Will new-age psychologists meet the demand for rising mental health challenges?

In the second week of June the Rehabilitation Council of India RCI that governs the field of rehabilitative psychology announced a set of regulations for a BSc in Clinical Psychology programme which has not caused as much uproar as it shouldAimed to address the shortage of trained mental professionals in mental health care the course truncates the education a professional needs to become a clinical psychologist Right now the education path is a BA in Psychology then an MA in the same to become a counselling psychologist Add to this an MPhil in Clinical Psychology and you can call yourself a clinical psychologist On paper you need this from an RCIregistered institute Shrinking these eight plus years of theory and supervised work with patients in some cases of MPhil and MA to four years of BSc to fill in a gap access to mental health care may generate quantity but strain qualityldquoIncreasing mental health institutes and specialists workforcerdquo said the notice ldquothough has met the needs of those with acute and severe mental illness 4537 of the total mental morbidity the available trained professionals are insufficient to meet the high demands of mental health care of minor illnesses which account for 83 per cent of the total mental morbidityhelliprdquoGuftagu and Leherrsquos drum circle for queer people in Vashi The most compelling argument against a BSc Psych is that a therapist needs to place a patient in their socioeconomiccultural realities of community gender sexuality and political climateTo mental health professionals so much of this move the thought process behind it and the fact that a body set up to solely regulate programmes for rehabilitative measures is gatekeeping the doorways to the field and deciding who is a therapist and who isnrsquot isdeeply problematicThe RCI is an apex body under the Ministry of Social Justice and Empowerment and the Department of Empowerment of Persons with Disabilities While there is an overlap between mental health and rehabilitation because a patient of schizophrenia may need institutional care it should be the role of the Ministry of Education to take a call on shifting a discipline from Science to Arts and to detail the curriculum within it for the whole field of psychologyThe first layer to unwrap is that all over the world psychology is part of Humanities or Arts an interdisciplinary study While treating a patient authentically the therapist will have to place them in a context of their socioeconomic background age physiology community gender construct sexuality current political or cultural climate while detangling personality disorders past traumas and attachment issues A broader education in anthropology or sociology would support the therapist more than Physics or ChemistrySadaf Vidha Divija Bhasin and Rupa Chaubal PicShadab KhanAnd of course there is the matter of empathy and stress on emotional intelligence Which is not to say a student of science will lack these but to offer the course solely to these students narrows the entry pathway and excludes those with an aptitude and preference for ArtsHumanities And thus lowers the number of therapists who will eventually help and the quality of education and handson expertise they have to support themldquoThe RCI is a national body for registrationrdquo says Dr Lata Das ldquoand on paper itrsquos a good vocational course but rigid boundaries of only 30 seats for those with a Plus Two in Science will not helprdquo Das is a faculty at the Centre for Lifelong Learning School of Social work at Tata Institute of Social Sciences TISS and her view comes from 20 years of experience For vocational courses she says several reputed institutes such as TISS have various diplomas in psychology that can supplement the skills of an existing profession in a field like teaching or facilitate a midcareer change And such programmes will help tackle mental health at systemic levelldquoNowhere in the world is there a mandatory expectation to be a science student to study psychologyrdquo says New Delhibased who was among the first to flag off the RCI move on social mediaWhen we speak to the founder of the mental health organisation The Friendly Couch she requests that we be careful in calling her a psychologist counselling psychologist or psychotherapist and not a coach or clinical psychologist She has a BA in Psychology from Delhirsquos Ambedkar University an MSc in Applied Clinical Psychology from the University of Bath UK and an MA in Clinical Psychology from Amity University NoidaThere is a crucial difference pertinent to the debate at hand and why RCIrsquos move is welcome to regulate the very chaotic field ldquoRCI governs all of psychology and decides who is a therapist and who isnrsquotrdquo says Sadaf Vidha founder Guftagu Therapy in Vashi ldquoYou can call yourself a clinical psychologist only if you do an RCIregistered MPhil just a Masters is not enough Most ethical practitioners have a Masters in either Clinical or Counselling PsychologyrdquoHowever the government has not neatly categorised these As per the Mental Healthcare Act of 2017 one needs to be an MPhil registered clinical psychologist to work with patients However the National Commission for Allied and Healthcare Professions Act 2021 recognises the Masters in Counselling or clinical degree and other people like Artsbased therapists or psychologists and coachesBut all the players in this ecosystem need not be at odds with each other In fact categorising the severity of cases can fill the treatment gap says Vidha A clinical psychologist deals with mental illnesses while a counselling psychologist concerns herself with a more holistic worldview such as a relationship crisis that may also include a mental illnessWe live in enlightened times Never before has there been so much talk about mental health and openness to therapy to improve interpersonal relationships deal with daytoday stress heal from trauma address attachment issues and become whole as well as for personal growth and achieving onersquos potential In this landscape help cannot come from professionals who only know the names of disorders or of the Five Signs That You Are a NarcissistldquoIndia needs preventive and promotive work in Mental Health Sciencesrdquo says Das speaking as an educationist and not representing her institute ldquoRCIrsquos circular says the students will receive lsquoadequatersquo skills but thatrsquos not an adequate explanation Each specific skill and the outcomes for students at each level need to be spelt out since the RCI circular mentions that the programme is based on National Education Policy and National Higher Education Qualifications Framework NHEQF Level 6 as per UGC guidelines The fundamental premise underlying the NHEQF is that higher education qualifications such as certificate diploma and degree are awarded based on the demonstrated achievement of learning outcomes and academic standards expected from graduatesrdquo These could mean competitive