HomeHealth Care NewsStates Band Together to Expand Treatment for Mental Illness

States Band Together to Expand Treatment for Mental Illness

State legislatures are considering the “Interstate Licensed Professional Counselors Compact,” which would allow mental health therapists licensed in one jurisdiction to practice in any other that is party to the agreement.

The proposal would expand mental health services delivered primarily through telehealth but also in person. The compact could offer consumers consistent standards of practice across borders by sharing disciplinary sanctions in the event of complaints against a provider.

The compact would allow officials to nearly instantly verify the licensure status of practitioners.  Individual states would continue to regulate care.

States with active military service personnel have been especially receptive because the compact allows spouses to continue working in the event of a move.

Ten states must enact the compact into law before it can go into effect, according to counselingcompact.org. As of March 2022, Alabama, Georgia, Maryland, Mississippi, Utah, and West Virginia had enacted legislation, and bills were pending in 16 states.

Pandemic Drove Demand

Demand for mental health services has risen since the pandemic began, says Matt Dean, a senior health policy fellow at The Heartland Institute, which co-publishes Health Care News, in written testimony on the compact.

“The pandemic has made things much worse for those living with mental illness and stressed otherwise healthy people to the point where they now need help,” said Dean. “Isolation, stress, and life changes have created an unprecedented surge in demand for already scarce mental health services.”

Mental illness has increased during the pandemic, according to a study by the Centers for Disease Control and Prevention published in 2021.

“During August 2020–February 2021, the percentage of adults with recent symptoms of anxiety or a depressive disorder increased from 36.4% to 41.5%, and the percentage of those reporting an unmet mental health care need increased from 9.2% to 11.7%,” states the report. “Increases were largest among adults aged 18-29 years.”

COVID-19 lockdowns made access to care more difficult, says Dean.

“[P]atients were prevented from travel or from participating in residential, group, and (in many cases) in-person counseling,” said Dean.

Colorado’s Access Issues

Patients in Colorado, which ranks 47th among the states in terms of overall mental health care according to a national survey published by Mental Health America, a nonprofit advocacy group, have been especially hard-pressed.

In-person care is difficult in rural areas of the Rocky Mountains, says Dean, who testified before the Colorado Senate Finance Committee.

“Access issues driven by sparsity and terrain certainly impacted that ranking,” said Dean.

Colorado has unmet demand for mental health counseling, says Kiara Kuenzler, Psy.D., CEO of Jefferson Center, a private health care provider, according to a news report on the State of Reform website.

Kuenzler said her organization has more than 60 unfilled positions for licensed professional counselors and could serve many more patients each year if the compact takes effect.

Telehealth Speeds Compact

Minnesota is considering the counseling compact, says state Sen. Jim Abeler (R-Anoka).

“Telehealth has really taken off since the pandemic,” Abeler told Health Care News. “It has moved the discussion forward by 10 years.

“When people cross state lines and they want to continue care with their counselor in the former state, they suddenly find out they can’t,” said Abeler. “So, this fills that gap. I think of any compact [in health care], this would make the most sense. It will help deal with the staff shortages and access issues which are really harming the entire health industry.”

Licensing compacts exist for a wide variety of health care professions, including speech and occupational therapists, physician assistants, and nurses. They either expedite the licensing process or offer “mutual recognition” of licenses from home states. The counseling compact uses the mutual recognition model. All provisions in the model legislation must be enacted by a state to officially join the compact.


AnneMarie Schieber (amschieber@heartland.org) is the managing editor of Health Care News.


Internet info:

Counseling Compact Model Legislation, The Council of State Governments National Center for Interstate Compacts, December 4, 2020:

AnneMarie Schieber
AnneMarie Schieber
AnneMarie Schieber is a research fellow at The Heartland Institute and managing editor of Health Care News, Heartland's monthly newspaper for health care reform.


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