The following letter was submitted to the Competitions Tribunal by EPASSA (Educational Psychology Association of South Africa) on the 8th of March 2017 and summarises so clearly the unfair and discriminatory actions of several Medical Aids against Educational Psychologists.
8 March 2017
SUBMISSION TO THE COMPETITIONS TRIBUNAL
BY THE EDUCATIONAL PSYCHOLOGY ASSOCIATION OF SOUTH AFRICA
The Educational Psychology Association of South Africa, EPASSA, aims to promote the interests of Educational Psychology as a profession and to facilitate the provision of quality psychological services to the public. We would like to inform the Competitions Board of unfair practices that are occurring in a manner that is discriminatory against educational psychologists. We request that the Board assists us in obtaining relief for our embattled profession.
Educational psychologists have similar core skills as other psychologists in the areas of assessment, psychotherapy and research. In addition, educational psychologists are particularly skilled in the areas of learning and development. However, several medical aids incorrectly claim that educational psychologists cannot treat the same conditions as clinical psychologists and have stopped paying for educational psychology services. There has been insufficient open protest against this discrimination from the regulators of our profession and from the regulator of medical aids.
South Africa’s need for non-discriminatory mental health services
Both historically and presently, psychological services in South Africa have been inadequate for most of the population, whereas private services are more accessible in more affluent areas. We have an immense need for psychological services, but a shortage of psychologists.
Our regulator, the HPCSA’s Professional Board for Psychology, may argue that South Africa’s mental health service delivery is not too bad for a developing country. This does not detract from the fact that there is a serious shortfall. We should not be striving for the lowest common denominator when it comes to mental health. Last year we saw the tragic loss of over 100 lives because of a negligent approach by the Department of Health to the care of Life Esidimeni patients – an incident that some are calling a “mental health Marikana.” Mental health in South Africa has always been a woefully neglected area.
The contributions educational psychologists can make
We need to ensure a more equitable distribution of power and equal opportunity structures in mental health. Psychology and Educational Psychology could have a lot to offer, were they given a chance. There have been earnest attempts by psychologists to embrace principles and practices of non-domination, egalitarianism and respect for diversity.
Unfortunately, private practitioners, who constitute the vast majority of applied psychologists in this country, are largely excluded from policy discussions. Applied psychologists are mostly confined to private practices – partly out of choice, but mostly because there are few public positions for psychologists. Discussions about revisiting the country’s mental health system are largely confined to universities and regulatory authorities, and excludes most private practitioners.
Some academics and policy-makers regard private practitioners as self-centred, money-making enterprises. On the other hand, many private practitioners, who may be progressively minded, feel alienated and strangulated by scope of practice issues that threaten their livelihoods, which are in any event modest.
Obviously, the more broadly and competently trained psychologists are, the better this will be for members of the public requiring services. A need to make Psychology and Educational psychology less elitist and to harness multiple helpers is pertinent given our shortage of psychologists. It is silly if not unethical for the role of educational psychologists to be unduly limited.
It is the contention of the committees of both EPASSA and the South African School Psychologists Association (SASPA), that so long as they have the requisite training, skills, knowledge and/or experience, all psychologists, no matter their registration category, are legally entitled to evaluate behaviour, mental processes or personality adjustments; to use psychotherapeutic procedures to relieve or change personality, emotional, behavioural or adjustment problems or mental deficiencies; and to use psychological methods to prevent such problems or mental illnesses. This understanding is not our own concoction; it is based on current regulations.
Educational psychologists should not be thought of as remedial therapists or restricted to areas of learning support. Many educational psychologists are trained in various clinical procedures, with adults, children, families and groups . In terms of defining our role, we should capture the essence of Educational Psychology – the unique contributions that educational psychologists make in addressing pressing issues relating to learning and development. At the same time, we must protect the core competencies that educational psychologists, like all psychologists, contribute, per the Scope of the Profession, in a country with limited resources. We need to move beyond either-or to both-and conceptualisations of the role of educational psychologists.
