Gower, H. K., & Gaine, G. S. (2023).
Canadian Psychology / Psychologie canadienne.
Advance online publication.
Abstract
Ethical and regulatory documents in Canadian professional psychology were reviewed for principles and standards related to the rationing of psychotherapy. Despite Canada’s high per capita health care expenses, mental health in Canada receives relatively low funding. Further, surveys indicated that Canadians have unmet needs for psychotherapy. Effective and ethical rationing of psychological treatment is a necessity, yet the topic of rationing in psychology has received scant attention. The present study involved a qualitative review of codes of ethics, codes of conduct, and standards of practice documents for their inclusion of rationing principles and standards. Findings highlight the strengths and shortcomings of these documents related to guiding psychotherapy rationing. The discussion offers recommendations for revising these ethical and regulatory documents to promote more equitable and cost-effective use of limited psychotherapy resources in Canada.
Impact Statement
Canadian professional psychology regulatory documents contain limited reference to rationing imperatives, despite scarce psychotherapy resources. While the foundation of distributive justice is in place, rationing-specific principles, standards, and practices are required to foster the fair and equitable distribution of psychotherapy by Canadian psychologists.
From the recommendations:
Recommendations for Canadian Psychology Regulatory Documents
- Explicitly widen psychologists’ scope of concern to include not only current clients but also waiting clients and those who need treatment but face access barriers.
- Acknowledge the scarcity of health care resources (in public and private settings) and the high demand for psychology services (e.g., psychotherapy) and admonish inefficient and cost-ineffective use.
- Draw an explicit connection between the general principle of distributive justice and the specific practices related to rationing of psychology resources, including, especially, mitigation of biases likely to weaken ethical decision making.
- Encourage the use of outcome monitoring measures to aid relative utility calculations for triage and termination decisions and to ensure efficiency and distributive justice.
- Recommend advocacy by psychologists to address barriers to accessing needed services (e.g., psychotherapy), including promoting the cost effectiveness of psychotherapy as well as highlighting systemic barriers related to presenting problem, disability, ethnicity, race, gender, sexuality, or income.
