Over 144,000 Mental Health Counselors (MHCs) are active across the United States, and an estimated 19% growth is expected in the field over the next 10 years. Demand for professional counseling services is growing, as approximately 18% of all adults in the United States were reported as having some form of mental illness in 2015, and mental health care costs amounted to $201 billion in 2013 – more than heart conditions or trauma.
Scopes of practice (SOPs) for MHCs vary across the country, although all states grant the authority to perform core mental health services, such as provide professional assessment/appraisal, engage in psychotherapy/counseling, and make referrals to other healthcare professionals. While the education and training is routinely uniform, thanks to accrediting organizations like the Council for Accreditation of Counseling & Related Educational Programs (CACREP), nuances in wording can impact the practice authority.
The purpose of this pilot study was to conduct a comprehensive analysis of state SOPs for MHCs with a focus on the various state credentials for MHCs, and explore how licensing policies affect the current MHC workforce and their delivery of behavioral health care. To this end, the BHWRC extracted SOP information from online statutes and administrative rules for MHCs from all 50 states and Washington D.C. The BHWRC also conducted a focus group and three key informant interviews with licensed MHCs around the country to add practical context to the SOP data.
MHC credentials generally fall into three categories: training, independent practice, and supervisory. Applicants for licensure as an MHC in any state tend to follow the same path; an applicant finishes their education, applies for a training credential, earns postgraduate work experience and supervision, applies for an independent practice credential, and then decides whether they want to continue with that credential or take on extra education/practice to earn a supervisory credential.
All states have at least one independent practice license for MHCs. Training credentials, however, took the form of a license in only 33 states, and supervisory credentials took the form of a license in only 19 states. While education requirements are similar for MHCs across the country, due to the wide acceptance of CACREP standards, postgraduate practice hours, supervision, and continuing education hours can vary significantly across the states.
Unlike “counseling” and “assessment,” the term “diagnosis” was not explicitly included in the SOP language in the states of Arkansas, California, Idaho, Iowa, Missouri, Pennsylvania, and Utah. Although the term ‘assessment’ in these states is usually interpreted to authorize the use of the DSM, the omission of ‘diagnosis’ could lead to restrictions on practice or reimbursement. Citizens are less likely to be aware of the mental health counseling profession than they are of psychology, psychiatry, or social work. MHC services are typically less expensive than clinical psychologists or psychiatrists, and are effective at treating depression, anxiety, and other common behavioral health conditions. As such, due to a lack of understanding about MHCs, the public is more likely to utilize behavioral health services that are more expensive but not necessarily superior.
From these findings, the MHC workforce could benefit from such policies as:
- Opening up licensure by endorsement and licensure by reciprocity policies across states. This would allow the MHC workforce to be more mobile, potentially alleviating unmet mental health care needs in underserved areas.
- Funding public education initiatives for patients to better understand the behavioral health workforce. This would enable patients to choose the professional that meets their specific needs and budget.
- Building scope of practice laws from the accredited education that MHCs receive, and precisely wording the laws to explicitly include all core mental health services. This could empower the MHC workforce to meet the growing behavioral healthcare needs of our country.
In summary, more uniformity in MHC credentials across the states, both in title and function, would benefit the profession and public. National standardization could help this provider type to meet the growing behavioral health needs of this country.