SectionsOIA Reveals MOH's Decision to Exclude Counsellors as HIPs Mental Wellbeing is a Crucial Component of Workplace Health and Safety Understanding the Culture: Counselling that is Practical Standing Up for the Country's Counsellors Gumboot Fund's Saga Demonstrates the Need for Appropriate Counsellor Funding
Counselling Aotearoa December 2019
OIA Reveals MOH's Decision to Exclude Counsellors as HIPs
An Official Information Act request reveals the Ministry of Health’s decision to exclude NZAC registered counsellors as Health Improvement Practitioners (HIPs), despite their enhanced quality assurance programme and ongoing professional development requirements.
The OIA request followed concerns regarding the $455 million investment over four years for a new universal frontline mental health and addiction service.
That funding would see up to 12,000 more people receiving mental health training over the next four years, 8,000 places created on the Mental Health and Addiction 101 programmes, and new training programmes for health coaches and HIPs developed.
However, the Association was concerned about the role, or lack thereof, counsellors would play in this investment.
As such, information was sought pertaining to:
- The decision to select as Health Improvement Practitioners (HIPs) only registered health professionals under the Health Practitioners Competency Assurance Act, or recognised as health professionals under the Substance Addiction Compulsory Assessment and Treatment Act.
- The decision to exclude as HIPs properly trained, qualified and experienced counsellors who are registered with the NZ Association of Counsellors.
Deputy Director-General of Mental Health and Addiction, Robyn Shearer, said in her response that the decision to: “specify that Health Improvement Practitioners (HIPs) are registered under the Health Practitioners Competency Assurance Act 2003 (HPCA Act) was made to distinguish clinical roles for registered health professionals from Health Coach and Nongovernmental Organisation (NGO) support worker roles for the unregistered workforce.
“The decision was necessary during the initial phase of establishing these roles to ensure that clinicians working as HIPs are subject to provisions under the HPCA Act.
“These provisions include the way in which HIPs are registered, the process for complaints and how professional competence is maintained and assessed. This decision will be reviewed in the future once the HIP role becomes established and findings are evaluated.”
But NZAC President, Christine Macfarlane, says excluding counsellors registered with NZAC is playing fast and loose with New Zealanders’ mental health.
“There is already a well-qualified, experienced and professional mental health workforce in New Zealand, including nearly 3,000 counsellors who are registered with NZAC.
“The huge problem is this workforce is woefully underfunded which creates major inequities in the provision of mental health care.
“What we really need is more funding for subsidised or free access to competent mental health therapy services, whether they be provided by qualified counsellors or other mental health professionals.”
Mental Wellbeing is a Crucial Component of Workplace Health and Safety
Deteriorating mental health, often coupled with alcohol addiction, can be costly – not just personally, but for the economy, too.
For example, mental health issues are costing the Australian economy between $43 billion to $51bn per year, according to a draft paper by the Government’s Productivity Commission.
The Mental Health, Draft Report revealed an approximate $130bn additional cost is created by diminished health and reduced life expectancy for the one in five Australians living with psychological conditions.
It’s a similar story here in New Zealand, says NZAC provisional member Shantraj Bethel who investigated the systems to counteract the country’s workplace mental health issues.
While there are complexities around defining a mentally healthy workplace, recognising risk factors and stressors that can impact mental health in the workplace is a critical step to addressing it.
In a recent survey of 1,001 small business owners – conducted by cloud accounting firm Xero with the Mental Health Foundation – found that 39 per cent were so busy running their businesses that they didn’t have time to think about their mental health.
Furthermore, 40 per cent didn’t feel responsible for their staff’s wellbeing, one in five employers provided support such as counselling and budgeting advice, and only one third of employers felt staff would benefit from improved wellbeing.
Comparatively, 78 per cent of respondents said they allowed time off or flexible hours to deal with personal issues.
One such method to addressing these issues, Mr Bethel says, should be the shared responsibility of the counselling profession and its Association to seek conversations with industry leaders.
“The ‘it’s okay’ message about seeking mental health support has been strongly heard these past few years, and decisionmakers seem to be acting. But there is still a lot of work to be done in order to normalise seeking help for one’s mental health.
