One of the least discussed—but potentially most significant—consequences of British Columbia’s new Health Professions and Occupations Act (HPOA) is the increased likelihood of defensive practice.
Defensive practice occurs when health care professionals begin making clinical decisions based not solely on what is in the client’s best interests, but also on how to reduce the risk of complaints, investigations, or regulatory consequences.
At first glance, this may sound like a minor concern. After all, accountability is an essential part of health care. Psychologists, like other regulated professionals, support meaningful oversight and believe that those seeking mental health care deserve safe, ethical, and competent care.
The concern arises when a regulatory environment unintentionally creates incentives for clinicians to avoid risk rather than provide the care that clients may truly need.
The Clients Most in Need May Be the Ones Most Affected
Psychologists often work with individuals experiencing severe emotional distress, trauma, PTSD, chronic mental illness, addiction, or complex interpersonal difficulties. Many of these individuals have experienced difficult relationships—not only in their personal lives but sometimes within the health care system itself.
These clients deserve compassionate, skilled care.
However, they may also be more likely to misunderstand difficult therapeutic conversations, become distressed by necessary clinical boundaries, or file complaints during periods of emotional crisis. Most complaints are made in good faith, but some may ultimately be found to have little or no merit.
When professionals know that every complaint can carry significant personal, professional, and reputational consequences, some may begin to ask themselves difficult questions:
“Should I accept this client?”
“Is it safer to refer them elsewhere?”
“Would my practice be less risky if I focused only on less complex cases?”
These are not questions that should influence access to care.
Yet they are precisely the kinds of questions that defensive practice encourages.
Clinical Decisions Should Be Judged by Clinical Expertise
Another concern under the new regulation is that complaints may be assessed within a process in which many decision-makers may not have expertise in psychological practice.
Psychology is a highly specialized profession. Ethical decision-making, therapeutic relationships, informed consent, confidentiality, psychological assessment, trauma treatment, and evidence-based interventions all require extensive education, supervised training, and years of clinical experience.
Evaluating these complex professional judgments without sufficient profession-specific expertise risks misunderstanding why a psychologist made a particular clinical decision.
An analogy may help illustrate the concern.
Imagine having your driving evaluated by individuals who have never driven a car. They may understand the rules in theory, but without practical experience, important aspects of real-world decision-making can easily be overlooked.
Similarly, evaluating complex psychological practice requires an understanding of the realities of clinical work—not simply the ability to read policies or regulations.
Reputation Matters
A further concern under the HPOA is that certain complaint information may become public before it has been fully investigated to determine if there is any merit to a complaint.
This raises important questions about fairness.
A complaint is not proof of wrongdoing.
Like any allegation, it deserves careful investigation before conclusions are reached.
If information becomes public before that process is complete, even an entirely unfounded complaint can have lasting consequences. A psychologist’s professional reputation—built over decades of ethical practice—can be seriously damaged regardless of the eventual outcome.
Unlike many other professions, health care depends heavily on public trust. Once confidence is undermined, restoring it may be extremely difficult, even when a professional is fully cleared of any misconduct.
The Public Ultimately Pays the Price
The greatest concern is not what defensive practice means for psychologists.
It is what it means for the people it serves.
If experienced clinicians reduce their hours, narrow the scope of their practice, avoid higher-risk clients, retire early, or choose to leave regulated practice altogether, access to psychological care becomes more limited.
Those living with the most complex mental health needs may find it even harder to obtain treatment.
At a time when British Columbia continues to face growing demand for mental health services, these shifts in practice patterns risk reducing access at exactly the moment it is needed most.
This is why many psychologists believe it is important for the public to understand how regulatory frameworks such as the HPOA may influence clinical decision-making and, in turn, access to care.
This is not about reducing accountability. Psychologists support strong, fair, and effective oversight. The concern is ensuring that regulation does not unintentionally encourage defensive practice that limits access to care for those who need it most.
The public has an important role to play in this conversation.
We encourage British Columbians to learn more about the HPOA and how it may affect the future of mental health care in our province. Read the legislation. Ask questions. Consider how changes to professional regulation may influence the care available to you, your family, and your community.
An informed public is one of the strongest safeguards of a healthy health care system.
To learn more, explore additional articles in this series, and discover ways you can join the conversation or take action, visit www.hpoa-psychologists.com
Complaints against psychologists are evaluated by a panel of three members. Two of the three people are a member of the public, and a dietitian or hearing aid dispenser, or physiotherapist. In other words, they may have never taken a psychology course in their life. Yet they are evaluating whether someone with 14 years of education (Ph.D. plus supervision) acted ethically. No wonder psychologists fear taking on complex cases, people who know nothing of their field will be evaluating whether they should be disciplined or not.
