Here’s how Utah is expanding access to mental health care amid a shortage of providers

This story is part of the Salt Lake Tribune’s ongoing commitment to identifying solutions to Utah’s biggest challenges through the work of the Innovation Lab.

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Kids are back in school, travelers are boarding planes again, and indoor dining is back. Yet for many, a return to “normal” has not included a change in the heightened levels of stress, anxiety and depression that have accompanied a long pandemic.

Although there was a great need for mental health care before, during, and after COVID, mental health professionals treating Americans are in short supply.

More than 150 million people live in areas with a shortage of mental health professionals, according to a study by the Health Resources & Services Administration, and more than 40% of psychologists surveyed in 2021 by the American Psychological Association survey said they could not meet the demand for treatment.

This problem is particularly acute in Utah. The nonprofit organization Mental Health America recently ranked Utah 48th among the 50 states and the District of Columbia, meaning the state had both a higher prevalence of mental illnesses and access with less care.

Seeking to address access challenges, Utah lawmakers and mental health providers were already seeking to expand access to mental health telecare long before COVID-19 and its phantom mental health crisis took shape.

In 2017, the Utah legislature passed a measure that would prepare psychologists in the state for the rapid change ahead. The Interjurisdictional Psychology Compact gave state psychologists “a boost” when COVID-19 hit, said Nanci Klein, a clinical psychologist and director of professional affairs for the Utah Psychological Association, because therapists who had opted for the program “were prepared to work remotely. »

The expansion of telehealth means that people living in remote rural areas can access specialist treatment without having to deal with the stigma of parking their car in front of a therapist’s office. This means a busy nurse practitioner can meet her counselor on Zoom while sitting in her car on her lunch break. Or that students returning to their home countries for the summer can maintain constant care with a therapist they worked with during the school year.

Psychologists and licensed counselors say interstate licensing agreements are a way to expand the geographic boundaries of their practice and provide patients living in areas with a severe shortage of mental health practitioners more options for specialized care.

How do compacts work?

The pact passed in 2017 allows psychologists from participating states to practice virtually across state lines with “e-passports,” Klein said. To qualify, psychologists must be fully licensed in their home country and also complete three hours of continuing education courses related to the use of technology in psychology.

Getting one of those licenses means that if a psychologist like Klein has a University of Utah student as a patient and that student goes home for the summer, say, to Nevada, Klein could continue the treatment. and schedule virtual tours without violating licensing laws. . However, she could not move to Hawaii and begin practicing in person without obtaining a license in her new home state.

Klein says the pact has helped expand “opportunities for uninterrupted treatment.”

More recently, Utah joined a counseling pact — which has yet to be “live,” said Gray Otis, a licensed clinical mental health counselor involved in the effort in Utah. More than a dozen states have joined, and licensed counselors will likely be able to practice in participating states by 2024.

Like the psychology pact, the counseling pact will help ensure “continuity of care when clients or counselors move or travel to other states,” according to a letter of support from the American Association of State Counseling Boards.

“Utah is kind of a leader in looking at behavioral health, mental health, in a positive way to support the most people,” Otis said. “The counseling pact is one more building block, if you will, to support better public health through better public mental health.”

Those wary of pacts worry that multi-state licensing agreements will lead to less oversight of practitioners or potentially leave psychologists or counselors without enough clients.

Otis said that with COVID and the many mental health and drug and alcohol abuse issues that have accompanied the pandemic, “no one is running out of business.”

“Compacts have some very specific, important, and useful guardrails in place,” Klein said. Still, she cautions against scrapping licensing requirements altogether. During the 2022 legislative session, lawmakers passed SB283, which reduced the number of clinical hours needed for social workers and clinical mental health counselors to be licensed.

“I think that’s not necessarily an ideal solution,” Klein said. “Because then you free up people who may not be optimally trained to provide services to the community.”

How to reach people where they are

Telehealth is popular among patients and providers, said Dr. Rachel Weir, psychiatrist and head of mental health integration at the Huntsman Mental Health Institute. “They don’t have to drive, they don’t have to park, they often don’t have to take an entire half day off work to go see their therapist.”

Still, Weir said, telehealth is no panacea to the continued shortage of mental health professionals to meet client needs and demand. “You’re expanding your geographic reach and providing access to people who might not normally have it, but you’re not expanding access,” she said.

Ultimately, telehealth does not create more psychiatrists, psychologists, or mental health counselors.

“That’s the same number of people you always deal with,” Weir said. “It does not change my availability.

She also noted that if out-of-state providers aren’t considered part of the network by insurance companies, those therapists might choose to only accept cash payments. This could ultimately harm, not help, underserved populations.

Compacts are just one part of a bigger change in health care. Weir called the ECHO project “a truly innovative way to reach rural people.” The project, which began in New Mexico, offers local providers a videoconference with a single psychiatrist to present cases.

“It gives patients, through their own provider, more immediate help, rather than waiting and waiting and waiting to see a mental health professional,” Weir said.

Finally, Weir warned that while telehealth has benefits, for some people an in-person visit with a therapist might be the only reason to leave home, which could also be helpful for mental health. “It must be a hybrid,” she said.

It’s important, Weir said, to make sure the need for connection is always met.

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