Safety of mental health clients at risk if psychologists remain unregulated

SINGAPORE - There is growing concern among mental health professionals of risks to client safety if psychologists remain unregulated in Singapore. 

The current absence of regulatory oversight, along with breaches of confidentiality and professional misconduct when these occur, can erode public trust and endanger vulnerable individuals, Mr Adrian Toh, president of lead professional body Singapore Psychological Society (SPS), told The Straits Times.

SPS is currently in discussions with the Ministry of Health on the possible regulation of the psychology sector.

The regulation of mental health professionals is gaining attention, as unqualified individuals

have been found offering counselling services on online platform Carousell

.

Professional counsellors say this is part of a broader trend of untrained help being offered on social media and messaging platforms.

Currently, among mental health professionals in Singapore, only psychiatrists, who are medically trained doctors, are regulated by the Singapore Medical Council. 

Other key practitioners such as psychologists and counsellors are not regulated. However, professional bodies such as SPS and the Singapore Association for Counselling (SAC) provide guidance on professional and ethical conduct for their members.

Psychiatrists are medical doctors who oversee interventions such as medication, hospitalisation and medical treatments.

While psychologists do not give medical advice or prescribe medication, they can provide diagnoses based on psychological assessment and evaluation tools.

Counsellors are trained to provide mental health support for clients with problems and struggles that are specific and current to their present realities, like stress or grief.

While SAC has called for regulatory oversight over counsellors, the association said there has been no formal response from government ministries so far.

The role of the psychologist

Psychologists are now moving beyond clinical settings and playing a broader and more proactive role in different sectors, said Mr Toh. 

In schools, they develop resilience-building programmes and provide early intervention for students. In the community, they work with vulnerable groups to offer preventative mental health support. 

While most psychologists maintain high professional standards, the absence of legal safeguards creates risks for clients, practitioners and the mental health sector, said Mr Toh. 

SPS oversees 700 practising psychologists registered with the society. It receives an average of six complaints of unethical practice each year. These include overcharging and breach of confidentiality.

Even though the number of complaints is relatively small, it still highlights the importance of oversight, said Mr Toh. 

In the absence of regulation, the society has a disciplinary advisory committee that examines complaints filed against its members and works with the psychologist involved to address any breaches of standards. 

This is so that members of the society have the opportunity to learn and improve their practice, added Mr Toh. 

When engaging a psychologist, members of the public can check if the professional is registered with SPS. Members of the association are required to adhere to a code of ethics and offer services within their area of competence. 

Serious consequences

One of the biggest concerns about the lack of regulation is that anyone can claim to be a psychologist, regardless of training, qualifications, or supervision.

Using the example of a person with severe post-traumatic stress disorder who seeks therapy from someone who lacks formal training in trauma care, Mr Toh said that if the purported psychologist uses ineffective or even harmful interventions, the client’s condition could worsen rather than improve. 

“In cases involving suicide risk, psychosis, or severe mental health condition, improper assessment or treatment can have devastating or even life-threatening consequences,” he added.

Mr Toh has heard of instances where practitioners without the requisite training conducted assessments and subsequently diagnosed neurodevelopmental conditions such as autism and intellectual disability.

“These reports, which are supposed to draw a clear picture of a child for early intervention or to enter into a special school, may not clearly reflect a child’s abilities,” said Mr Toh. 

“Without regulation, there is no system in place to verify credentials, restrict unqualified individuals from practising, or hold them accountable for harm caused.” 

Regulation could also have the benefit of ensuring psychologists have high standards of practice if, for instance, they are required to undergo continual professional development, he added. 

Another pitfall of the lack of oversight is that there are no legal safeguards to ensure confidentiality is maintained.

Mr Toh has received informal feedback on such ethical breaches, such as a psychologist who openly complained about a client during a dinner, revealing enough information that others could identify who it was. 

“Breaches of confidentiality can cause emotional distress, financial harm, or even social stigma. If a psychologist improperly shares a client’s personal details, it could jeopardise careers, family relationships, and overall mental well-being,” he said.

Other examples of potential unprofessional and unethical behaviour include financial exploitation, such as overcharging clients or recommending unnecessary therapy sessions, discrimination and inappropriate relationships with clients.

“For example, there was a psychologist who belittled a client’s cultural or religious background during therapy, causing significant emotional harm and making the client feel even more isolated,” Mr Toh said. 

In a regulated profession, breaches of confidentiality or instances of ethical behaviour would likely result in serious consequences, such as suspension or removal from practice.

Without statutory oversight, there is no formal recourse for clients.