Dear College of Health and Care Professionals of BC,

Thank you for the opportunity to provide feedback on the draft Quality Assurance (QA) bylaws. We are deeply concerned that several of the proposed provisions, while perhaps intended to protect the public, risk undermining patient safety, confidentiality, and the ability of psychologists to provide ethical and effective care. Below, the following are outlined: (1) general concerns, (2) a section-by-section review of the bylaws with specific concerns, and (3) recommendations.

1. General Concerns with the Proposed Bylaws

• Blurring of Quality Assurance and Discipline: The broad investigative powers in the draft bylaws shift QA away from a supportive, developmental process and toward a disciplinary function.
• Erosion of Confidentiality and Ethical Obligations: Provisions requiring access to patient records or third-party information without consent place psychologists in direct conflict with ethical codes and undermine patient trust.
• Defensive Practice and Reduced Clinical Transparency: Psychologists may feel compelled to practice defensively, limit their caseloads to less complex or “lower-risk” clients, and reduce openness in clinical discussions, which diminishes quality of care.
• Negative Impact on Patients: These changes risk harming the very individuals QA is meant to protect, particularly those with complex needs, by discouraging clinicians from engaging fully and transparently.

2. Section-by-section review of the proposed bylaws with specific concerns

QA Group 

Bylaw 10.7 - The composition of the QA Group may include, but is not limited to, employees of the College.

Concerns:

• Including College employees in QA groups raises serious concerns about independence and impartiality. Without safeguards, the process risks being influenced by organizational or political priorities rather than professional standards of care.
• This could create an atmosphere of surveillance for psychologists, discouraging openness and increasing stress. When psychologists fear bias, they may become less willing to engage fully in QA processes, which reduces the potential for genuine learning and improvement.
• Impact on patients: Provider stress and defensive practice reduce the quality of care and make it harder for patients to access supportive, open therapeutic environments.

Grounds for a Quality Assurance Assessment

Bylaw 10.11 - In addition to assessment grounds in section 99(1)(a) to (c) of the Act, a Quality Assurance Assessor may conduct a Quality Assurance Assessment of a Licensee in any of the following circumstances:

(a) as a result of a non-random selection process with the intention that every Licensee, or every Licensee in a specific class, periodically undergoes a Quality Assurance Assessment;

(b) in compliance with a condition imposed under the Act;

(c) as contemplated by any grounds set out in the QA Program; and

(d) on a recommendation by the Registrar on any basis other than those prohibited by section 98(2) of the Act.

Concerns:

• Mandatory, broad assessments of all licensees—without cause—place heavy time and energy demands on psychologists. This time is taken directly from patient care. Longer waitlists, interrupted continuity of care, and less availability of psychologists when they are needed most. This especially affects vulnerable populations with limited access to mental health services.

Methods of Quality Assurance Assessment

Bylaw 10.12 - In addition to the methods of assessment in section 99(2)(a) to (c) of the Act, a Quality Assurance Assessor may do one or more of the following, for the purposes of conducting a Quality Assurance Assessment of a Licensee:

(a) Contacting peers, professional colleagues, and co-workers

Concerns:

• Colleagues may carry professional biases or personal conflicts, leading to unfair or distorted evaluations. This risks harming a psychologist’s reputation and career without improving patient safety.

(b) Contacting patients and/or family members (with consent)

Concerns:

• Vulnerability of patients: Patients are already experiencing mental health challenges and are vulnerable to bias. Involving them in evaluating their therapist undermines the therapeutic relationship, risks re-traumatization, and could discourage patients from being open in therapy.
• Breach of privacy and disclosure risks: Some patients’ families may not even know they are seeking psychological services. Contacting family members could inadvertently “out” someone’s involvement with mental health care, violating privacy in a deeply harmful way.
• Not aligned with patient best interests: The process is not intended to support the patient’s treatment, but to review the psychologist’s performance. This shifts focus away from patient well-being and instead uses patients and their families as tools in a regulatory process.
• Risk of re-traumatization: Asking vulnerable patients or their family members to provide evaluations about therapy can trigger feelings of judgment, betrayal, or invalidation. This undermines the therapeutic alliance and may worsen mental health symptoms.
• Therapeutic relationship damage: Therapy depends on trust and confidentiality. If patients know that their therapist might be evaluated through direct feedback from them or their family, they may hold back sensitive disclosures or withdraw from treatment altogether.
• Bias and lack of fairness: Family members may not understand the clinical context of therapy and could misinterpret a therapist’s interventions. Their opinions may reflect personal conflicts, cultural stigma, or misunderstandings rather than professional performance.
• Safety risks: Involving family members could be dangerous in cases of domestic violence, family estrangement, or abusive dynamics. It could expose patients to harm if family members gain access to information about their therapy.
• Erosion of public trust: Knowing that the College might contact patients or families to comment on their psychologist may discourage individuals from seeking psychological services at all, reducing access to care across the province.

