To Address The Growing Mental Health Crisis, Empower Providers

With my EdM in Counseling degree almost in hand, I’m currently on the hunt for suitable employment. When people hear that I’m searching for a counseling job, their response usually goes something like: "I'm sure you're swimming in job opportunities. We need all the help we can get right now!" If only it was that simple.

After receiving a master’s degree, mental health counselors must work for two years under supervision before they are eligible to apply for independent licensure to operate as a Licensed Mental Health Counselor (LMHC). Requirements for licensure in Massachusetts state that these two years of work experience must be at a "public or private Recognized Educational Institution or health or mental health institution regulated by the state" and that "a Clinical Field Experience Site does not include...private practice." This arbitrary restriction sets the licensure process for counselors apart from that of equivalently-prepared social workers, who are authorized to work in private practice while working towards their independent licensure. It also does a disservice to the public.

For example, I recently replied to a posting for a "Master's-prepared Pre-licensed Public Health Fellow" at Aurora Counseling Associates in Natick, described as "working mostly with MassHealth clients...while receiving supervision toward licensure." This position was created by BethAnn Schacht, LMHC, the director of Aurora and an experienced counselor who wants to extend her practice to those who may otherwise not be able to afford counseling, while simultaneously providing supervision to a new clinician. BethAnn quite reasonably did not realize that her practice, being private, would not fit the state definition of an approved clinical site. Dismayed by this realization, she took the posting down. In our ensuing conversation, BethAnn told me, "I am straddling a line here where my heart is increasingly connected to larger community needs...and yet we're a private practice, attracting clinicians who have typically worked in the public health community for a number of years and are ready for a different experience. So a unique and new position made sense to me...and what better way than to also help out a [new] clinician?” Arbitrary licensure requirements prevent BethAnn, the public, and a new clinician from benefiting from her intention.

There are additional legal and professional structures which make it unnecessarily difficult for counselors to provide effective, safe, and skilled services to the public. For example, The Mental Health Counseling profession in Massachusetts is overseen by the 10-member Board of Allied Mental Health and Human Services Professions, which also oversees 4 other professions. The Board meets for about 2 hours every month, during which time they must perform all necessary administrative tasks relevant to the 5 professions which they represent. Only two of the Board members are LMHCs, yet there are now over 7,000 LMHCs in Massachusetts and the Board is receiving 80 -100 applications for LMHC credentials per month. It’s not hard to imagine that the interests of counselors - not to mention the other professionals overseen by the Board - are not sufficiently represented by this arrangement. As a result, individuals seeking mental health care - and the new professionals hoping to help them - lose.

Bills have been drafted which would address these and other issues. One such bill, HD 2015, would transfer oversight of the counseling profession to a 9-member board of mental health counselors. With the passage of this bill, work such as upgrading regulations, reviewing complaints, completing audits, and processing license applications would be done by a dedicated group of individuals from within the profession. This would mirror the structure of the social work profession in Massachusetts, which has its own dedicated Board. It would also create an entry level license for new mental health counselors in order to expand initial work opportunities, increase consumer protection, provide clarity for billing, and make more counselors eligible for state and federal loan reimbursement programs.

Another bill, HD 2014, would add LMHCs to the list of professionals authorized to mandate the transport of individuals in acute psychiatric distress to a hospital for a safety evaluation. Professionals already on this list include physicians, psychologists, psychiatric nurses, LICSWs, and police officers - who have no clinical training. This list must be modernized to reflect the professional status of mental health counselors and protect clinicians and consumers.

A final set of bills, HD 2011 and HD 2012, would establish and fund a Behavioral Health Workforce Development Trust Fund. Because new mental health counselors are required to receive at least 200 hours of clinical supervision before applying for licensure, yet there is no source of legislated support for the costs associated with providing this, financial and time-resource hardships are placed on already-stressed agencies. Funding would come from the state’s extant Workforce Development Trust Fund and enable supervisors of pre-licensed mental health counselors to apply for grants. This funding is essential to ensure a well-trained behavioral health workforce.

Passing these bills will have a significant and direct effect on those in Massachusetts struggling to be consumers - and providers - of mental health services. In the midst of a worsening mental health crisis, we need to act boldly and swiftly to empower providers.

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Jeff Adams is a second-year student in the Master of Education in Counseling program at Boston University.