 16 in the document on Ethical and professional Rules of the Health Professionals Council of South Africa) states:

Performance of professional acts:

    1. A practitioner shall perform, except in an emergency, only a professional act –

(a) for which he or she is adequately educated, trained and sufficiently experienced; and

(b) under proper conditions and in appropriate surroundings.

The other booklets detailing the minimum standards for the other psychology practitioners guiding these practitioners in terms of licensing and registration are important as the PBP (via the working group) has recommended that all psychology practitioners should inform themselves of all the documents that relate to the SOP of psychology practitioners so as to ensure that contexts of SOP is formed. These booklets follow the same format and sentiment as to what psychology practitioners should adhere to.

Regarding SOP the following are also of importance:

    1. “health profession” means any profession for which a professional board has been established in terms of section 15 and includes any category or group of persons provided for by such a board (Health Professions Act 56 of 1974 in the definitions section)
    2. “professional category” means the division or subdivision of a field in which any registered health profession may be practised; (Health Professions Act 56 of 1974 in the definitions section)
    3. “register”, when used as a noun, means a register kept in accordance with the provisions of this Act, and when used in relation to any registration category or a member of any such category of persons in respect of which a register is kept, means the register kept for that category; (Health Professions Act 56 of 1974 in the definitions section)
    4. “this Act” includes the regulations, rules and any proclamation or order issued or made under this Act; (Health Professions Act 56 of 1974 in the definitions section)
    5. “speciality”, in relation to a person registered in respect of any profession under this Act, means any particular discipline, division or subdivision of a profession which is recognised under this Act as a speciality in which such person specialises or intends to specialise; (Health Professions Act 56 of 1974 in the definitions section)

Further to the above, the following as stated under section 15 of the Health professions Act 56 of 1974, title: Objects of Professional Boards:

“(c) subject to legislation regulating health care providers and consistency with national policy determined by the Minister, to control and to exercise authority in respect of all matters affecting the education and training of persons in, and the manner of the exercise of the practices pursued in connection with, any health profession falling within the ambit of the professional board;

(d) to promote liaison in the field of the education and training contemplated in paragraph (c), both in the Republic and elsewhere, and to promote the standards of such education and training in the Republic;

(e) to make recommendations to the council to advise the Minister on any matter falling within the scope of this Act as it relates to any health profession falling within the ambit of the professional board in order to support the universal norms and values of such profession or professions, with greater emphasis on professional practice, democracy, transparency, equity, accessibility and community involvement;

(f) to make recommendations to the council and the Minister on matters of public importance acquired by the professional board in the course of the performance of its functions under this Act;

(g) to maintain and enhance the dignity of the relevant health profession and the integrity of the persons practising such profession; and;

(h) to guide the relevant health profession or professions and to protect the public”

Section 15B of the Health Professions Act 56 of 1974 states:

“(1) A professional board may –

(c) subject to prescribed conditions, approve training schools;

(d) consider any matter affecting any profession falling within the ambit of the professional board and make representations or take such action in connection therewith as the professional board deems advisable;

(e) upon application by any person, recognise any qualification held by him or her (whether such qualification has been obtained in the Republic or elsewhere) as being equal, either wholly or in part, to any prescribed qualification, whereupon such person shall, to the extent to which the qualification has so been recognised, be deemed to hold such prescribed qualification;

(f) after consultation with another professional board or boards, establish a joint standing committee or committees of the boards concerned; and

(g) perform such other functions as may be prescribed, and generally, do all such things as the professional board deems necessary or expedient to achieve the objects of this Act in relation to a profession falling within the ambit of the professional board.

(2) Any decision of a professional board relating to a matter falling entirely within its ambit shall not be subject to ratification by the council, and the council shall, for this purpose, determine whether a matter falls entirely within the ambit of a professional board.”

Under section II of the Health Professions Act 56 of 1974 it is abundantly clear that only formal education and training may be considered for licensing and registration of a professional under the act to practice his or her specified profession and/or category/speciality of such a profession:

“EDUCATION, TRAINING AND REGISTRATION

    1. Control over training

(1) Notwithstanding anything to the contrary in any other law contained but subject to the provisions of the Nursing Act, 1978 (Act No. 50 of 1978), no person or educational institution, excluding a university or a technikon, may offer or provide any training having as its object to qualify any person for the practising of any profession to which the provisions of this Act apply or for the carrying on of any other activity directed to the mental or physical examining of any person or to the diagnosis, treatment or prevention of any mental or physical defect, illness or deficiency in man, unless such training has been approved by the professional board concerned.”

From the Health Professions Act  56 of 1974, its regulations, notices and rules, practitioners registered under the Health professions Act 56 of 1974, must follow and obey such as well as announcements, notices, letters and communication from the Professional Boards, in the case of psychology this would be the Professional Board for Psychology. Thus the latest determination via the overview of scope of practice from the PBP stands and should be implemented by CPF members and other psychology practitioners as it applies.

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