(c) Reviewing specified or random patient records

Concerns:

• Breach of confidentiality: Patient records contain highly sensitive details that are shared under the assumption of privacy. Reviewing these without clear cause is in direct conflict with our professional Code of Conduct and undermines the foundation of trust in psychological care.
• Risk of defensive record-keeping: If psychologists know their records may be randomly audited, they may write notes defensively, focusing on legal protection rather than clinical utility. This results in records that are less helpful for treatment continuity and less authentic to the therapeutic process, ultimately harming patient care.
• Misinterpretation without context: Records often do not capture the nuance of the therapeutic relationship, cultural context, or clinical judgment. Taken out of context, treatment decisions or progress notes may appear problematic when, in reality, they reflect appropriate and effective care.
• Violation of patient safety and privacy: Patients may avoid disclosing sensitive or stigmatized information (e.g., trauma, suicidal thoughts, family conflict) if they fear their records could be reviewed by the College. This compromises the depth and honesty needed for effective treatment.
• Erosion of trust in psychological services: If patients believe their records could be accessed without consent and without a specific risk being identified, they may avoid therapy altogether—reducing access to critical care.

(d) Reviewing the licensee’s professional activity history (patterns of referrals, diagnoses, treatment, etc.)

Concerns:

• Risk of Unfair Judgment in Complex Cases: Complex cases often require unusual patterns of care. If these are reviewed without context, psychologists may be judged unfairly for serving high-needs or complex clients, leading to defensive practice and fewer psychologists willing to take on challenging cases.
• Significant Administrative Burden: Reviewing a clinician’s history would require client consent for access to records. This creates heavy workload demands in contacting clients, tracking permissions, and managing disclosures, diverting time from clinical care.

(e) Interviewing or engaging in discussions with the licensee

Concerns:

• Adversarial and Time-Consuming Process: These interviews can feel adversarial and stressful, especially without clear safeguards separating QA from discipline. Time spent preparing for and attending these discussions takes away from patient care.

(f) Requiring the licensee to undergo a specific clinical skills assessment

Concerns:

• Stressful and Unrepresentative Skills Assessments: Skills assessments can be time-consuming, stressful, and may not reflect the psychologist’s actual competence in real-world therapeutic relationships. They also take significant time and energy away from serving patients.

 

(g) Conducting an on-site peer assessment of the licensee’s practice

Concerns:

• Undermines Confidentiality and Therapeutic Integrity: Having observers present during therapy sessions undermines confidentiality and patient safety, discourages disclosure, and may deter clients from seeking services. It also interferes with psychologists’ ability to provide care, ignoring that therapy and assessment depend on privacy and the therapeutic relationship.

Bylaw 10.13 - A Licensee who is not the subject of a Quality Assurance Assessment must provide any information or records requested by a Quality Assurance Assessor.

Concerns:

• Direct Conflict with Ethics and Confidentiality: Forcing psychologists to turn over records without patient consent directly conflicts with the Code of Ethics and risks breaching confidentiality.
• Impossible Position for Psychologists: Psychologists would be forced to choose between obeying the College and upholding their ethical obligations.
• Erosion of Public Trust: Patients whose records are shared without consent may lose trust in the profession and healthcare system, reducing willingness to seek care or disclose sensitive information.
• Unreliable and Harmful Feedback Sources: Having patients or colleagues evaluate a psychologist’s performance risks biased, harmful, or re-traumatizing input due to mental health challenges, therapeutic dynamics, or professional rivalries.
• Negative Impact on Patients: Breaches of confidentiality and involving patients in reviews undermine trust, discourage disclosure, and harm the therapeutic conditions necessary for safe and effective care.

3. Recommendations

We urge the revision of these sections of the proposed bylaws to better protect both patients and providers. Specifically, QA processes must:

1. Protect patient confidentiality and require consent for access to clinical records.
2. Ensure assessor independence and eliminate conflicts of interest.
3. Limit broad, non-targeted reviews that reduce patient access to care.
4. Keep Quality Assurance clearly separate from disciplinary investigations.