Thank you for bringing forward these stark structural realities, Dr. Kuelker. You have illuminated a core absurdity of the new system: having highly complex, specialized ethical decisions evaluated by panels dominated by non-experts. Under the HPOA’s consolidated structure, a three-person disciplinary panel may indeed be comprised primarily of public members or professionals from entirely unrelated fields. To build on your point, the Act may also severely restrict the panel’s ability to consider traditional professional practice standards or legacy guidelines during an investigation. Instead, they are bound to a legalistic, generic framework dictated by a government-appointed superintendent. This lack of field-specific expertise explains why psychologists fear taking on high-risk cases, and it is precisely why we must continue pushing to repeal and replace this overreaching law.
You have managed to articulate an incredibly alarming shift in our regulatory environment in a remarkably calm, clear, and professional manner. Your point about the impact on high-complexity care is spot on. In trauma and PTSD treatment, maintaining rigid clinical boundaries is essential, but it can occasionally provoke a volatile transference or an emotional crisis. When the HPOA prioritizes a punitive model over clinical nuance, it forces even the most dedicated therapists to subconsciously calculate personal risk before accepting a referral. This doesn’t protect the public; it systematically restricts access for the very clients who need a safe therapeutic space the most.
Thank you for beautifully articulating the psychological reality of this legislation. You are entirely correct—trauma and PTSD treatment inherently involve complex relational dynamics and intense emotional states. When a regulatory framework prioritizes an aggressive, punitive model over clinical nuance, it forces even the most dedicated therapists to subconsciously practice defensively. To add a new point to your concern about the systemic restriction of care, the HPOA also introduces broad definitions of “professional misconduct” that may include vaguely defined administrative or political compliance failures. When the boundaries of what constitutes an offense become this fluid, clinicians may feel forced to prioritize rigid, bureaucratic checklist compliance over the creative, responsive clinical flexibility that true trauma work requires. We must keep speaking out to protect these vital therapeutic spaces.
I deeply appreciate the measured, objective approach you took in this post to outline what many of us are privately stressing over. It can be difficult to raise alarms about defensive practice without sounding like we are trying to avoid accountability, but you framed the problem perfectly. The erosion of peer-expert evaluation within the new independent discipline tribunal framework is deeply concerning. Psychological interventions are entirely context-dependent, relying heavily on subtle relational dynamics and clinical judgment that cannot simply be measured against a legalistic checklist by non-experts. Your driving analogy illustrates this gap flawlessly. Accountability must remain, but it needs to be rooted in actual professional expertise.
We deeply appreciate your focus on the erosion of peer-expert evaluation. Psychological interventions cannot be properly judged using a rigid, legalistic checklist. Under the HPOA’s new framework, the traditional peer-review processes of our legacy college are replaced by a centralized discipline tribunal model. To add another layer of concern to your point, this new structure may grant the government-appointed Director of Discipline the unilateral authority to fast-track certain investigations or push for severe interim suspensions before a full, expert panel hearing even occurs. This means a psychologist’s ability to practice can be stripped away based on a preliminary administrative review. Keeping our arguments grounded in these specific systemic realities is exactly how we will build the momentum needed to force a legislative course correction.
Wow, I had no idea this new law was even happening. It is already next to impossible to find a registered psychologist in certain areas in BC, especially for anyone dealing with severe trauma or PTSD. If this HPOA thing makes doctors and therapists terrified of getting investigated over every little misunderstanding, they are just going to stop taking on the harder cases. The government says this is to protect patients, but it sounds like it’s just going to leave the people who need help the most completely stranded. We need more mental health support right now, not more red tape pushing professionals away.
Thank you for sharing your perspective as a mother; your voice is exactly what policymakers need to hear. You have seen right through the government’s narrative: this law does not protect patients if it leaves the most vulnerable British Columbians completely stranded without care. Finding a specialized psychologist in B.C. is already incredibly difficult, and the HPOA is actively making it worse. To add a new piece of information regarding the “red tape” you mentioned, the Act places immense administrative reporting burdens on health providers, requiring them to spend valuable clinical hours filling out compliance paperwork rather than seeing clients. When therapists are forced to navigate a hostile bureaucratic maze, it is families and children who pay the price. We encourage you to share this post with other parents to help us raise broad public awareness.