Some medical aids who wish to skimp on spending on mental health service delivery, seize on the terms learning and development, which terms are used in government gazette regulations to describe the role of educational psychologists. They apply these terms narrowly to justify discriminating against educational psychologists. These medical aids find accomplices amongst a few clinical psychologists who, from what they say about educational psychologists and how they discuss our role, are monopolistic and territorial in trying to keep educational psychologists out of what they regard as their turf. This is evident from their ongoing lack of insight into the role of the educational psychologist as noted in the comments they make.
It makes no sense to define the words learning and development narrowly. Learning and development are manifold and broad concepts, particularly within the concept of psychology. UNESCO, the United Nations Educational, Scientific and Cultural Organization, has identified Four Pillars of Learning in a document compiled by global representatives. This document recognises learning as a process that provides (1) cognitive tools to better comprehend the world; (2) skills that enable participation in the global economy and society; (3) self-analytic and social skills that help individuals reach their potential; and (4) exposure to principles of human rights, democracy, intercultural understanding, respect and peace. This definition has been cited by departments of educational psychology at several South African universities.
Interventions such as the assessment of areas of strength, weakness and/or pathology, counselling and therapy may be used by educational psychologists to help support persons, by means of learning and development, to transcend psychological and social barriers, to attain optimal functioning and to address maladjustment and pathology. In 2012, an Educational Psychology Task Team identified that educational psychologists often work with clients with a broad range of psychological conditions.
Discrimination against educational psychologists
Despite the legitimate role of educational psychologists and the contributions they can and do make in a country short on mental health services, educational psychologists have experienced a slamming closed of doors. Several medical aids incorrectly claim that educational psychologists cannot treat the same conditions as clinical psychologists. These medical aids have been aided and abetted by statements from the Clinical Psychology Forum. Thankfully, the Clinical Psychology Forum has been unable to adversely influence Discovery Health, the largest private medical aid. Tremendous damage has been caused in the case of several other medical aids. This includes large, but cash-strapped medical aids that curtail pay-outs to educational psychologists for family, adult and child mental health services.
There has been insufficient open protest against this discrimination from the Professional Board for Psychology as the regulator of our profession. The Professional Board for Psychology promulgated invalid regulations relating to our scope of practice in 2011, and, by failing to guide the profession appropriately, tacitly colluded with discrimination against educational psychologists.
EPASSA repeatedly requested the Board to release guidelines that would properly assist psychologists who are victims of discrimination. We requested that the Board consult with EPASSA while drafting such guidelines. The Board refused, and over a year later dumped guidelines on the Internet that one of our committee members discovered by chance. The guidelines have a degree of potential, but need refining, as they are quite inadequate in, amongst other things, describing the reasons why referrals may be made to educational psychologists. Some believe that the Board’s recent guidelines reflect an attempt to reframe the role and to redefine the identity of educational psychology as academic support, in a manner that places undue weight on the preferences of certain academics serving on or influencing the Board, as opposed to the lived experience of other psychologists.
EPASSA waged many battles in 2016 to protect educational psychology from short-sightedness and blatantly inaccurate perceptions about the role of educational psychologists. We hoped that many issues that are tantamount to discrimination against educational psychologists would be resolved in Court in November 2016, in legal action that was brought by RelPAG, the Recognition of Prior Learning Action Group. However, despite being well-prepared and incurring hundreds of thousands of rand in legal expenses, EPASSA as amicus curiae was unable to argue its case viva voce in the High Court. This was a blow, as we believe the Court would have accepted our legal arguments.
The Minister of Health conceded before the court case, as argued by EPASSA in legal papers, that the scope of practice was promulgated unlawfully and was invalid. However, the main applicants to the court case ran out of funds and agreed that the scope of practice regulations would nevertheless operate for the next two years. This turn of events provides the Minister with an opportunity to amend the regulations before they lose their legal effect in two years’ time and emboldens some to continue misinterpreting our profession.
