KOWHEORI-19
COVID-19
Te Poari o ngā Kaihaumanu Hinengaro o Aotearoa (the Board) acknowledges the mahi of psychotherapists. Psychotherapists have and continue to manage the challenges of the COVID-19 endemic while supporting the well-being of their clients.
Update as of 19 October 2022
Yesterday, Cabinet carried out another scheduled review of the COVID-19 public health settings. Due to the recent increases in case numbers, and the new Omicron subvariants that are driving waves of infection overseas, the advice from Manatū Hauora (the Ministry of Health) was that the 7-day isolation period and the requirement to wear masks in certain healthcare settings should remain for the time being.
The next review will take place by the end of November. In the meantime, the ‘Epidemic Notice’ ― which currently gives effect to the self-isolation and mask-wearing measures ― will not be renewed. If the Manatū Hauora public health team believes some more controls are needed, measures such as general mask-wearing requirements can be put in place, under the COVID-19 Public Health Response Act.
Update as of 12 September 2022
The Prime Minister has announced that:
Covid-19: Omicron
Aotearoa New Zealand has Omicron in the community and the country has a three-phase response process.
There is more information available about each of the phases on the Ministry of Health’s website. The information covers both what this means for members of the public and what this will mean for critical health workers (including psychotherapists) regarding their work.
Phase One: There are some cases in the community
Phase Two: Cases have spread in the community
Phase Three: There are thousands of cases per day
Covid/ Omicron update: as of 14 July 2022
According to the Ministry of Health, we’re at the beginning of a second Omicron wave that could be bigger than the first, with the more transmissible BA.5 variant becoming the dominant strain in the community..
The mandate for allied health workers still applies: all Psychotherpists are required to be vaccinated in order to undertake face to face (in person) work with clients. Telehealth remains an option for unvaccinated Psychotherapists.
Following the earlier announcement on the second COVID-19 booster becoming available to people over 50, health and disability workers aged 30+ and people aged 16+ with pre-existing conditions that place them at higher risk, the eligibility criteria for free RATs has been removed so they are even more freely available. Packs of medical masks will be provided free along with free RAT kits from testing centres (and in more locations) by the end of the coming week.
Covid/ Omicron update: as of 29 April 2022
Although New Zealand has moved to the Orange setting of the traffic light system, there is a need to remember, the country is still very much in response mode.
Hence the requirement, (in accordance with the COVID-19 Public Health Response (Vaccinations) Order 2021), “all allied health practitioners (including practising Psychotherapists) must be fully vaccinated”, still applies.
However, there is a provision for a vaccine exemption as per section 7b of the Order. and Schedule 2 Part 7. In addition, there is a forthcoming valid/lawful mask exemption (see below)
Vaccination update: vaccine exemptions
For those contemplating applying for a vaccine exemption, it is recommended you familarise yourself with the following Ministry of Health sites: COVID-19: Exemptions from vaccination | Ministry of Health NZ and here: COVID-19: Mandatory vaccinations | Ministry of Health NZ
Please note: Vaccine exemptions are not readily granted.
Valid vaccine exemptions
The only lawful, valid exemption is an exemption granted by the Director General of Health. Refer section 9b of the Order. This is because of earlier abuse of the exemption-application system, which resulted in Amendments to the Vaccination Order (late last year).
For persons who are in receipt of a valid exemption, there are guidelines that must be adhered to, including the date on which the exemption expires (see below).
In summary, the key points are:
- An application for an exemption must meet the specified exemption criteria (set out in section 9A of the Order)
- Only a Director General approved/issued exemption is lawful and valid.
- If an application is accepted, a copy of the exemption (including the expiry date) will be sent to the practitioner concerned from the Director General.
- There may be conditions attached to the exemption: these must be adhered to.
- Current valid exemptions are timebound (a period of no longer than 6 months).
What if a vaccine exemption is found to be not, or no longer lawful/valid:
a) practitioners will be at risk of breaching the vaccination order if they provide ‘in person’ treatment, and therefore, being fined by the Ministry of Health;
b) if their health and safety measures are insufficient, they risk investigation or prosecution by MBIE; and
c) a client could also complain to the HDC if they felt that their psychotherapist was practising when they were unvaccinated and not exempt from vaccination, or if their health and safety measures exposed them to COVID.
Therefore:
- If a psychotherapist is granted/holds a lawful valid exemption, they must take appropriate health and safety steps to protect their clients;
- A psychotherapist should disclose their vaccination status – or their exemption status - if asked by a client: this information is relevant to a client making a fully informed decision about receiving treatment from that person.
