Montana lawmakers attempt to grow mental health and addictions workforce

HELENA – Buried in the mountain of bills debated in this year’s legislative session, Republicans and Democrats have approved a series of policies designed to tackle a widespread problem: the shortage of mental health workers and behavioral skills in a state in desperate need of it.

About 90,000 teens and adults in Montana have a substance use disorder, according to the most recent federal data. About 1 in 10 residents report suffering from “frequent mental distress” – a state health department statistic that matches Montana’s. consistently high suicide rate. According to providers and healthcare associations, the worsening crisis of needs is an ineffective pipeline to get professionals where they need to be.

“Our numbers are out of this world in terms of people coming to us for help,” Janet Woodburn, CEO of Sapphire Community Health in Hamilton, said in testimony to lawmakers in February. “And we can’t provide it because we don’t have enough professionals to do it.”

Woodburn and other promoters, including medical associations and regulatory boards, have put their weight behind about half a dozen bills to address the labor shortage this year, largely by reviewing licensing requirements for psychologists, social workers and licensed addiction counselors. Republican-sponsored bills have always garnered unanimous support from lawmakers, a rare trend in a polarizing session.

“It was just good, solid legislation. It wasn’t provocative, it wasn’t the kind of thing you’re going to have a disagreement on, ”said Sen. Jason Small, R-Busby, who sponsored four proposals that have since been enacted in a recent phone. . interview. “I can’t believe the thanks I have received from other lawmakers for some of these things.”

One of Small’s policies, Senate Bill 90, relaxes the standards for licensed psychologists from other states who wish to move to Montana by requiring five years of recent experience instead of 20. The policy would also allow Postdoctoral graduates charge for insurance when working under supervision. a licensed psychologist, a move that supporters say will help attract early-career professionals to the state.

“We have a fairly populated county and a lot of needs. Frankly, at the moment it’s very difficult to show people. If I want to make a recommendation, most people tell me they don’t take new patients. “

Dr Sara Baxter, Clinical Psychologist, Ravalli County

“At present, we have about one psychologist for every 4000 Montanais. Just thinking about how many people I have to serve today, I’m overwhelmed by the thought of how many people I have to serve today, ”said Sara Boilen, board member for the Montana Board of Psychologists, in her supportive SB 90 testimonial. compromising our rigorous licensing standards, this bill allows us to remove some unnecessary hurdles that likely deter qualified psychologists from relocating their practices to our state. “

A similar measure sponsored by Representative Frank Garner, R-Kalispell, gives the Board of Behavioral Health the rule-making authority to assess the equivalent experience of applicants who do not have specific requirements to obtain various licenses. The bill includes provisions for those seeking licensure in marriage and family therapy, addiction counseling, clinical professional counseling, and clinical social work.

Supporters of Garner’s House Bill 177, including the Montana Primary Care Association, have said it allows the board to assess a candidate’s unique qualifications and educational background rather than disqualifying them from being licensed. exercise.

“What this board doesn’t have is a regulatory authority to have the flexibility to think about the equivalency of out-of-state candidates,” said Stacey Anderson, AMPA’s director of policy. , during a public testimony. “So if someone has 20 years of experience as a licensed addiction counselor in another state, if they are missing a piece of Montana law, they should go back to school or take a retest.” , whatever the case. . “

This rigidity, said Anderson and other supporters of the bill, obstructs the process of obtaining competent providers with clean professional records to serve patients in need. In a rural state striving to reduce the stigma surrounding mental health and addiction treatment, the space for more professional clinicians is growing.

In Small’s hometown of Busby, about an hour and a half east of Billings on the Northern Cheyenne Reservation, access to mental health professionals is strained.

“At the end of the day, it’s just about making things work for the working Montanans,” Small said, noting how inconvenient it is to get to Billings for a date in the middle. of a work week. “I waste a whole day if I have to go and do something.”

Establishing a strong cohort of psychiatrists and other behavioral health experts in Busby and other rural Montana towns may not happen immediately. An intermediate step, however, could come from a third small bill, Senate 217, which changes the process for billing insurance in collaborative psychiatric care facilities with coordinated treatment plans between a primary care provider. and a consultant in psychiatry. With less than 100 licenses psychiatrists working in Montana, the legislation intends to make psychiatric care more accessible to distant patients.

Petty and other supporters of the new laws acknowledged receiving minimal public attention during the packed 90-day session, in part because of the obscure and technical nature of the changes.

“It’s not sexy, it’s not interesting,” Anderson said of the policy fixes. “These are just real wacky and precise bills.”

However, the often unanimous votes indicated that lawmakers from both parties and across the state believe the professional shortage deserves creative solutions.

“It’s really about digging deep into the politics that govern these professions and saying, ‘where are the barriers?’” She said.

Some mental health professionals have expressed optimism and hope that help may be on the way. Ravalli County clinical psychologist Dr. Sara Baxter supported many of these policies during the session based on the healthcare pressure she sees in her own community.

“We have a fairly populated county and a lot of needs,” Baxter said in a recent telephone interview. Although there are social workers and licensed clinical psychologists in the county, she said, “Frankly, right now it’s very difficult to get people to see. If I want to make a recommendation, most people tell me they don’t take new patients. “

Baxter, one of the legislative representatives for the Montana Psychological Association, also supported other bills that did not pass this session, including a tax incentive to open psychiatric practices in rural areas. referred to as “areas of psychiatric opportunity”. Ultimately, however, Baxter said she was happy to see many important reforms survive the political process. If this trend continues, she said, the state could begin to bridge the gap between providers and Montanais in need of care.

“People, just at a common sense level, understand that this is an exceptionally stressful time in our history,” she said. “And everyone knows someone who’s having a hard time.”

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