If we had sufficient funds, EPASSA could apply, in accordance with a recent Constitutional Court ruling, to have the Relpag case re-opened. However, we have outstanding legal bills and we do not know that in 2017 we can again ask our members to come up with hundreds of thousands of rand for resumed court action. EPASSA has decided instead, at least for now, to rely on the South African Human Rights Commission, the Competitions Board and the Competitions Tribunal to take up our cause.
We are trying just about everything we can think of to address the intolerable situation where several medical aids are claiming that Educational Psychologists are acting illegally or what they call “fraudulently”. To date, GEMS, BONITAS, PROFMED, POLMED, SANLAM HEALTH, MEDIHELP and CAMAF have stopped paying for the services of Educational Psychologists. We are aware that their regulator, the Council for Medical Schemes, cannot force these medical aids to pay for the treatment of particular disorders or problems. However, we believe that by paying for services rendered by clinical and counselling psychologists, and not educational psychologists, these medical aids are being discriminatory. The Medical Aid Liaison Board, of which EPASSA forms part, has requested an urgent meeting with the Council for Medical Schemes and the Professional Board for Psychology because both these bodies have a history of either delaying on answering our correspondences, or when they do answer, of referring us back and forth between each other for an answer.
Misrepresentation of our role
Some years ago, the Clinical Psychology Forum stated that clinical psychologists were the only psychologists who were sufficiently trained and experienced to diagnose and treat patients with psychological and/or psychiatric disorders. This, of course, is incorrect. All psychologists may, by law, diagnose and treat individuals in ways that are compatible with their training and experience.
The Clinical Psychology Forum (CPF) seems determined to position clinical psychology in the medical field, and appear to have made it their business to try impress on medical aid schemes what services schemes should and should not pay for. CPF statements have suggested a lack of knowledge, and disregard or disdain for the scope of profession stipulated in gazetted regulations. Psychological acts apply to the field of Psychology as a collective, not to just some clinical psychologists who present themselves as the chosen few.
The Clinical Psychology Forum recently alerted clinical psychologists that they may be obligated to report other colleagues who act outside of their scope of practice. However, when challenged by EPASSA, the CPF has been unable or unwilling to identify what would constitute acts outside of the scope of educational psychology. We believe that the CPF are unable to find any regulation that prohibits educational psychologists from engaging in any particular psychological act. No medical aid, organizational body, university or regulatory body has been able to answer with any shred of evidence where any law stipulates a psychological condition or event that an educational psychologist may not treat. There are many clinical psychologists who work collaboratively with educational psychologists and who are peeved by statements made by the CPF.
The Clinical Psychology Forum are adamant that there are fundamental differences in the training of different categories of psychologists. In an affidavit submitted to Court, the CPF claimed, “Those wanting to practice Education Psychology must complete Bachelors, Honours and Masters Degrees in Educational Psychology which is different from Psychology.” This is nonsense. How can Educational Psychology be different to Psychology? There are many educational psychologists who completed the exact same Bachelors, Honours and Doctoral Degrees as clinical psychologists; and there are many whose Masters degrees, internships and post-qualification experience and training overlapped significantly with the training of clinical psychologists. I am advised that until recently, two universities in South Africa offered their training at Master’s degree level for educational, counselling and clinical psychology in the same class. Many educational psychologists are trained in clinical ways, have worked in clinical settings and continue to work competently and lawfully in the assessment and treatment of a wide range of mental disorders across the life span. We must challenge deceptive narratives that prejudice educational psychologists in violation of constitutional rights and the rights of the public.
