Stressed-out people are being left without help because many medical aid schemes refuse to pay anyone but clinical psychologists to counsel those with depression or other mental illness. Educational, counselling and industrial psychologists say their practices are under threat because of regulations that severely restrict them in treating patients.The turf war between shrinks has seen NGOs representing 600 psychologists taking the minister of health and the Health Professions' Council of SA to court. The case will be heard in November in the Cape Town High Court.The conflict began in 2011 when the Health Professions' Council drew up regulations limiting the "scope of practice" of each field of psychology. The regulations differentiated between forensic, counselling, neuro, clinical, industrial, educational and other psychologists in terms of their training and the work they could undertake.The regulations have been interpreted by large medical aids such as Bonitas and GEMS, the Government Employees' Medical Scheme, to mean that only clinical psychologists can be reimbursed for helping people who are mentally distressed. This has left thousands of educational, industrial and counselling psychologists unable to claim for their services from medical aids.The Rural Health Advocacy Project, represented by NGO Section 27, has recently been recognised as a friend of the court in the litigation. It plans to give evidence "that the regulations are irrational and are so unreasonable that no reasonable person could have promulgated them".The NGO argues that one in six people experiences a mental health disorder in a year - the most prevalent being anxiety disorder.In court papers, joint applicant the Justice Alliance of SA estimates that South Africa has 1.37 psychologists per 10000 citizens. In the US, the figure is 28 and the global average is six. There are about 8000 psychologists, including 2500 clinical psychologists, in South Africa.Rural Health Advocacy Project director Marijke Versteeg-Mojanaga said about 75% of the people requiring mental health services did not receive them. The strict regulations prevent those with severe problems accessing help from any psychologist other than a clinical psychologist.Educational psychologist Susan Kriegler, from the Recognition of Life Long Learning in Psychology Action Group, estimated that up to 60% of education and industrial psychologists could be forced to close their practices."Many thousands of people with emotional problems, as well as marital problems, learning problems, and work-related problems, who have until now received therapy from these non-clinical psychologists, will no longer have access to psychological assistance," she said. The applicants argue in their legal papers that psychologists in any specialisation should have their years of experience and additional training recognised - and be allowed to work in areas in which they are competent.In rural areas and in smaller towns there are virtually no clinical psychologists, Kriegler told The Times. The Clinical Psychology Forum, which was admitted as a friend of the court this month, said people with mental health problems should not be treated by any psychologist who lacks "proper training".William Griffith, in his affidavit, said clinical psychologists go through "strenuous selection criteria to ensure that they have both academic ability and a stable and mature personality, to deal with people with mental problems".Only seven to 10 students are accepted per educational institution each year from about 180 applications, he said.Griffith said that attacking the regulations on how psychology is practised would not solve the problem of the shortage of psychologists in rural areas.Industrial psychologist Johan Landman, who works in Kroonstad, in the Free State, has helped patients with anxiety and "burnout syndrome" for 15 years, and set up a private in-hospital stress clinic with a staff psychiatrist. Most of his patients were teachers or civil servants and belonged to GEMS, which no longer pays industrial or educational psychologists."Previously, I used to see 40 to 50 patients a week. Now I am lucky if I see five," he said...