Unlocking Potential: A Call to Action for Expanding Mental Health Treatment Options
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According to the National Alliance on Mental Illness, annually, 1 in 5 adults and 1 in 6 youths (ages 6-17) face mental health disorders. This stark reality underscores a national mental health crisis — ninety percent of the public views this as a crisis. The situation is compounded by the scarcity of treatment options, particularly in rural and economically disadvantaged urban areas where there are barriers like provider shortages, administrative hurdles, and inadequate public transportation.
However, emerging telehealth and temporary licensing options are offering viable solutions for mental health therapies that transcend geographical limitations. Increased access to telehealth services with licensed psychologists is one part of a solution to bridge the treatment gap, especially in rural areas that rely on telehealth for mental health and substance abuse services.
Established in 2015 by the Association of State and Provincial Psychology Boards (ASPPB), the Psychology Interjurisdictional Compact (PSYPACT) was created to facilitate cross-border telehealth and temporary in-person psychological services. Its goal was to address the pressing demand for accessible and flexible behavioral health care. Many jurisdictions adopted PSYPACT during the early stages of the pandemic to facilitate treatment options because of the restrictions on face-to-face treatment. Now that remote part-time or full-time work models have continued, it is important to increase these telehealth treatment options.
The key benefits of PSYPACT include the following:
Enhanced Access to Care: PSYPACT empowers licensed psychologists to serve clients across state lines, benefitting rural and border cities, and other underserved areas who might otherwise have limited access to mental health care.
Continuity of Care: It ensures ongoing psychologist-client relationships, irrespective of relocation.
Professional Flexibility: Licensed psychologists from APA-approved institutions can broaden their practices seamlessly, without the need for multiple state licenses.
The good news is that as of July 1, 2024, forty-two states, the District of Columbia, and the Commonwealth of the Northern Mariana Islands have passed legislation that allows doctoral-level licensed psychologists to practice across jurisdictional lines. The bad news is that eight states and three U.S. territories — Alaska, California, Guam, Iowa, Hawaii, Louisiana, Montana, New Mexico, Oregon, Puerto Rico, and U.S. Virgin Islands — have not enacted PSYPACT legislation. These locations are limiting their residents’ access to vital treatment services. As a result, individuals temporarily or permanently residing in any of those eight states and three territories do not have access to telepsychology providers beyond their borders, nor can they schedule in-person visits with licensed psychologists who happen to be temporarily in their state.
A review of the legislative documents in states where PSYPACT has not been adopted explains some of the reluctance to adopt PSYPACT. First, existing psychologists worry that an influx of out-of-state telehealth professionals could saturate the market, diminishing local market share and income. Second, in some states, the legislative and administrative amendments required to align existing licensing protocols with PSYPACT’s criteria are considered an undue burden. Third, there is worry about maintaining the standard of care and ensuring quality control over out-of-state psychologists.
Dr. Ben Greenberg, a New Mexico psychologist, summarized the frustration of practicing in a non-PSYPACT state. “It is frustrating that I do not have the legal authority to provide services to my existing patients when they are out of state. If New Mexico were to join PSYPACT, it would help the continuity of care I provide to my patients. I understand the concerns raised about joining PSYPACT, but our obligation to provide quality care to our patients, wherever they are located, should be our primary goal.” But twice, New Mexico legislators failed to pass legislation to join PSYPACT.
California, the state with the largest number of psychologists in the United States, has an additional complication that is stalling proposed PSYPACT legislation. The educational requirements of PSYPACT are more rigorous than what California requires. Many currently licensed California psychologists would not be able to use PSYPACT to practice outside of California, but psychologists from PSYPACT states would be able to practice in California. Even if this is perceived to be unfair to California therapists, it benefits patients, and that should be what counts.
We are dealing with a textbook example of the perfect being the enemy of the good. It is imperative for the remaining eleven jurisdictions to prioritize the mental well-being of their citizens over bureaucratic inertia and market protectionism. In the quest to expand mental health treatment resources, we must not allow the pursuit of an ideal solution to obstruct the implementation of effective, immediate measures.
About the Author:
Virginia Gleason, a 2022 Harvard Advanced Leadership Initiative Fellow, applies wide industry experience to helping public entities create solutions to help alleviate suffering and promote public safety and wellness. A graduate of the University of Oregon Law School, she began her career as a lawyer in private practice but moved to pursue her passion in public service, serving at four different law enforcement agencies. Virginia now focuses on organizational compliance with laws, regulations, professional standards, and ethical practices; utilization of data to increase the value and credibility of public services; practices that support inclusion; and risk management. She is an adjunct professor at the Seattle University Department of Criminal Justice and Forensics and an instructor for FBI-LEEDA.