Regulating the quality of psychotherapeutic services

Abstract

This essay begins with the apparent paradox that mental health services are more lightly regulated than medical services. The latter are typically subject to detailed licensure while the former, at least in Canada, are not. This is so despite consumer information problems in choosing and evaluating service providers, and despite potentially adverse third-party effects. The essay reviews the policy options available for regulating quality: on the output side, malpractice, criminal liability, administrative proscription of particular procedures, and government subsidization of particular services; on the input side, certification, licensure, public sector job specifications, and government subsidization of training inputs. The authors argue that information about the relationships of training, service, and outcome, even among experts, is so imperfect and controversial that all available options are seriously flawed, especially licensure. The authors conclude that much less frequently employed policy instruments may be as far as the government can prudently move in attempting to influence quality in the market for psychotherapeutic services. These include multiple certification regimes, government subsidization of services, and training programs or administrative proscription of procedures at the fringe of this market.