- From a general health and safety perspective, it may be that the risk of infection can only be properly addressed by not providing health services ‘in person’ (as per the risk assessment guidelines stated below, on this website). This is something that a psychotherapist will need to carefully consider.
Mask exemptions
Mask wearing remains a very important part of the public health response to the ongoing Omicron outbreak.
In the week of 25 -29 April, the Government announced a new face covering exemption card will be available to apply for from 31 May.
Changes to the COVID-19 legislation will be enacted to recognise this exemption card as proof of a genuine exemption. As well as having legal status, the cards will be linked to a person’s National Health Index (NHI) number and will have their name printed on them.
Earlier Covid 19 updates
As at midnight Tuesday 15 February, the country moved from Phase One to Phase Two. As of 24th February the country moved into Phase Three.
Also on 15 February, the mandatory vaccination was amended to give ‘2nd vaccinated’ psychotherapists a little more time to receive their booster vaccinations. The new due-by date was extended to 24 February.
You can find more information about this on the Ministry of Health website.
For psychotherapists the Board’s guidance remains as before. In work with clients, psychotherapists’ use of surgical masks, or online via digital media will continue to be the best practice during each of the phases.
Clinical reasoning and risk assessment remain the fundamental principles for considering care and whether a psychotherapist sees a client kanohi-ki-te-kanohi (with the appropriate processes in place) or remotely. The Ministry of Health’s risk assessment guide provides information on risk factors to consider.
Phase Two: ‘critical workers’ continuing to work
When Phase Two of the Omicron response was announced on 15 February, critical workers in health were provided with a pathway that enabled them to continue to work kanohi-ki-te-kanohi. The pathway allowed critical health workers to be exempted from health orders (which requires the public to isolate after becoming ‘close contacts’ or having been infected). However, the provision to continue to work only applied and still applies to critical workers who register on the Close Contact Exemption Scheme. It requires those who register to follow alternate public health rules (see below).
Psychotherapists can find more information on the Close Contact Exemption Scheme on the Ministry of Health website. To register for the scheme you need to go to the Close Contact Exemption Scheme registration portal hosted by the Ministry of Business, Innovation and Employment. More information is available at business.govt.nz.
In the event of a psychotherapist being exposed to someone with Covid-19, or having been infected themselves, or as an asymptomatic-close-contact of a Covid-19 case, their safe return to work is paramount. Psychotherapists who are vaccinated and have registered on the Close Contact Exemption Scheme will be able to continue to work if a) they return a negative rapid antigen test (see below for more details) prior to each day they are at work during the isolation period, and b) they are following the risk assessment guidelines (as outlined above). It also means psychotherapists will only be allowed to go to work – not anywhere else.
Rapid Antigen Testing (RAT)
In Phase Two the following information was provided about Rapid Antigen Testing (RAT) and its sage in regard to employees returning to their place of work. The link to the Minuistry of Health website also contains the details on collecting test kits and undertaking a RAT (test) as part of the scheme.
During Phase Two fo those registering for the scheme, psychotherapists were provided with information about RAT: including information about RAT test-kit collection sites in their area. More information is also available at business.govt.nz
RATs are not mandatory and won’t be suitable for everyone. Psychotherapists also have the option to work remotely via digital media. It is up to each psychotherapist to assess whether to register as a critical worker and use RATs to enable an early return to kanohi-ki-te-kanohi work.
Phase Three: as of 24 February 2022
Now that we are in Phase Three of the Omicron response, much of the information provided for Phase Two still applies. However, because of the widespread nature of Omicron in the community the use of PCR testing has been replaced by the provision of RAT test-kits to anyone requesting them. Testing Guidance was published on the Ministry of Health website on 3 March.
As of Friday 11 March, for those who have been infected and for those who are close contacts (in the same household) the isolation period changes from 10 days to 7 days. Further information, updates and links to the Ministry of Health website will be added to this website as new Phase Three details are announced.
Please be mindful that the various sections of the Covid-19 section of the Ministry of Health website and the business.govt.nz website continue to be updated almost daily.
Other Covid-related information
Protection Framework (traffic light system)
Aotearoa New Zealand moved into the COVID-19 Protection Framework (traffic light system) on the 3rd December 2021. The COVID-19 Public Health Response (Protection Framework) Order 2021 (the Order) sets out the requirements for each traffic light setting.