skillsets to map out a case and its programmeldquoSay 100 people need therapy only 10 get itrdquo says Vidha a therapist and researcher who specialises in relational psychoanalysis for childhood and attachment trauma ldquoThe solution doesnrsquot lie in diluting the current study expectation We need a layered approach to address various groups of people based on severitymdashcounsellers with diplomas and certificates can be first responders or helpline counsellors then come those with a Masters degree and then the ones with MPhils Doctor of Psychology PsyD or PhDsrdquo A PsyD degree focuses more on handson clinical training along with research preparing students for field careersBhasin and Vidha also emphasise the need for licensing and an ethics board where malpractice can be reported ldquoOut there are coaches with a certificate or a counselling diploma taking on serious cases which is leading to a lot of malpracticerdquo says Vidha ldquoThey even offer conversion therapy for queer and trans people which is horrifyingrdquoThere is an effort by the body called the Psychologists Collective to form the Psychology Council of India They have petitioned the government to remove RCI from governing psychologists and form a body comprising psychologists to regulate degrees educational experience and work experience in the profession Rupa Chaubal its president says ldquoThe stakeholders were not given a chance to voice their opinion consent or objections before deciding upon the qualifications for the title of a Clinical Psychologistrdquo One option is a fouryear nested programme after BScBA Psychology to get a PsyD It can have exit points that prepare the professional to work at different levels ldquoIf you finish the first yearrdquo suggests Vidha a participating member of the Psychologists Collective ldquoyou get a professional diploma Two more years gives you another degree in four years you earn a PsyDrdquoThis will also accommodate the skills needed for a working professional Currently even some Masters degrees do not equip therapists with process skills supervised onfield sessions long term therapy plans and an understanding of ethics Many do not have a supervised internship programme A student of BSc Psych would be even less supported if her combination subjects are Physics and Botany as opposed to an Art studentrsquos Sociology and Political ScienceldquoInternationallyrdquo explains Chaubal ldquoClinical Psychology follows a biopsychosocial model The suggested curriculum of BPsy MPsy as well as PsyD strongly relies on the medical model Clinical psychology needs a psychosocial foundation it cannot be in the stronghold of a biomedical model You are not treating only the mind of the person you need to know where that person is her realities and be able to tailor the interventions accordinglyrdquoldquoPeople need to learn a lot that education does not prepare them forrdquo says Vidha ldquoAnd a BSc in Clinical Psychology will not help the case It will have little to no practical counselling skills and will not cover micro skills about the therapeutic relationshiprdquoCurrently it is not mandatory for counselling psychologists to work during their Masterrsquos degree Only some colleges offer internships with supervised counselling sessions The same goes for the MPhil degree even though all the colleges offering it come under the RCIChaubal points out that Maharashtra did not have an RCI institute until Amity University came up in 2014 and it had eight seats Even now there are very few RCIrecognised institutions from where the RCI degree courses can be pursuedChaubal says this little technicality looms over veterans in the field who feel like they are practising illegally ldquoWe may have PhDs guided them worked in reputed government organisations such as Nagpur AIIMs or have over 35 years of experience but face bullying on social media where someone will say we cannot call ourselves clinical psychologists because we donrsquot have an RCI registrationrdquo Chaubal for instance has an MA in Counselling Pscyhology from Mumbai University an MA in Clinical Psychology from SNDT and an MPhil from Tiss in Couselling and Clinical Practice and 22 years of practice experience Dr Das has a PhD from TISSldquoThe essence of the new regulation is helpful because it makes placement mandatory during the degreerdquo says Bhasin ldquoThis new course will help fill that gap although it is not ideal as the RCI is not solely for psychologistsrdquoPerhaps the RCI has thought this through but there are no details available They are yet to respond to a legal notice sent by The Psychologists CollectiveldquoThere is little to no transparencyrdquo says Bhasin ldquoNo information is given about who makes the decisions and they do not answer questions on mail If any psychologist or psychology student has a question they are left with no answersrdquoHer vote is also to an independent government level body made up of practising psychologists ldquoThere should be a license system the RCI system is a registrationrdquo she says ldquoWhich means all psychologists must adhere to a set of rules and ethics Currently anyone can work as a psychologist without consequences without ever having studied psychology and there are no consequencesrdquo You can coin yourself a therapist with a certificate in a supplementary modality such as inner child healing past life regression or shadow workBut trauma cannot be divided so neatly ldquoSomebody who comes to you for marital problems may have history of child sexual abuse a personality disorder attachment problemsrdquo says Vidha ldquoAll of that influences marital problems So the distinction that if you are working with rehabilitative populations then you need an MPhil and if you are doing counselling you just need a BSc is ethically incorrectrdquoA concern among practising educationists and professionals such as Dr Das and Chaubal is how the regulation will fit retrospectively And what are the prospects of those from other pathways to get into international programmes and education institutes given that RCI is a government limb jobs and opportunities such as being on decisionmaking committees may tilt towards RCIdominant trainersThen therersquos a Recognition of Prior Learning metric that takes into account formal and informal learning Credit points or years of practise that put professionals on par with those churned by a change in education pathway ldquoWhat about employabilityrdquo asks Dr Das ldquoWill other candidates be eligible for a job as much as a BSc Psy studentldquoIf the RCI registers BSc Clinical Psychology graduates as Counseling psychologists how does one license such a candidate How can the training equip a candidate to work as a counseling psychologistrdquo are Chaubalrsquos questions Underlining this decision is that RCI seems to think that counselling doesnrsquot need as many skills The best course may be that it only regulates psychologists in rehabilitative fieldAt the time of going to print the RCI had not responded to middayrsquos questions