A recent publication by Veness, Tibble, Grenyer, Morris and Spittal et al. (2019) investigated the likelihood of a complaint to the regulator for a number of professions working under the Australian Health Practitioner Regulation Agency (AHPRA) scheme, including psychologists. The aim of this research was to determine the likelihood of a future complaint for mental health practitioners and to compare this with complaints about practitioners working in physical health.
Mental health and physical health practitioners
The study used a retrospective cohort design in which the researchers used registration and complaints data from AHPRA and for New South Wales from the NSW Health Professional Councils Authority. Data was collected for four groups: psychiatrists, psychologists, physicians (specialist medical practitioners), and other allied health practitioners (optometrists, physiotherapists, osteopaths and chiropractors). The study compared the data for the psychiatrists with that for physicians, given that both groups are medically trained for a similar period of time. The allied health group was the comparison group for psychologists. While it was acknowledged that there was no ideal comparison for psychology, it was argued that the allied health practitioners selected had similarities with psychology in that they had been regulated professions from the commencement of the national scheme. In addition, they have similar consultation processes to psychologists in that they provide individual therapies, often in private practice settings.
Scrutinising the data
The number, type and outcome of complaints for each of the four groups was recorded for all complaints over a six-year period (2011–2016). The researchers calculated incidence rate ratios to quantify the number of complaints. For complaint types, AHPRA codes these into 149 complaint categories which for this study were classified by the researchers into 16 ‘complaint issues’ listed under three broad headings: health of practitioner, performance and conduct. The incidence rate ratios for the groups were compared (adjusting for practice years); psychiatrists were compared with physicians and psychologists with allied health practitioners. Regression analysis was used to look at the association between practitioner characteristics (age, sex, practice location and rate of complaints) for mental health practitioners.
About the complaints
Between 2011 and 2016, 1944 complaints about psychiatrists (n = 3706), 2448 complaints about psychologists (n = 37201), 1917 complaints about physicians (n = 8303) and 1594 complaints about allied health practitioners (n = 64787) were made, the majority being complaints from patients or their relatives.
Making comparisons and drawing conclusions
The comparisons of complaint types between mental health practitioners and physical health practitioners make for interesting reading with differences in rates of complaints about for example, confidentiality, reports and interpersonal behaviour. The authors point out only a couple of examples. Mental health practitioners were more likely to have complaints about professional conduct issues (45.3% for psychiatrists and 64.4% for psychologists) when compared with physical health practitioners (29.2% for physicians and 56.8% for allied health practitioners). Complaints about sexual boundaries were considerably lower for all groups when compared to other conduct issues (4.4% of complaints about psychiatrists and 6.7% about psychologists compared to 3.7% for physicians and 7.5% for allied health practitioners).
Regarding the incidence rate ratios across groups, psychiatrists had more than double the complaint rate when compared to physicians (119.1 vs 48.0 complaints per 1000 practice years) and psychologists had almost triple the rate of other allied health practitioners (21.9 vs 7.5 complaints per 1000 practice years). Based on these figures there has been approximately one complaint per eight years for psychiatrists, per every 21 years for physicians, one every 46 years for psychologists and one every 134 years for allied health practitioners.
In looking at the outcomes of the multivariate analysis, after adjusting for sex and practice location, older mental health practitioners had a higher risk of having a complaint made than did younger practitioners with the risk increasing steadily by age. In addition male mental health practitioners (both psychiatrists and psychologists) had higher rates of complaints than did female mental health practitioners. Psychologists practising in regional or rural areas had a higher complaint rate than those in metropolitan areas (this was not the case for psychiatrists).
Final thoughts
Some of the results were not surprising in that they are consistent with previous research (e.g., practitioners who are older, male and working in settings likely to be more isolated being most at risk of complaints). Despite this, being reminded about the number and type of complaints received and how psychologists compare to other practitioners can be insightful and hopefully educative.
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