Mental health clinics in the Maldives are struggling to continue treating hundreds of patients after a new regulation rendered a majority of staff ineligible to become licensed professionals.
According to new criteria published in the government gazette by the health ministry on May 10, a masters degree and 500 hours of clinical experience will be required to register at the Allied Health Council as behavioural analyst psychologists.
Clinical, child, counselling, or applied psychologists must have a doctorate (PhD or PsyD) and 1,000 hours of experience.
Citing articles 91 and 92 of the 2015 Health Professionals Act, the Allied Health Council then announced on May 25 that the penalty for working without a license is a fine not exceeding MVR50,000 (US$3,200).
The announcement forced the Malé-based Maldives Institute of Psychological Services, Training, and Research (MIPSTAR) to temporarily halt its psychological services last week as only three of its 10 technical staff were eligible to practice.
MIPSTAR said it provides consultation services to nearly 3,000 patients.
The Institute of Counselling and Psychology was meanwhile left with only three out of nine psychologists to treat 500 patients. The ICP can now only attend to the most critical patients.
Despite growing mental health problems among the population, the Maldives has an acute shortage of qualified mental health professionals. Appointments to consult psychiatrists at the government-run Indira Gandhi Memorial Hospital and the private ADK hospital often take days to secure.
The new rules have drawn stringent criticism as graduates who were working as assistant psychologists are no longer eligible to practice even as interns under the supervision of qualified psychologists.
However, professionals with a bachelor’s degree will be able to register as a “psychologist’s assistant” with the Maldives Board of Health Services before April 1.
On Sunday, disqualified staff from MIPSTAR and ICP along with new psychology graduates from the Maldives National University met separately with health ministry officials and members of the Allied Health Council.
Mariyam Muslima, a counsellor from MIPSTAR, told The Maldives Independent that the council insisted that mental health professionals were consulted before formulating the rules.
“They said that the professionals they consulted had told them that a graduate of a three-year degree programme was not competent enough to practice psychology,” she said.
But the council declined to name the professionals they consulted, she added.
The council members also said that the MNU’s psychology degree programme was of “low quality.”
However, the meeting with Health Minister Dr Iruthisham Adam and senior ministry officials was more positive, Muslima said.
“The minister thanked us for going to discuss our concerns, and assured us that it [new rules] will be reviewed,” she said.
A health ministry spokesperson told The Maldives Independent that the council will have a meeting to discuss the issues. The official stressed that the health council is a semi-autonomous body functioning under the ministry.
Nayaz Ahmed, president of the council, said it would “take the necessary steps” to address the concerns.
Asked whether the council took into consideration the shortage of PhD holders as well as the implications for students pursuing a bachelor’s degree at MNU, Nayaz said that the council consulted behavioural science “experts”.
The council believed the new criteria was necessary to regulate the mental health profession, he added.
Mental health professionals, including Dr Aishath Ali Naaz who heads MIPSTAR and Dr Mariyam Shakeela, a former health minister, who heads the ICP, have taken to social media to raise concerns.
Naaz told The Maldives Independent that the clinic is “swamped” as three psychologists are attempting to treat nearly 3,000 patients.
“We’ve had over five graduates from countries like US, UK, Australia, and India practicing here for over a year. None of them were ever asked to do anything without being given instructions or under my supervision, and their work was excellent,” she said.
Saudha Fathmath from the ICP, a clinic which opened six months ago, said: “I’m really concerned about the regulation. Right now, we can only attend the most urgent, critical patients. We cannot close the center and alienate critical patients like those with suicidal tendencies, but considering the high demand, it’s impossible to do for one or two people alone.”
Dr Naaz also questioned how students with a government bond – a legal obligation to serve after graduating – could find employment if they were required to have 500 hours of clinical experience.
“Clinical experience is important for graduate students to decide on a field to major in,” she said.
The national university meanwhile began offering a bachelor’s degree in psychology three years ago.
Aishath Shanoora, a lecturer and head of the psychology department, told Sun Online that her students should be able to work under supervision after graduating.
“If it’s not made possible, there is no future in this field not for students, not for the country,” she said.
Saudha, a former lecturer at MNU, also defended the psychology programme: “It has assessments, requires the completion of a certain number of clinical hours. The staff I had working for me who studied at MNU, were very, very good. They were familiar with the assessments they had to do, they had done it before during the course.”
While she agreed with the need for regulatory and oversight bodies, Saudha said ground realities must be taken into account when enacting regulations.
“State institutions like the police, the FCPD sometimes need psychological assessments. Laws for child abuse also require psychological assessments. If centers like ours are not functional, who will do those assessments?” she asked.
She also noted that clinical experience is a prerequisite for many masters degree programmes overseas.
“How do bachelor’s degree graduates get this experience if they cannot even work as an intern under supervision?” she asked.
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