Spiritual & Religious Care-Givers and the CRPO … An Overview of the Legislation, And Consideration of the Question, “Am I In? Or Out?”

Bob Bond

April 2014

Let this blank expanse represent the set of all things one person could do to another. In parallel with this presentation’s text, a diagram will evolve …

Governments create Colleges

Where malpractice by a professional can cause harm, the government responds by holding the professional to account within a College.

Regulated Health Professions Act (RHPA), 1991

Controlled acts 27. (2) A “controlled act” is any one of

the following done with respect to an individual:

1. [Communicating … a diagnosis] 2. [Performing a procedure … below the

dermis]

RHPA, 1991 Controlled acts 3. [Setting … a fracture] 4. [Moving the joints of the spine] 5. Administering a substance by injection

or inhalation. 6. [Putting an instrument, hand or finger in

a body opening] 7. [Applying a form of energy]

RHPA, 1991 Controlled acts 8. [Giving a drug] 9. [Giving eye glasses] 10. Prescribing a hearing aid for a hearing

impaired person. 11. [Giving a dental appliance] 12. Managing labour or conducting the

delivery of a baby. 13. [Allergy testing]

RHPA, 1991 Controlled acts

Note: On a day to be named by proclamation of the Lieutenant Governor, subsection (2) is amended by the Statutes of Ontario, 2007, chapter 10, Schedule R, subsection 19 (1) by adding the following paragraph:

14. Treating, by means of psychotherapy technique, delivered through a therapeutic relationship, an individual’s serious disorder of thought, cognition, mood, emotional regulation, perception or memory that may seriously impair the individual’s judgement, insight, behaviour, communication or social functioning.

RHPA, 1991 Controlled acts restricted

27. (1) No person shall perform a controlled act set out in subsection (2) in the course of providing health care services to an individual unless,

(a) the person is a member authorized by a health profession Act to perform the controlled act; or

(b) the performance of the controlled act has been delegated to the person by a member described in clause (a).

Controlled Acts

the set of all things one person could do to another

RHPA, 1991 Controlled acts restricted - Exceptions

29. (1) An act by a person is not a contravention of subsection 27 (1) if it is done in the course of, … (c) treating a person by prayer or spiritual means in accordance with the tenets of the religion of the person giving the treatment; …

Controlled Acts

Treating by prayer or spiritual means according to the practitioner’s religious tenets

RHPA, 1991 Controlled acts restricted - Exceptions

29. (2) Subsection 27 (1) does not apply with respect to a communication made in the course of counselling about emotional, social, educational or spiritual matters as long as it is not a communication that a health profession Act authorizes members to make.

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Controlled Acts

Treating by prayer or spiritual means according to the practitioner’s religious tenets

Counselling about emotional, social or educational matters

Counselling about spiritual matters

Counselling

RHPA, 1991 Treatment, etc., where risk of harm

30. (1) No person, other than a member treating or advising within the scope of practice of his or her profession, shall treat or advise a person with respect to his or her health in circumstances in which it is reasonably foreseeable that serious bodily harm may result from the treatment or advice or from an omission from them.

RHPA, 1991 Treatment, etc., where risk of harm

Counselling 30. (4) Subsection (1) does not apply with respect

to counselling about emotional, social, educational or spiritual matters.

Exceptions 30. (5) Subsection (1) does not apply with respect

to anything done by a person in the course of, … (c) treating a person by prayer or spiritual means in accordance with the tenets of the religion of the person giving the treatment; …

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Controlled Acts

Treating by prayer or spiritual means according to the practitioner’s religious tenets

Counselling about emotional, social or educational matters

Counselling about spiritual matters

Counselling

MOHLTC1, HPRAC2 & CAPPE

2001 – HPRAC Report suggests amending RHPA to include psychotherapy

2002 – OCMHP3 formed (& CAPPE briefly present!)

1 MOHLTC = Ministry of Health and Long Term Care 2 HPRAC = Health Professions Regulatory Advisory Committee 3 OCMHP = Ontario Coalition of Mental Health Professionals

MOHLTC, HPRAC & CAPPE

2005 – Minister of Health asks HPRAC to make recommendations on Psychotherapy as a profession.

2005 – CASC rejoins OCMHP as it becomes known to us the MOHLTC has decided there will be ONE College for all ‘talk’ caregivers.

MOHLTC, HPRAC & CAPPE

Autumn 2005 – CASC’s voice (aligned with OCMHP): “Do not regulate by Controlled Act”; “Regulate by Title Protection”

2006 – HPRAC recommends a College based on Enforceable Scope of Practice; OCMHP strongly objects (still supporting Title Protection).

MOHLTC, HPRAC & CAPPE

Summer & Autumn 2006 – Briefs + lobbying + Ministry meetings by the OCMHP

Bill 171, Health System Improvements Act

An Act to improve health systems enacts, amends and repeals legislation

Schedule R, Psychotherapy Act, 2007 College established: The College of Psychotherapists and Registered Mental Health Therapists

Psychotherapy Act, 2007 Scope of practice 3. The practice of psychotherapy is

the assessment and treatment of cognitive, emotional or behavioural disturbances by psychotherapeutic means, delivered through a therapeutic relationship based primarily on verbal or non-verbal communication.