The Order aims to prevent, and limit the risk of, the outbreak or spread of COVID-19, and implements the new traffic light system.
What is the Traffic lights system designed to do?
Red is designed to protect at-risk people and the health system from an unsustainable number of hospitalisations.
Orange is designed to reduce increasing community transmission that is putting pressure on the public health system and at-risk people.
Green is designed to minimise the cases of COVID-19 community transmission.
What does this mean for psychotherapists?
To support allied health professionals the Ministry of Health released a COVID-19 Protection Framework (guidance)along with a flowchart for determining how to operate, including the use of vaccine certificates.
Psychotherapists can operate under all levels of the traffic light system and 'are still required to meet certain requirements, including requirements to display QR codes, maintain contact tracing records. In addition to the requirements specified in the Order, infection prevention control precautions remain the primary mechanism to protect yourself and the people you see.'
Clinical reasoning and risk assessment remain the fundamental principles for considering care and whether a psychotherapist sees a client kanohi-ki-te-kanohi (with the appropriate processes in place) or remotely.
The following processes apply during all traffic lights i.e., Green, Orange, and Red:
- screening for COVID 19 symptoms prior to any kanohi-ki-te-kanohi appointment
- infection prevention and control measures including personal protective equipment (PPE) where required. Wear a mask if you cannot maintain physical distancing or other risk factors are present.
- transmission precaution measures including consideration of ventilation
- physical distancing measures
- keep accurate documentation of appointments to aid contact tracing if required
- ensure that your place of work is registered with the NZ COVID Tracer App and that the poster with the unique QR code is clearly displayed at the entrance to the premises.
Ministry of Health advise that screening questions and any other infection prevention and control measures must be based on the COVID-19 Case definition and its Higher Index of suspicion (HIS) criteria (symptoms).
Vaccination certificates
'To ensure that New Zealanders can access essential health services, some health services are prohibited from requiring vaccination certificates or vaccination. These health services must not deny access to premises or provision of goods and services on vaccination grounds. The health services that are subject to this prohibition are health services that are partly or wholly funded by certain government entities. These health services are subject to the rules that apply to “designated premises” under the order.'
What does this mean? This means if a psychotherapist receives partial or whole public funding (for example from Accident Compensation Corporation) they are defined as a 'designated premises' and may not request a COVID-19 Vaccination Certificate or other evidence of being vaccinated.
Risk assessment will help psychotherapists decide whether they see the client kanohi-ki-te-kanohi (with the appropriate processes in place) or work remotely via telehealth. As a reminder, the Ministry of Health has released a position statement on the management of unvaccinated individuals in healthcare settings.
If a psychotherapist does not receive public funding, they may be able to require Vaccination Certificates as an entry requirement to their premises. Risk assessment will help a psychotherapist decide whether they see the client kanohi-ki-te-kanohi (with the appropriate processes in place) or work remotely via telehealth.
‘The Ministry is of the view that in most cases, with vaccinated staff and other precautions in place, that the risks are unlikely to be high enough to provide sufficient justification to not follow the Health and Disability Commissioner (Code of Health and Disability Services Consumers' Rights) Regulations 1996. In other words, denying access to health care on the basis of vaccination status is unacceptable.’ This means that health practitioners cannot deny care based solely on vaccination status, ‘restrictions to access to health care must be informed by a risk assessment, and the onus is upon the provider to justify that the risks are sufficiently high to support those restrictions.’ i.e., work remotely via telehealth.
Reminders
Additional information
Information that may assist the transition to the COVID-19 Protection Framework (traffic light system).
For the most up to date information about My Vaccine Pass and the COVID-19 Protection Framework please visit the Unite against COVID-19 website.
For the latest Information on vaccines in the workplace please visit the Employment New Zealand website: Vaccines and the workplace
Use of Verifier App for businesses: The Ministry of Health has built a free verifier app called NZ Pass Verifier which is available on the App Store and Google Play, for companies to use to scan and verify a My Vaccine Pass.
The National Telehealth Service: The National Telehealth Service provides a COVID-19 clinical advice line for community health. This service offers clinical support and advice 8am – 8pm every day, including weekends and public holidays. COVID-19 Clinical Advice Line 0800 177 622
Ministry of Health resources on infection prevention control procedures, personal protective equipment and contact tracing for kanohi-ki-te-kanohi interactions with clients.
The Awhina App is available for practitioners to download.