Delay in counselling therapist regulation hindering access for Indigenous people in Alberta

Mental health professionals say the Alberta government's delay in creating a new professional college for counselling therapists is creating financial and logistical barriers for Indigenous people seeking help. 

Indigenous people can't receive coverage under the First Nations and Inuit Non-Insured Health Benefits (NIHB) plan for sessions with Alberta counselling therapists because the federal program only covers fees for practitioners that are regulated by a professional college.

Counselling therapists in Alberta are not regulated. Alberta's United Conservative government could change that by proclaiming a regulation but has delayed doing so, previously stating it was not a priority.

Leigh Sheldon, CEO of Indigenous Psychological Services and a member of the Swan River First Nation near Slave Lake, said creating the proposed College of Counselling Therapy of Alberta (CCTA) would increase the pool of practitioners who could become eligible providers under NIHB. 

"It would change so much because we have a lot of clients who need to get in and there's not enough providers," Sheldon said in an interview. 

"To become a provider is such a huge barrier, that if a counsellor or a mental health therapist or even a provisional [psychologist] that can get on that list, it would really support our people in need."

Shaheen Alarakhia, owner of Holistic Healing Counselling in Edmonton, has had to turn people away. Although she is designated a Canadian Certified Counsellor, NIHB won't pay for her services because she doesn't belong to a professional college. 

Alarakhia recalls an Indigenous woman who was disappointed to learn Alarakhia's services weren't covered under NIHB.

"She shared with me that I was the sixth person that she called, that she had been wanting to work on some of the trauma that she has gone through," Alarakhia said. 

"I'm competent to do the things that she wanted to work on but I couldn't be the one to help her."

Ontario, Quebec, New Brunswick, Prince Edward Island and Nova Scotia have professional colleges to oversee the work of counselling therapists and psychotherapists. Regulation of professions is a provincial responsibility.

Indigenous Services Canada administers the NIHB. A department spokesperson confirmed counselling therapists and psychotherapists in those five provinces are eligible providers under the plan, which provides 22 hours of counselling each year to Indigenous people or more if required on a case-by-case basis. 

"If counselling therapists in Alberta were to come to be regulated by a legislated regulatory body, as they have in some other provinces, this category of licensed professionals would meet the eligibility criteria for the NIHB Program, once they are eligible for independent, unsupervised practice," spokesperson Matthew Gutsch said in an email.

Not a government priority

The nearly two-decade push to regulate counselling therapists and protect vulnerable clients from unethical and untrained practitioners is close to the finish line. 

After the Mental Health Services Protection Act was passed by the previous NDP government in December 2018, the Association of Counselling Therapy of Alberta (ACTA) came into being. 

ACTA's purpose was to lay the groundwork for transitioning into the CCTA, which would make counselling therapists, addictions counsellors and child and youth care counsellors subject to a code of ethics, standards of practice and a disciplinary process.  

ACTA has signed up hundreds of counselling professionals. It has a registrar and has created all the regulations, bylaws and standards of practice required to provide oversight for its members. All that is left in the process is for cabinet to proclaim the CCTA regulation. 

That proclamation was expected in the summer of 2021 but by September of that year then-minister of health Tyler Shandro informed the association that creating the CCTA was no longer a priority for his government.

When previously asked about the reason for the delay, the Alberta government wasn't clear about what the issue was.

Mental Health and Addictions Minister Nicholas Milliken was not available for an interview for this story. 

His press secretary, Colin Aitchison, said the government wants to do more consultation because Indigenous communities have asked the province not to proceed with the regulation.

"We acknowledge this work has not moved forward as quickly as we would have liked," Aitchison wrote in an email to CBC News. 

"The team at Alberta Health that is responsible for consulting on the establishment of a new college is the same team that has been focused significantly on the positioning and implementation of other regulatory work, as well as being involved in health workforce priorities.

"Entering 2023, we are looking forward to making progress and continuing to consult with stakeholders and Indigenous communities."

Waiting lists

As the delay continues, Indigenous Albertans face lengthy waits to see registered psychologists, registered clinical social workers and registered psychiatric nurses, the Alberta providers who are eligible under NIHB.

Seeing a counselling therapist means having to pay for the service out-of-pocket — which can be around $200 an hour. 

Sheldon said she has about 89 people waiting each month to see one of her eligible providers. 

The scope of the problem is large. Sheldon offered more than 2,000 free counselling sessions within eight months to people who couldn't access the NIHB program but had to stop because it wasn't sustainable. 

Sheldon said Indigenous people need the right kind of support, which includes an emphasis on the healing aspects of their culture in additional to counselling. She said making people wait for six months or more for help creates more harm.  

"When you're turning a residential school survivor away because we don't have a provider, that's not OK and it's really disheartening," she said.