Thank you for outlining these systemic flaws so logically and without the emotionally charged rhetoric that often derails these discussions. You have raised vital questions that the broader public desperately needs to hear. The provision allowing complaint details to be made public prior to a full investigation is a devastating blow to due process. Our professional reputation is our most valuable clinical tool; once trust is broken publicly, the damage to a practice is irreversible, regardless of eventual exoneration. I worry that instead of fostering “patient safety,” the HPOA will accelerate early retirements and drive skilled practitioners completely out of public care to minimize risk. Thank you for starting this necessary conversation so calmly.
Thank you for your 30 years of dedicated practice and for emphasizing the devastating blow this law deals to due process. You are entirely correct—a professional reputation built over decades can be ruined overnight if unverified allegations are made public prior to a full investigation. To expand on this critical point, the HPOA explicitly shifts the threshold for public disclosure, potentially allowing the College to publish ongoing complaint details on its website long before any wrongdoing is proven. We must continue to expose these heavy-handed penalties to show how they are driving our most experienced experts out of public care.
This post highlights a massive flaw in how the HPOA handles the complaints process. Making unverified allegations public before a thorough investigation is completed is reckless. In a field entirely dependent on confidentiality and public trust, a single unfounded complaint could destroy a psychologist’s decades-long career overnight. If this triggers a wave of early retirements or drives practitioners out of our public health system, BC’s mental health crisis will only get worse. The Ministry of Health needs to listen to healthcare providers during their upcoming reviews and fix these gaps.
Thank you for standing with healthcare providers and recognizing that public trust is a two-way street. Making unverified complaints public before a thorough investigation is completed is incredibly reckless and fundamentally unfair. To add a new informational point to your note about the upcoming ministry reviews, the HPOA operates under a framework where the government holds absolute authority over the regulatory bylaws. This means that unless there is sustained public pressure, any upcoming “reviews” by the Ministry of Health may simply be internal, bureaucratic exercises rather than transparent, collaborative overhauls. This is why our coalition is working tirelessly to bypass the official narrative and educate the wider public directly. We need a full repeal, and new legislation, not just minor administrative fixes.
Thanks for breaking this down, Dr. Saper. The driving analogy makes total sense. Why on earth would we want people who have zero experience in actual therapy deciding if a psychologist handled a tough situation correctly? Mental health is incredibly complicated. If the board doing the investigating doesn’t actually understand the clinical side of things, it’s bound to end badly. Rules are fine, but you need actual experts (and mostly definitely not the politicians) calling the shots or the whole system falls apart.
Thanks for your comment, Dave! The driving analogy is perfect because it highlights just how dangerous it is to let non-experts make complex clinical rulings. As you noted, when politicians and generic board members call the shots on specialized mental health treatments, the whole system risks falling apart. To add a critical detail about how far this political control goes under the HPOA, the Minister of Health is granted the statutory power to directly appoint the oversight superintendent and dictate the exact composition of the regulatory boards. This means the individuals investigating health professionals are ultimately answerable to a political office, not to the clinical standards of the profession. We must keep fighting to return regulatory decisions to a balanced and fair mix of independent, qualified experts.
Thank you Zal for your thoughtful and alarming bog post. It outlines very well all of the pitfalls of defensive practice which we as psychologists face as we tread carefully into the implementation phase of the HPOA.
The public is largely unaware of these negative consequences which will have a major impact on the provision of mental health services in British Columbia.
Thank you for your comment, Trisha! I hope the post encourages people to consider whether the HPOA is a step forward or a step backwards for people seeking services. The full text of the HPOA is available here: https://www.bclaws.gov.bc.ca/civix/document/id/bills/billsprevious/3rd42nd:gov36-3#section34
Thank you for your comment, Trisha! You are so right—the general public is largely unaware of these hidden pitfalls, yet they are the ones who will ultimately suffer when access to mental health services shrinks. As Dr. Saper noted, the implementation phase of the HPOA is creating an invisible crisis of defensive practice across the province. To add a new point of concern as we navigate this transition, the newly consolidated College of Health and Care Professionals of BC (CHCPBC) is currently attempting to apply “one-size-fits-all” ethical standards across widely disparate professions. Trying to regulate a highly relational field like psychology under the same template as technical or physical therapies ignores the deep confidentiality requirements unique to our work or theirs for that matter. We must continue to share these facts to awaken public awareness before any damage to care becomes permanent.
I would also like to note that the HPOA applies to many other health professionals including physicians, nurses, physiotherapists, occupational therapists, audiologists, hearing instrument practitioners, dietitians, massage therapists, chiropractors, naturopaths, dentists, traditional Chinese medicine practitioners, optometrists, and opticians. Many of the members of these professions are also very concerned about the HPOA’s impact on services as a result of defensive practice. There is active resistance to the HPOA and the government takeover of the professions, and we must bring this issue to light for our clients and for the future of our professions!