que charest charade

An article posted in February on the Protégez-vous.ca website contains incorrect information about the online referral service of the Quebec Order of Psychologists.

The author of the article states that "The first information you are asked for is the location in which you want to search.”

Unfortunately, this is not true.  In fact the first thing that one is asked by the OPQ referral service is to choose between "psychologist" and "all authorized professionals."

Now let’s say that one comes to the OPQ website and needs help, perhaps with issues around a relationship or work.  One might very well think along lines such as this: “I am looking for therapy, and that is a psychological service.  I am at the website of the Order of Psychologists.  I guess I am looking for a psychologist.”  That would seem reasonable, but the search results will actually exclude all licensed couple and family therapists, sexologists, occupational therapists, social workers, psycho-educators and others who are able to help.  It will include many psychologists with little training and no license in these fields.

Yet, the author of the article tells us that Rose-Marie Charest, the President of the OPQ "assures that psychologists are not privileged at the expense of other therapists."

Unfortunately this is not true either.

how the OPQ's online referral service fails to protect the public and what to do about it

[pour la version française, cliquez ici ]

The OPQ’s online referral service is NOT helping the public access the services of all qualified psychotherapists specialized in the disciplines the public is looking for. 

Here’s how its online referral service fails to help you find the right provider:

1)     Non-psychologist psychotherapists are not always included in the search results under topics in which they hold licenses or have specialized training, e.g. in couple and family, sexual or work issues, whereas the names of psychologists who are unlicensed or untrained in these issues are always included in the search results.

2)     Non-psychologist psychotherapists are never listed as being able to do conduct evaluations in their areas of expertise, i.e. relationship, sexual or occupational problems, but psychologists who are without expertise and are unlicensed in these areas always are.

3)    Non-psychologist psychotherapists get no referrals when the OPQ’s online service is used by the public to find a professional funded by IVAC, SSQ, CSST or Health Canada because this search option automatically filters out all but the names of psychologists.

If you are a psychotherapist in private practice, you may be as surprised as I was to learn that many of your services are inaccessible to the public using the OPQ’s online referral site, even if you have paid good money for both your license and your professional page listing.   

AND THAT IS NOT ALL.  The OPQ is currently holding private meetings with four major, publicly-funded organizations (SSQ, CSST, Health Canada- Aboriginals and IVAC) to determine which providers of psychotherapy services will be financially supported by these organizations.  

Can we trust them?

For more complete information, please consult Psychotherapy and Public Protection.  It includes an overview and critique of the OPQ’s online referral service, a petition addressed to the President of the Order of Psychologists asking her to refer the public to all psychotherapists qualified to provide the treatments they seek, and sample letters to employers requesting coverage of all licensed providers of psychotherapy.

private meetings in the public interest

I recently learned from Diane Côté, Director of Communications at the OPQ, that their Legal Advisor is currently attending private meetings with four major third party subsidizers of psychological services in Quebec (SSQ, the CSST, Health Canada –Aboriginal Program, and IVAC).

The purpose of these meetings, according to Côté, is "to determine whether or not [these third parties] accept that services be delivered by psychotherapists and under what conditions.” [my translation]  She also specified that these meetings were not "inter-professional" and "not public."  Apparently, the OPQ will be the sole professional Order to determine, in  private meetings with the above government agencies, whether and how public funds are going to be made available to consumers seeking subsidized psychotherapeutic services in Quebec.

In the same (June 16) communication, Ms. Côté also confirmed that, when members of the public consult the OPQ’s online referral service in search of subsidized services by these third party payers, they are currently provided with only "the names of psychologists" even though many other psychotherapists are qualified to provide these services.  Mme Côté did not seem concerned about that, or about whether it was in the public’s interest to exclude these other providers from the referrals offered by the OPQ's site to the public at large.  I can only assume this is because, as she told me in a previous email exchange, the Order of Psychologist’s online referral service is "not regulated by their professional code". 

One can only hope that, regardless of whether their meetings with government agencies are “regulated by the professional code” or not, the OPQ will make every effort  in the public interest to promote the services of all psychotherapists licensed by their Order, including non-psychologist providers who are, not only as qualified as psychologists to provide these services to the public, but who have specialized licenses in the types of treatment sought by the public which most psychologists lack, namely: licenses in marital and family therapy, social work, occupational therapy, nursing, psycho-education, career counseling, and sexology.  