The current Professional Board for Psychology also seems to misunderstand and misrepresent the law relating to our profession. As mentioned, some colleagues believe that the Professional Board’s recent guidelines perpetuate a narrow view of the role and identity of educational psychology. Tellingly, Professor Tholene Sodi, deposing to an affidavit on behalf of the Professional Board for Psychology wrote last year, “It would not be in the public interest for an educational psychologist to perform acts for which a clinical psychologist is registered to perform without the professional board first certifying that such a psychologist be qualified to do so.” No matter what Professor Sodi avers, there exists no convenient mechanism whereby the Board certifies which educational psychologists may or may not engage in psychological acts for which a clinical psychologist is registered. Sodi’s statement is misleading and contradicts the scope of profession regulations. There was a time when Professor Sodi’s own, clinical, private practice engaged in psycho-educational assessments.
The Professional Board for Psychology has in a manner sided with the Clinical Psychology Forum. Professor Gertie Pretorius, deposing to an affidavit on behalf of the Professional Board, stated that the Clinical Psychology Forum had presented an argument “in line with the underlying rationale for the 2011 Amendment Regulations.” We now know that those regulations, enthusiastically referred to by Prof. Pretorius, were passed unconstitutionally. However, the Professional Board still tacitly supports discrimination against educational psychologists by failing to speak out coherently against such discrimination.
Both the Professional Board for Psychology and the Council for Medical Schemes turned a blind eye when we implored them to protect educational psychologists against unfair discrimination. Both these bodies are made up of people appointed by the Minister of Health. These ministerial appointees do not necessarily enjoy the support of most psychologists.
The Professional Board’s elective mutism around the plight of educational psychologists in private practice needs to be seen in the context of the HPCSA’s attitude toward medical aid issues. The President of the HPCSA believes that medical aids should not exist. About a month ago, the HPCSA president stated that with half of South Africa’s health professionals catering to only 17% of the population on medical aid schemes, the entire setup is, what he called, “a crime against humanity” and should be abolished. EPASSA fear we have been barking up the wrong tree hoping for the HPCSA’s Professional Board to endorse our rights to be paid by discriminating medical aids when the HPCSA believe that medical aids should not exist in the first place. At present, we have a “perfect storm”: incorrect assertions made by some staff at the Professional Board, seeming collusion by the Council for Medical Schemes, disparaging comments by non-educational psychologists protecting their turf, and apparent inaction on the part of some academics.
We have a ludicrous situation at present where some educational psychologists supervise counsellors who are paid by medical aids. However, these educational psychologists may not be paid for the same work by medical aids on the basis that the activity falls outside of the area of an educational psychologist.
Democratic and constitutional principles
The HPCSA and Board of Psychology are organs of state, and the Constitution of our country requires that public administration must be governed by democratic values and principles enshrined in the Constitution. The Professional Board must actively engage with both private and public practitioners and the public. We do not want lip service to be paid to some vague notion of public and professional engagement. We want significant democratic consultation. We need to hold policy makers accountable to the profession and to the people of this country. We must insist on real and meaningful professional and public participation in the formulation of mental health policies.
Psychology, of all professions, should be committed to consulting with people rather than pulling and pushing people in an undemocratic manner where they do not wish to be. The Board would have shown a level of flexibility, cooperation, collaboration and professional respect had they met with EPASSA prior to releasing the recent document on guidelines for Educational Psychologists. It would also have been prudent of the Board to include the Scope of the Profession as an introduction to the document. This is not important only in relation to scope of practice and medical aid issues, but also in terms of meeting the needs of the poorest of the poor, who are not on medical aids. We stand a better chance of helping to facilitate the development of healthy identities – in ourselves and others – if we adhere to themes of diversity, respect, human rights, self-determination and collaboration.
Two poignant letters
The following letters written by educational psychologists are poignant. The first letter speaks about the crucial role of educational psychologists in assessing the best interests of children. The second deals with the hardship of being an educational psychologist. Here is the first letter:
Proper IQ assessments take a lot of time, often over three hours and Medical Aids only pay for two hours a day. There is also no provision from Medical Aids that pays for reports such as these, which often take two to three hours to compile and type. Educational psychologists generally do these on pro bono basis.