Please note …

The Act does not define Psychotherapy! Characterization of the activity/work, in the

legislation, uses the same root word: “by psychotherapeutic means …”

HPRAC’s 2006 “New Directions” document NOT the Government’s voice However, it is the Voice of Government-

appointed ‘advisors to the Minister of Health’ regarding the Regulation Health Professions.

HPRAC’s 2006 “New Directions” document Repeatedly, Joyce Rowlands (Registrar)

has made it known the Transitional Council is using the “New Directions” definitions in their creation of the CRPO.

Allison Henry (current MOHLTC lead-person on the CRPO) has clarified the CRPO, if-and-when it wants, can define for itself “psychotherapy”.

HPRAC’s 2006 “New Directions” document “Psychotherapy is the provision of a

psychological intervention or interventions, delivered through a therapeutic relationship, for the treatment of cognitive, emotional or behavioural disturbances.”

HPRAC’s 2006 “New Directions” document “Psychotherapy is most often

characterized by an intense client-therapist relationship which involves the examination of deeply emotional experiences, destructive behaviour patterns and serious mental health issues.”

HPRAC’s 2006 “New Directions” document “The practice of psychotherapy is distinct

from both counselling, where the focus is on the provision of information, advice-giving, encouragement and instruction, and spiritual counselling, which is counselling related to religious or faith-based beliefs.”

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Controlled Acts

Treating by prayer or spiritual means according to the practitioner’s religious tenets

Counselling

Counselling about spiritual matters

Psychotherapy

“Religious Psychotherapy” e.g. prayer, confession & absolution, anointing, exorcism, …

Counselling about emotional, social or educational matters

HPRAC’s 2006 “New Directions” document “Commentators strongly supported the

proposition that faith-based practitioners who provide psychotherapy during the course of spiritual or religious care should meet the same qualifications and standards as other practitioners of psychotherapy. This is a matter that should be reviewed further.”

Psychotherapy Act, 2007 Authorized Act 4. In the course of engaging in the practice of

psychotherapy, a member is authorized, subject to the terms, conditions and limitations imposed on his or her certificate of registration, to treat, by means of psychotherapy technique delivered through a therapeutic relationship, an individual's serious disorder of thought, cognition, mood, emotional regulation, perception or memory that may seriously impair the individual's judgement, insight, behaviour, communication or social functioning.

This image cannot currently be displayed.

Controlled Acts

Treating by prayer or spiritual means according to the practitioner’s religious tenets

Counselling

Counselling about spiritual matters

Psychotherapy

“Religious Psychotherapy” e.g. prayer, confession & absolution, anointing, exorcism, …

Counselling about emotional, social or educational matters

Authorized Act

Psychotherapy Act, 2007 Restricted titles 8. (1) No person other than a

member shall use the title "psychotherapist" or "registered mental health therapist", a variation or abbreviation or an equivalent in another language.

Regulated Health Professions Statute Law Amendment Act, 2009

The Psychotherapy Act, 2007 is amended so that the protected title “psychotherapist” is replaced with the title “Registered Psychotherapist”. The new title “Registered

Psychotherapist” is only be available to those practicing under the College of Psychotherapists and Registered Mental Health Therapists of Ontario.

Regulated Health Professions Statute Law Amendment Act, 2009

Members of the five other Colleges who share the controlled act of psychotherapy are entitled to refer to themselves as psychotherapist; but only within the context of also communicating their own college or professional designation.

Regulated Health Professions Statute Law Amendment Act, 2009

The mandate of the College of Psychotherapists and Registered Mental Health Therapists of Ontario is amended to include “collaboration and consultation with other Colleges ...”

… and now THE QUESTION:

Viewing the ‘lay of the land’ as the legislation sees it, “Where, on the ‘map’, is your practice located?” The answer to this question decides

whether-or-not you apply to the College. Be clear: you cannot create a different

‘map’ (though we all might prefer to do so!). The government gets to draw it!

Where on the ‘map’ is your practice? Points to consider: Your work, as per CASC training and

standards, is carried out on the basis of the client’s spirituality and religion (i.e., not your own).

Where on the ‘map’ is your practice? Points to consider: Your work, as per CASC training and

standards, is not (primarily) “counselling” (as defined in “New Directions”, 2006).

Where on the ‘map’ is your practice? Points to consider: The client’s spiritual & religious issues

are incarnated in their cognitive + emotional + behavioural + somatic ‘disturbances’.

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Controlled Acts

Treating by prayer or spiritual means according to the practitioner’s religious tenets

Counselling

Counselling about spiritual matters

Psychotherapy

“Religious Psychotherapy” e.g. prayer, confession & absolution, anointing, exorcism, …

Counselling about emotional, social or educational matters

Authorized Act

Where, on this ‘map’, is your practice?

Conversation ? ? ? Comments ? ? ? Questions ? ? ?

The End ! ! !