Good quality mental health matters: How the proposed changes for mental health shortage will create more problems

By Dr. Marina Heifetz, C.Psych

The College of Psychologists and Behaviour Analysts of Ontario (CPBAO) is proposing amendments to registration and training of Clinical Psychologists to “modernize” registration practices by eliminating the minimum 4-year work experience (training) requirement for candidates with a Master’s degree. This will allow individuals to practice as psychologists without sufficient real-world experience or demonstrated competence in clinical decision-making. The College is also proposing to remove oral exams, reduce supervised experience, allow unlimited exam attempts, and weaken accreditation standards putting public safety and professional credibility at risk. As Professor Jonathan Weiss put it in his recent “Detailed Analysis of the College of Psychologists and Behaviour Analysts’ Council Proposed Changes,” these proposed changes pose increased risks to providing care to the public without the sufficient knowledge or supervised experience necessary for good quality care.

Professor James MacKillop and his colleagues at McMaster University have recently shared their data (soon to be published) based on 1,141 Ontario participants in the community. The findings show that 71% of participants disapprove of reducing requirements (44% of these indicated “strongly disapprove” in their response), with 20% being “neutral” and only 9% in favour (“approve”) of these changes. When asked “why” they are not in favour of these changes, 94% expressed concern with reduced quality of healthcare, 85% indicated concerns with more providers with lower competency, 78% expressed higher likelihood of misdiagnosis as a major concern, and 69% noted increased risk in high-stakes contexts (i.e., forensic, medical-legal, disability, etc.). This study provides the first step in understanding how the proposed CPBAO changes will sit with the public. In Ontario, expectations of psychologists to be highly trained is at the forefront. Lowering these standards is viewed as unsafe and harmful; supporting the importance of ensuring we figure out a better solution to support healthcare quality provided to our public. Similarly, Weiss’ (2025) risk analysis clearly showed increased risks posed to public safety should these proposed changes take place.

Psychologists are trained to be ethically responsible and intentional in supporting mental health based on their training. There are many vulnerable people that need support from mental health providers that have the extensive training necessary to support them. If this care is not provided appropriately, there are increased risks to these individuals as well as more financial strain in the system. For instance, research has shown that people with intellectual and developmental disabilities (IDD) are more prone to mental health difficulties than those without IDD (Emerson & Hatton, 2007), and psychiatric crises are a major reason for their emergency department visits (Sullivan et al., 2000), as well as hospitalization (Balogh et al., 2005; Cowley et al., 2005). Yet, many mental health providers lack appropriate skills to work with this population, as a result of a lack of sufficient knowledge, training, and experience of hospital staff with respect to people with IDD (Weiss et al., 2009). These challenges in accessing good quality mental health care have contributed to financial strain on the system. As a Clinical Director of the Strong Minds program with the Special Olympics (a mental health branch focused on teaching the athletes coping tools for stress), I have seen individuals with IDD fall through the cracks and heard them and their families share stories of not receiving the necessary supports that could have made a great difference in their mental health along the way. Keeping this example in mind, it is important to recognize that lowering training standards may lead to the same outcomes on a larger scale. By not having professionals with good quality training, we are putting the general public at risk of falling through the cracks in a similar fashion as people with IDD have.

Some helpful solutions have been proposed as an alternative to support the need for more accessible care to psychologists while holding up our high training standards. For instance, the Psychology Advocacy Network (PAN; a network that has been working hard to ensure public safety in Ontario) has proposed some realistic ideas supporting national standards across Canada, increasing funded training programs (e.g., PsyD), and increasing psychologists’ presence in public health settings.

We encourage Ontarians to vote against these proposed changes before December 9th, the survey may be accessed through https://www.surveymonkey.com/r/BZ5SB8Q

Resources:

Balogh R., Hunter D. & Ouellette-Kuntz H. (2005) Hospital utilization among persons with an intellectual disability, Ontario, Canada, 1995–2001. Journal of Applied Research in Intellectual Disabilities, 18, 181–190.

Cowley A., Newton J., Sturmey P., Bouras N. & Holt G. (2005) Psychiatric inpatient admissions of adults with intellectual disabilities: predictive factors. American Journal on Mental Retardation, 110, 216–225.

Emerson E. & Hatton C. (2007) The mental health of children and adolescents with intellectual disabilities in Britain. British Journal of Psychiatry, 191, 493–499.

Sullivan B., Berg J., Bradley E., Brooks-Hill R., Glodfarb C., Korossy M., Lovering J. & Lunsky Y. (2000) Enhancing the emergency department outcomes of patients with mental retardation. Annals of Emergency Medicine, 36, 399–400.

Weiss, J. A. (2025, November 2). Detailed Analysis of the College of Psychologists and Behaviour Analysts’ Council Proposed Changes. Toronto: ON.

Weiss, J.A., Lunsky, Y., Gracey, C., Canrinus, M., & Morris, S. (2009). Emergency psychiatric services for people with intellectual disabilities: Caregiver perspectives. Journal of Applied Research in Intellectual Disabilities, 22, 354-362.