Monthslong waitlists and high costs: Why many Utahns are struggling to get mental health treatment
In the spring of 2023, Brandon was having suicidal thoughts and worried he wouldn’t make it to see the birth of his third child. Brandon’s situation was serious, and through strong family support, he sought help. Brandon was admitted to an inpatient facility and met with psychiatrists, therapists and medical doctors. He received a proper diagnosis, was prescribed the correct medication and made steady progress. After 30 days, Brandon checked himself out of the facility to seek outpatient support while getting back to his life and family.
However, outpatient support was difficult to find. Brandon contacted a program, and seven months later, he is still on their waitlist. The trusted therapist from his inpatient stay also had a monthlong waitlist for outpatient therapy and, like many therapists, did not accept insurance. Already struggling financially, Brandon could not afford $200 per session out of pocket. Despite taking all the right steps, Brandon was left with no outpatient therapy for months.
Brandon’s experience is not an isolated one. In fact, between 750,000 and 1 million people need behavioral health care in Utah, but only 530,000 currently receive it. It’s no wonder Gov. Spencer Cox is prioritizing Utah’s mental health. From an economic perspective, untreated behavioral health issues increase medical and criminal justice costs and lower Utahns’ earnings by more than $2 billion. On a human level, untreated behavioral health issues can lead to increases in suicidal ideation and attempts — much like Brandon’s — and a host of other issues that affect well-being.
Due to this dire lack of access to behavioral health care, the Utah Department of Commerce’s newly-created Office of Professional Licensing Review decided to focus its first review on state licensing laws for behavioral health professions. While professional licensing exists to prevent incompetent or unethical practitioners from doing harm, overly burdensome licensing requirements can block otherwise qualified individuals from joining the workforce. Thoughtful regulation can improve outcomes for consumers on two fronts: improving access to services by allowing more qualified professionals into the field while also improving the safety of those services.
Related
One of the office’s key findings in its review of behavioral health professions was the structure of the workforce: Over 70% of Utah’s behavioral health workforce requires a master’s degree or higher, as is illustrated in a figure from the Utah Department of Commerce. Currently, there are very limited professional licensing options for those with anything less than a master’s degree in the behavioral health field. The cost and time needed to obtain a graduate degree, pass the requisite national exam and complete supervised training hours limit the number of providers, which in turn limits access and increases patient costs.
In stark contrast, the physical health care workforce relies heavily on a network of “extenders.” For example, a registered nurse with a four-year degree extends the expertise of a physician, improving access, enhancing patient care and lowering costs. In fact, most of the licensed workforce in physical health care have a four-year college degree or less. This allows the highest-trained physicians to practice at the top of their skill set and provides a more efficient delivery of care, thereby improving access and patient costs.
In addition to the workforce structure issues, overly rigid or ambiguous regulation (imposing burden without any benefit to patients) may be constraining practitioner supply; for instance, requiring a set number of hours of training without quality checks, requiring a national exam without clear evidence of its ability to assess skills, or ambiguous statutory language preventing capable practitioners from practicing at the top of their license.
To improve accessibility, we recommend that the Utah Legislature adopt the following measures:
Fill workforce gaps
Create a new certification for Behavioral Health Technicians based on a one-year academic program in applied behavioral health. Additionally, create more professional licensing options for applicants with a bachelor-level qualification to attract more workers to the behavioral health sector. This will help in producing more extenders who can assist highly trained mental health care workers to work at the top of their training.
Train smarter
Focus required training hours for therapists on activities that increase patient safety — and allow more flexibility in continuing education.
Expand pathways to licensure
Allow therapists in training to substitute more on-the-job training in place of national, standardized exams, providing more avenues for safe, qualified practitioners to become fully licensed.
Expand scope of practice
Broaden the scope of practice for qualified professionals to operate to the full extent of their education and training, e.g. allow psychologists with additional training in psychopharmacology to prescribe a limited set of drugs for mental health disorders.
We are confident that these changes to licensure, along with the other recommendations available in our Report and Executive Summary, can vastly increase Utahns’ access to behavioral health care and help improve the safety of that care. However, licensure reform can only take us so far. We also need more capacity in higher education to train mental health workers and innovative insurance provisions that expand access while lowering the cost of quality treatment. For example, insurance companies could provide better compensation, support and flexibility to attract and retain behavioral health professionals.
Utah has the tools to dramatically increase the behavioral health workforce and get Utahns the services they need. Inaction will continue to cost Utahns’ lives and strain our economy. It will take a multipronged approach and strong political will to see these changes through. Like many others across the state, we look forward to the day when Utah’s families, like Brandon and his family, have access to effective and affordable behavioral health services.
Margaret Woolley Busse is the executive director of the Utah Department of Commerce, and is passionate about public service and public policy, working previously with the Harvard Business School and U.S. Treasury Department.
Jeff Shumway is the director of the Office of Professional Licensure Review (OPLR), where he leads a team of employees who take a critical look at all state licensure requirements.
