SINGAPORE - Some psychologists are calling for better regulation and recognition of their profession amid plans to increase the number of psychologists in the public sector as part of the national push for better mental health.

This comes after some private psychologists expressed unhappiness that they cannot use the word “treatment” and have to make clear they are not medical doctors in advertisements, as part of a healthcare Act implemented in 2023.

A regulatory framework would raise the standards and safeguards of the profession, as it would include a professional body to which they would be accountable, said psychologists and observers, including the Singapore Psychological Society (SPS).

It would also be a more positive move than recently updated rules under the Healthcare Services Act (HCSA) to forbid psychologists who perform healthcare services from using the word “treatment” in advertisements, where they also have to make clear that they are not medical doctors, said psychologists The Straits Times spoke to.

“Purporting to treat” refers to “claims that the services offered can treat any ailment, disease, injury, infirmity or condition affecting the human body”, according to the Ministry of Health’s (MOH) latest list of frequently asked questions on the HCSA, which was updated on Jan 25.

Also, those who have a PhD or doctorate must have a disclaimer in their advertising to say their “Dr” title is not a medical or dental qualification.

These rules, which took effect in June 2023, are aimed at better regulating such services and providing greater transparency, so that the public will not be misled by healthcare service advertising.

The SPS sent e-mail circulars on the changes, the latest in January 2024, and these have since caused some displeasure among its members.

The society has 700 registered psychologists governed by its code of professional ethics. Of these, 174 hold the Dr title, conferred with degrees such as PhDs or doctorates in specialised fields within psychology.

Registered psychologists with SPS must have a postgraduate applied psychology degree with practicum hours, or be registered or licensed in specific countries, according to the society’s website.

About 320 of those registered with SPS specialise in clinical psychology, which involves working with individuals with mental health disorders and psychological distress, according to clinical psychologist and SPS president Adrian Toh.

Principal clinical psychologist Sanveen Kang, who is director at specialist psychology clinic Psych Connect, said not allowing “treatment” to be used implies that psychological therapy may not be effective.

“This may be misleading, as most mental health conditions are treatable. This might lead to over-reliance on medication.”

Both psychiatrists and psychologists are trained and work together to support the care of their clients, said Dr Kang, and many treatment manuals used worldwide and locally for some mental health conditions are developed by psychologists.

Dr Shawn Ee, clinical psychologist and director of The Psychology Practice, said psychologists do not give medical advice or prescribe medication, unlike a psychiatrist. But the Act in its current form undermines the role of psychological interventions, based on the latest scientific research, as a first-line treatment for many mild to moderately severe mental disorders.

More public education on the work of psychologists is needed to encourage people to be more discerning about choosing a professional to treat one’s mental health concerns, he said.

Mr Toh said the society will continue to meet MOH representatives to explore the possibility of using the word “treatment” in advertising by psychologists, given that psychologists do provide treatments based on international guidelines, such as cognitive behavioural therapy.

“To the public, this will affect their help-seeking behaviour. They might think, ‘If this cannot be treated, why would I go to a psychologist?’ It also really undermines the role of psychologists in the mental health scene,” he added. 

Need for more clarity

Promoting educational talks, workshops and lectures on psychological interventions for mental conditions to the public is considered a healthcare advertisement, according to MOH’s FAQs on the HCSA. 

An alternative to the word “treat” could be “support”, the document stated. “The main objective of HCSA is to better safeguard the safety and welfare of patients and to ensure continuity of patient care,” it added. 

A spokeswoman for MOH said the restrictions on the use of the Dr title were imposed after consultations. “There was strong feedback from both the public and healthcare professionals that such advertisements with use of the Dr title have misled many people,” she said.

“Since the HCSA requirements came into effect, there has been feedback from SPS on how the two sections have affected them. In particular, members of SPS felt that they do treat certain mental conditions, and they should not be prohibited to state this in their advertisements. 

“We are engaging SPS to better understand and explore ways to address their concerns.”

Nominated MP Razwana Begum Abdul Rahim, an associate professor and head of the public safety and security programme at the Singapore University of Social Sciences, said the use of the Dr title by a PhD holder in the medical setting could be confusing, unlike when used in academia, where PhDs are common.

She suggested adding PhD at the end of a name in an advertisement instead of using the Dr title at the front.

Calls for regulation

SPS is working with MOH on the possible regulation of the psychologist profession, said Mr Toh, adding that this would raise standards and prevent unqualified individuals from practising.

“We understand that when the practice of psychology is regulated, psychologists will not be subjected to having the disclaimer on advertisements, as they would be accountable to the Allied Health Professional Council,” he added.

This comes amid plans by the Government to ramp up services and trained professionals to address growing mental health needs in society, including increasing the number of public sector psychologists by 40 per cent.

Nominated MP and consultant psychiatrist Syed Harun Taha Alhabsyi called in Parliament on Feb 6 for the Government to consider a regulatory framework for clinical psychologists.

He said that given the vulnerable population they work with, there should be more clarity about the criteria needed to become a clinical psychologist.

Psychologist Ooi Sze Jin, founder of psychology clinic A Kind Place, said the solution should be regulation rather than placing rules on advertising. “If there is no regulation, anyone can still claim to be able to help people deal with trauma, depression, anxiety or any other mental illness,” she said.

Ms Ooi added that regulation would help people distinguish between different types of psychologists so they can seek the right help.

Dr Ee said regulation would hold psychologists to high expectations and subject them to a strict code of conduct, with consequences if breached.

The Australian-trained and registered psychologist added that it is common practice in Australia to require stringent background checks by a regulatory body to ensure that psychologists have the necessary credentials and are carrying out their duties ethically and responsibly.

Similarly, Dr Kang said that “psychologist” is a protected title in countries such as the United States. A system of national registration and regulation ensures greater accountability and quality of practice, she said.

She hopes to see a sense of community in the mental health landscape in Singapore, where the public and private sectors can complement each other.

“I am also hoping that the work psychologists do is seen as valuable and meaningful in the wider healthcare network,” she said.