“Reducing the stigma and increasing accessibility to mental health practitioners in all walks of life is crucial to addressing our mental health problems.
“Alongside those themes, however, is the need for open and honest conversations between the counselling and mental health profession and industry leaders.”
Mr Bethel says that dialogue would go a long way to identifying and meeting employers’ and employees’ mental health needs.
The other side of that equation is having effective Occupational Health and Safety Management Systems (OHSMS).
In a paper submitted as part of his NZ Diploma in Workplace Health and Safety, Mr Bethel found that the construction industry is profoundly affected by worrying mental health and alcohol addictions.
“It not only affects the individuals working in the industry, but also their families, the industry’s productivity, quality and reputation,” he says.
“Unfortunately, there is strong reluctance to acknowledge and address the mental health and alcohol abuse issues in New Zealand men. Consequently, the suicide rates are the highest in New Zealand’s construction industry.
“Implementing the effective OHSMS should reduce the burden of mental health and alcohol abuse on the constructions industry, because it improves the mental health and alcohol abuse prevention outcomes.
“This would in turn improve recruitment, retention, productivity, staff satisfaction and reduce absenteeism. Consequently, this would help in keep employment costs down; improve staff and client satisfaction; and reduce underperformance.”
Understanding the Culture: Counselling that is Practical
In the last of a new six-part series that explores the future of New Zealand’s counselling profession, former NZ Association of Counsellors President, Jonathan Loan, discusses what role the Association can play in engaging some of the country’s most reluctant to seek help.
Counsellors of men or farmers in rural communities don’t conjure the same images as those advertised on tv by insurance companies and property brokers.
Those adverts show someone, who normally wears a suit and tie, donning Red Band gumboots and a Swanndri to talk about policies or interested buyers with farmers.
Counsellors aren’t seen to be like that, for a number of reasons, former NZAC President, Jonathan Loan, says.
However, the best advertisement for men’s mental health and those living in rural and isolated communities are the personal stories of those who seek help for their mental wellbeing issues.
Such accounts have had some of the most positive effects on the normalisation of reaching out for help than anything else Jonathan says he has seen in his 25-year counselling career.
Part of that reason is because counsellors are often seen as a “foreign breed”, he says.
“And they’re often perceived as a city thing. Additionally, if you’re not part of that community, you’re not necessarily trusted or seen as somebody who plays a role within that community.
“But I think the sharing of those stories has been positive because people see that there are other people who are experiencing what they’re going through, too.”
Working with a lot of male clients, Jonathan sees a fair degree of reluctance in them seeking out a counsellor – they’re more likely to be referred by a GP or through the Family Court.
Or they wait until their circumstances have become unbearable, he says.
“Because seeing a counsellor is seen as a solution to a problem rather than a self-improvement, or self-discovery exercise.
“This is a generalisation, but I think it’s not uncommon to seek help only when you really need to. Many men will only see a doctor, for example, when they’re bed ridden. In rural communities, you’ve got to be fairly unwell before you seek help or before you recognise you need some form of help.”
This is where Jonathan believes the counselling profession and the Association have a responsibility to continue educating and raising awareness of the benefits of counsellors and mental health support.
Before reducing stigma in those communities which are reluctant to ask for help, the counselling profession needs to be trusted.
“There needs to be more education around who counsellors are, what they do and why the idea of a mental and emotional health warrant of fitness is a good one.
“Not only that but education around when a good time is to talk to someone, and how can one begin that process before the problem becomes nearly insurmountable.”
And that means the Association might need to better understand those who need help, but are unwilling to ask for it, Jonathan says.
“I think a lot of people, particularly men, and rural people as well, like to see something that is practical and has some sort of immediate benefit, because you only have a brief window.
“So, if you can present something that is immediately useful, then you’re more likely to engage in a long-term counselling relationship, or a longer-term relationship. For many men and probably for farmers, the brief intervention stuff is probably going to be more accessible and seen as more useful.
“With men, you’re talking about people who like to solve stuff – the counter to that is, when you become depressed, it’s something that can’t be solved immediately, but finding some sort of first step towards that can be really helpful.
