Utahns are struggling to get mental health care. Could loosening licensing requirements help?

Officials say there could be as many as half a million Utahns who need a therapist or other mental health help, but who haven’t been able to get into treatment.

State leaders know that Utahns are struggling to access mental health care. At a news conference Tuesday, Gov. Spencer Cox said many residents can’t find a therapist who will take them, that others are facing long wait times and many are forced to pay for treatment out of pocket.

To fix this access problem, state officials are proposing loosening licensing requirements, which they say will allow more people to become mental health workers. The more qualified therapists and behavioral health workers we have in Utah, Cox reasoned, the better chance people will have access to that critical mental health help when they need it.

“We are seeing too many of our friends and neighbors, our children and our family members that are being touched by mental health concerns,” Cox said, citing increasing depression rates nationwide and Utah’s particularly high suicide rate in recent years.

The Office of Professional Licensure Review has spent the last year studying the licensing of mental health professionals, and in a new report estimated that as many as 515,000 Utahns who need mental health services have not been able to get treatment.

“This is a chasm,” said Margaret Busse, the executive director for the Utah Department of Commerce, which oversees the state licensing division. “And it is certainly contributing and worsening our mental health crisis.”

Busse said OPLR’s focus was to look at licensing for mental health workers, and see what was working and if there were places where regulations were too burdensome on licensees without benefiting patient safety. She said they found some instances of licensing that were likely too rigid, such as requiring mental health workers to complete a set number of training hours without any checks into the quality of that training. Another regulation that may not be effective, she said, is a requirement that mental health workers pass a national exam, without clear evidence that it adequately assesses someone’s skills.

She said that access to mental health services is exacerbated by a lack of “extender roles” — essentially mental health worker jobs that require a bachelor’s degree or lower. Busse, for example, said students graduating with bachelor’s degrees in psychology have no pathway to working in the clinical care field unless they complete a master’s or doctorate degree.

But it will be up to the Utah Legislature to decide which licensing laws will be changed.

Sen. Curt Bramble, R-Provo, is sponsoring a bill that would reduce the number of clinical hours an applicant must complete before becoming a licensed mental health professional, increase the number of supervised clinical hours, and create a pathway to license behavior health workers without an examination requirement.

But Bramble’s bill, thus far, doesn’t entirely address another issue that OPLR found in its review of mental health professional licensing: That Utah may have a “safety problem” within the behavioral health profession.

The report cites data that shows Utah ranks far above the median for the number of reports to a national data bank for licensed mental health workers. The National Practitioner Data Bank is a confidential information clearinghouse created by Congress that tracks “adverse actions” — like the loss of a license or medical malpractice payments made by health care professionals.

In addition to the higher number of reports, Utah sees those practitioners reoffend at a rate that is “very high” — 44.5% have another report to the database, compared to the nationwide median of 25%. According to the report, Utah is fourth in the nation for the highest proportion of such repeat offenders.

Bramble’s proposed legislation does incorporate one recommendation from OPLR to increase safety, by allowing mental health professionals to participate in a state program for health professionals struggling with their own mental health or substance use instead of public disciplinary action. But OPLR also recommended that mental health workers should be required to disclose to their patients how they can file a complaint with licensers and what inappropriate care looks like.

When asked Tuesday whether the bill could include these types of educational efforts to address patient safety, Bramble said, “Stay tuned.”

“The bill is a work in progress right now,” he said. “It’s not begun the legislative refining process.”

Bramble said at the news conference that he knows this won’t be an easy bill to pass during the legislative session, which begins next week.

“There are those whose incumbent legacy authority is going to be challenged, the safety blanket of their licensing is going to be challenged,” he said. “And yet, we believe at the end of the day, we’re going to have a much better program.”