Departmental educational psychologists are so thinly spread that they simply cannot do proper assessments with children. I currently have a seventeen-year-old male patient who is in grade ten. He failed for the first time when he was in grade nine, he repeated grade nine and was “passed” to grade ten. He failed and is now repeating grade ten. According to “the system” he will be pushed up to grade eleven even if he fails grade ten again at the end of this year, furthermore he will be passed to grade twelve at the end of 2018 because the system only allows the school to fail a child once in a three-year phase! I assessed this young person. I was shocked at the results. Scholastically this boy is totally illiterate and barely numerate. He has a reading age of 6 years 3 months!!! The overall IQ is 52!
My friend who works at a township school has more than twenty grade six pupils who are in desperate need of special education, but departmental psychologists do not arrive and occasionally when they do they do, they do a Bender Gestalt and say the child is fine! So they fail one of the grades of the phase they are in and get passed up to fail again two to three years later, once in the next “phase”. At least when educational psychologists could claim from a medical aid, those whose parents had a medical aid could be assessed privately and properly placed. Now this no longer happens! I feel so sorry for the above mentioned young person, he can neither read, write nor spell, what is going to happen to him? With an IQ of 52 he is eligible for a state grant, but had Discovery Health not been willing to pay for the assessment, no-one would have known that, and he would have ended up with the hundreds of pupils, who fail the matriculation exam every year and who either repeat it fruitlessly to power of “n” or drop out completely to become one of the millions of unemployed and unemployable people!
Here is the second email, written last year by another colleague, who works in what I assume is a non-affluent area. As with the previous email, I have edited it, shortened it and removed identifying information. It was written last year. Since then, the situation for educational psychologists has worsened.
I am a qualified Educational Psychologist. I am also a single parent. My family survives only through my private practice. However, the current challenge is that since the beginning of May 2016 no medical aid has remunerated me for any services rendered.
Now, like many of my colleagues, I find myself in a total mess. I am drowning without any monthly income, I have bills such as bond, cars, rent, insurance, municipality bills, groceries, employees and not to mention petrol to and from this job, every single day, when it doesn’t even pay me.
What do I say to banks and debt collectors because they rightfully want their money? I have been working tirelessly for the past 3 months but have received NOTHING for my expertise.
I am tired of being given the run around, can [you] possibly alert banks about this contention experienced by those who are fulltime in private practice? To at least give us 3 months while we wait to possibly be reimbursed for our past services and possibly seek employment elsewhere?
Every single Educational Psychologist is a parent, a provider, a valuable citizen and a possessor of a critical and scarce skill. We have studied and worked so hard to be repaid with this emotional disintegration, financial abuse and humiliation.
Educational Psychology as a discipline is being brought into disrepute without opposition. Whatever happens to our children when people disregard the importance of those who raise them? How do we afford this conference if we can’t even feed our kids? Where will we be by then? In the streets? In our current political crises is the mental wellbeing of South Africans secondary to the wants of medical aid companies?
I hope and pray the committee will prioritise this issue and intervene on our behalf before we are unemployed, homeless, and trampled upon.
Discriminating against educational psychologists is not about protecting the innocent from unskilled and fraudulent psychologists or about serving community needs. It is about being territorial, it is about bullying, and it is about standing on the side-lines and watching victimization. EPASSA turns to the Competitions Board for assistance. We will back up any of our claims with documentary evidence when requested. While we are engaging in ongoing discussion, the public (including the vulnerable and those in dire need) are not being adequately assisted. Educational psychologists, as a group, are involved in numerous community based tasks to try to bridge the gap. With the assistance of medical aids and the support of the Board we, as professionals can reach out even further to those who wish to, and will benefit from out intervention and expertise as psychologists, and, in addition, as educational psychologists.
EPASSA CONTACT DETAILS:
Educational Psychology Association of South Africa
P. O. Box 924
Tel: 011 885 2237