“So, counsellors need to present things that are quite practical. And if you are able to connect and understand the culture – for this instance, the male culture – you’re more likely to be seen as someone who people can connect with and be seen as somebody who is useful and trusted.”
Standing Up for the Country's Counsellors
Demand for mental health support is escalating yet help appears increasingly hard to come by.
Compounding the problem, especially in the Christchurch District Health Board catchment area, was the partial strike action that saw about 600 psychologists, members of the Apex Union, restrict their face-to-face contact with patients to two hours a day throughout October.
The union’s Psychology division secretary, Annmaree Kingi, denounced people who are not psychologists in a Stuff article; stating psychologists could not be replaced by less qualified workers.
“The misconception is that you can train other mental health workers to do our job. It doesn't help, you need to be very qualified to deal with these things,” Kingi said.
“You need psychologists for these people, we are the ones who are trained for that. These people will not get the necessary help from a month-long mental health course, but that's what the government thinks they can do,” she said.
However, Counsellors Association president, Christine Macfarlane, is concerned with her comments, and its impact it may have on the perception of counsellors.
“We acknowledge the specialist services psychologists provide in the mental health sector, and agree your expertise and experience is invaluable. We also endorse the need for the government to further fund the access to therapeutic services for people who are experiencing trauma, increased distress and deteriorating mental health conditions.
“However, I’d like to point out that NZAC counsellors are also specialists in providing therapy for people with mental health problems and trauma, and have many years of experience in working in a variety of sectors.”
NZAC counsellors are required to have a minimum Bachelor of Counselling or Master of Counselling qualification, as well as completing a vigorous membership process for entry into the Association.
Additionally, its members are audited as part of the Association’s continuing professional development programme.
“The members of our respective professions are eminently qualified and well-placed to address the serious mental and emotional wellness issues affecting far too many New Zealanders.
“Our concern, which I think you share, is that this government does not always seem to recognise that, apparently preferring instead to invest in developing a new mental health workforce that may not be as qualified as our members or yours.
“That, we believe, is the real issue that should be addressed on behalf of New Zealanders who do suffer from mental health issues and who do need properly qualified support.”
Christine wrote to Ms Kingi, expressing her concerns and seeking a meeting to share mutual matters, and how they might address them together.
Gumboot Fund's Saga Demonstrates the Need for Appropriate Counsellor Funding
The abruptness with which the Gumboot Fund ran out of money shows, once again, the necessity for suitable funding of counselling, the Association of Counsellors say.
Association president, Christine Macfarlane, says that if appropriate resources aren’t granted, then New Zealand’s mental wellbeing will continue to be put at risk.
Her comments follow media reports of hundreds of young people being left in the lurch after the Gumboot Fund abruptly ran out of money in September, putting their treatment programmes on hold.
The issue was compounded by the November claims of Mike King, Gumboot Friday’s frontman, that the Ministry of Health refused a request for a financial top up for youth counselling charity.
The fund was launched by Mike King’s I Am Hope charity in April 2019, after a Facebook campaign and Gumboot Friday event collectively raised $1.3 million.
It is understood that some counsellors are continuing to see their clients for free, in a bid to avoid “serious clinical ramifications” before the next major funding top up in six months.
However, Ms Macfarlane says this saga proves that funding counsellors is hugely vital, especially in the face of ever-increasing demand for mental health support.
While she says the Coalition Government is making the right noises regarding mental wellbeing policies, more urgent action is needed to ensure that the right resources are in the right places now.
Mental health nurses in schools, mental health nurse practitioners in emergency departments, or primary health care while better than nothing, Christine says, are not appropriate for the level of mental health needs New Zealanders require.
Counselling, also known as Talking Therapy, is a very much under-resourced area of funding.
“Fortunately, there is already a large and well-trained resource ready to be utilised – counsellors.
Our profession has a tried and true workforce – with Association members numbering at about 3,000 – all of whom operate in a myriad of areas; from schools and prisons, to communities and NGO’s.
“We’ve set in place an enhanced quality assurance programme that has a minimum of Bachelor education, as well as ongoing professional development requirements, so the public can have confidence in using NZAC members’ services for the benefit of their wellbeing.”