But, in light of how the OPQ dissimulates conflict of interest as public protection on its website, it would be wise to view its need for secret meetings with a healthy dose of suspicion .

letter to employer

Below is a sample letter that you can forward to your employer's Department of Human Resources simply by copying and pasting the text into an email and adding your name at the bottom of the page.
Please copy me on each email you send at patricia.i.ivan@gmail.com
Thank you! 
[This letter was edited on October 22, 2014 for reasons stated in this blog post- link to come]

Dear Employer,

I am writing to you about my insurance coverage for psychological services.

Under a new law in Quebec, Bill 21, all professionals qualified to provide psychological treatment (psychotherapy) are licensed by the Order of Psychologists of Quebec as psychotherapists.  These professionals have training and expertise which many psychologists lack.  Some psychotherapists are experts licensed in marriage and family therapy, others in social work, occupational therapy, psycho-education, career counselling, nursing and sexology.  Others are highly trained in unique forms of therapy like somatic therapy, art therapy or psychoanalysis, and many others.

Currently, however, the services of these experts are excluded by many insurance policies which only cover the services of psychologists.

When the consumer needs a psychological treatment, these policies force the consumer to choose between:

1) reimbursed sessions with a psychologist who may have little or sometimes no clinical training in the type of intervention sought, or

2) non-reimbursed sessions with a psychotherapist who, while not a psychologist, may have a license and/or many years of clinical experience and, like any psychologist in Quebec, is accredited by the Order of Psychologists.

More rational insurance provide clients coverage for the psychological services of all licensed psychotherapists.

It makes no sense that some policies continue to do otherwise. When an insurance policy limits the consumer's choice of providers, there is no cost containment of the services used. On the contrary, the value of their policy decreases.

An insurance policy that gives access to the largest pool of qualified providers helps reduce service costs.

I want access to all qualified providers authorized to provide the services I need.  For psychological services, this means that I want psychotherapy sessions covered with all psychotherapists accredited by the Order of Psychologists of Quebec who are legally licensed to provide them.

Please note: I am not requesting that a new psychological service be added to my current coverage. I am merely requesting access to a larger pool of providers licensed to provide that service.

Please inform me how my current policy provides coverage for psychological services, especially whether it covers all professionals qualified to provide these services: psychotherapists. If this is not currently the case, please rectify that situation with our insurance carrier.

Thank you for your attention to this matter.

Sincerely,
[Your name]

psychotherapy; one title, many specialties

[cliquez ICI pour la version française]

Introduction
Since the adoption of Bill 21 in Quebec in 2009, both the use of the title of psychotherapist and the practice of psychotherapy have been restricted.  

Bill 21 defines psychotherapy as follows:

A psychological treatment for a mental disorder, behavioural disturbance or other problem resulting in psychological suffering or distress, and has as its purpose to foster significant changes in the client’s cognitive, emotional or behavioural functioning, interpersonal relations, personality or health. Such treatment goes beyond help aimed at dealing with everyday difficulties and beyond a support or counselling role.

The Order of Psychologists of Quebec (OPQ) has been given the mandate to issue permits to psychotherapists and thereby protect the public from just anyone claiming to be a psychotherapist and/or offering psychotherapy. 

This blog documents my conversation with the Order of Psychologists of Quebec on the subject of psychotherapy and the OPQ's mandate to protect the public, which began with my initial conversation with Mme Marie-Hélène Bertrand, and was followed by subsequent email exchanges with Krystelle Larouche and Diane Côté of the OPQ.

Public protection or self-promotion?

The Office des Professions defines the Mission of an order as follows:

The main mission of a professional order is to protect the public, namely all persons who use the professional services in the various spheres of regulated activities. The order protects the public by adequately meeting its role and responsibilities.

PLEASE NOTE*

It is false to assume that a professional order is an association that protects the interests of its members.  The latter can subscribe to separate and independent organizations that will represent its members in this way.

[*original bold]

It is specifically stated here that the mission of a professional order is to protect the public, not to represent the interests of its members.

Nevertheless, the Order of Psychologists of Quebec is doing just the opposite by marketing its own members on its online site.  

Their online referral service filters its search results so that the public is frequently referred to privileged members of the OPQ over other psychotherapists who are, in many cases, more qualified in the type of psychological treatment sought.  To find out how exactly it does this, click here.

The result is information that is misleading:

When consumers, in good faith, consult the Order of Psychologists's website to find a psychotherapist, they will not necessarily be referred to those with specialized licenses in the fields searched under.  But they will always be referred to those without any specialized license to practice in those fields.  They will not systematically be referred to the professionals best trained and qualified in the type of psychological treatment sought.  But they will always be referred to certain privileged members of the OPQ. 

