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senior practitioners, particularly when a specified number of those hours must be face-to-face. Another example is the barrier posed by requiring a PhD to practice independently. As with medical training, additional years of university training may predispose practitioners to practice in urban areas where, like medical specialists, they can expect higher incomes and access to colleagues. Whether for these or other reasons, few PhD Psychologists choose to practice in rural areas.

Some states have recognized the potentially negative effect of this competition between the mental health professions on access to mental health services as evidenced by the number of states that have promulgated legislation that would reduce competition. For example, states like New Hampshire have placed explicit language in licensing statutes and/or rules encouraging collaboration and cooperation among the professions. Most notable are states that have consolidated the oversight of these professions into a single board, or a single “Mental Health Practice” act. Other policies that may achieve this end include allowing supervision by members of other professions and encouraging collaboration with other professionals as part of the continuing education requirements.


Based on our findings and the discussion presented above, we present six recommendations that we believe could help address potential barriers to increasing the supply of rural mental health professionals. These are:

  • 1.

    States can simplify licensure and clarify clinical roles by combining regulatory functions for several professions into a single office or agency. A first step toward this end is either combining Marriage and Family Therapy and Licensed Professional Counseling into a single board, or creating a mental health professional practice act, as Utah has done, that addresses all mental health professions.

  • 2.

    State licensure laws do not support payers who choose not to reimburse Marriage and Family Therapists or Licensed Professional Counselors for essential mental health services. For example, the number of states permitting social workers to perform diagnosis and psychotherapy is not significantly different from the number permitting marriage and family therapists to perform those services. Yet Medicare chooses to reimburse SWs but not MFTs.. Therefore, Medicare should reconsider its payment policies regarding non-physician mental health practitioners. States that have not done so should consider vendorship laws


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