In practice this means that, when I consult the OPQ’s online referral service in search of help for couple issues, for example, I am very likely to come away with a long list of providers that includes professionals who are not licensed couple therapists, i.e., psychologists who have no specialized license in the field, but that excludes professionals who are licensed with a specialized permit to practice couple therapy. And this, in the exclusive interest of OPQ members who are not licensed couple therapists.

Imagine consulting a referral service for the College of Physicians and Surgeons because you have a sore throat, only to be provided with a list of doctors excluding those with specialized licenses in ear, nose and throat medicine, because including them would not be in the best interest of general practitioners!

This makes no sense and is not in the public interest.

Moreover, by preventing public access to specialized providers of psychological treatments, the Order of Psychologists of Quebec is enabling the irrational practices of the insurance industry.

Currently, some policies reimburse the cost of a specialized psychological treatment when offered by psychologists with no specialized license to practice in this discipline, but do not reimburse when offered by other psychotherapists who do hold a specialized license in this discipline and who are licensed to provide psychological treatment by the same professional order as psychologists: the OPQ. 

This discrimination against qualified psychotherapists does nothing to contain insurance costs, is not in the public interest, and should be immediately rectified.  

When the coverage for a “psychological treatment” is limited to treatment provided by a psychologist, the public’s choice of providers is irrationally limited to professionals who may have no specialized training in the type of treatment sought.  Coverage for a psychological treatment, which is the definition of psychotherapy by law, should include services from the complete range of qualified providers of that treatment: psychotherapists.

One would expect the Order of Psychologists to educate and accurately inform the public, if not to correct insurance inequities, then at least to not reinforce them with their referral service.  But apparently the OPQ is too busy promoting its members to be protecting consumers; so we have to take action to protect ourselves.

Action  
On May 21, 2014, I wrote to the Order of Psychologists of Quebec asking them to review their online referral service so that consumers could make more informed choices about the professionals they choose to consult than what they are currently able to do using this service. 

I received an answer from Mme Larouche on May 26, 2014  which gave some general information about the Order of Psychologist’s public protection mandate and the history of its referral service.

I replied to Mme Larouche on May 30,2014, asking her two specific questions.  These were:

1) whether she thought that the OPQ, by offering the public a referral service that excludes the majority of psychotherapists specialized in the field searched under, was adequately fulfilling its “public protection mandate applied precisely by informing and sensitizing the public,” as she said in her letter [my translation].

2) whether, by asserting that "searching by problem type is the best way to inform the public so that people can find the right professional according to their needs"[my translation], she was admitting that the OPQ, by offering the public a referral service that is not organized in this way, was providing an inferior service.

I did not receive an answer from Mme Larouche.  Instead, on June 6, 2014, I received an email from Dîane Côté in which she defends the Order of Psychologists’s online referral service, claiming that it is "not regulated by their professional code" [my translation] and informing me that it will not be changed in the near future.

My two questions were left unanswered.

The Order of Psychologists of Quebec is not adequately meeting its public protection mandate.  This is unacceptable for both consumers and providers of psychotherapy services.

Petitions
I have drafted a petition addressed to Mme. Rose-Marie Charest, President of the Order of Psychologists of Quebec, asking that, in the public interest, the OPQ’s online referral service cease interfering with the public’s freedom to choose its providers of psychological treatments, that it refer the public to all psychotherapists qualified to meet the type of treatment sought, that it cease filtering search results using criteria to exclude specialized permit holders in the field searched under, and that it provide the public with complete and relevant information on all meetings, discussions, negotiations and agreements with government organizations, insurance carriers or third parties, that determine how and in what matter psychotherapy services are to be provided to the public.

When you sign here, the petition is automatically forwarded to Mme. Charest and a copy sent to the Office de Professions du Québec, which assigns the Order of Psychologists its public protection mandate. 

For those who wish to take action to ascertain that their insurance policies cover all licensed psychotherapists qualified to provide psychological treatment, you can send a letter to your employer simply by clicking on this link and sending the sample letter to your employer's Department of Human Resources.

Some may fear that rectifying coverage in this way will increase insurance costs. This fear is unfounded.  The change requested is not for the coverage of an additional psychological service, but for access to a larger pool of providers licensed to provide that service.  This is actually more likely to reduce the cost of these services.

Your feedback in the form of comments, questions and criticism is welcome on this blog.
All original documents can be consulted here. 

Please forward to friends and colleagues.