Mental health patients might have to wait longer to get their conditions diagnosed – if they can get care at all. That’s according to mental health counselors, who say a rule change by the state is about to put thousands of them out of business.
These are state-licensed mental health professionals who diagnose conditions and set up treatment plans. They typically have a master’s degree or a PhD. Some of them see patients on a regular basis, or they refer patients to psychologists or psychiatrists.
The counselors say they are a critical link in the state’s mental health care system, and they help ensure patients get the right type of care when they need it.
“You’re going through some of the darkest things in people’s lives,” says Jessica Mariano.
Mariano is a licensed counselor. She says patient confidentiality prevents her from sharing specific stories, but she would speak in general terms about the people she deals with and the types of problems they face. She says these new rules would make it almost impossible to establish relationships with patients, which is critical to diagnosing a condition, and its cause.
“It could be traumatic. They could be telling you horrific details that they’ve had to endure. It could be the heaviness of their suicidal ideations – meaning they’re either having thoughts or just an intent for harming themselves, and these types of things can be very difficult to hear,” Mariano says.
The Department of Licensing and Regulatory Affairs proposed the change. It could threaten counselors with official sanctions if, for example, they make a diagnosis. The punishment could include losing their professional licenses. And, very critically, counselors say their services would not be covered by most insurance.
But the department’s Kim Gaedeke says this change has been in the works for a long time, and counselors should have known it was coming.
“They’ve been doing it without any authority,” she says.
Gaedeke says the new rules would simply provide “clarity” – and that the department’s enforcing a more-accurate interpretation of existing law.
“The counselors and the groups representing the counselors have known for a number of years, for decades, that in order for them to have this level of scope of practice to diagnose and use psychotherapy techniques, that they need to have a legislative change to the statute,” Gaedeke said.
But Gaedeke could not say how this new rule helps people who need or are seeking mental health treatment. She also could not say how patients are hurt by the existing rule which, as she pointed out, has been how the system’s operated for many years.
And that’s why state Representative Aaron Miller is asking, what’s the rush?
“I’ve heard from sheriffs, I’ve heard from community mental health agencies. I’ve heard from counselors themselves, who are all saying, 'Please don’t do this.'”
Miller says he’s confounded by the situation. He’s sponsored a bill – HB 4325 – that would restore the scope-of-practice rules that allow mental health counselors to diagnose and treat patients. He says the Department of Licensing and Regulatory Affairs should wait for his bill to be adopted instead of moving ahead on its own.
“There’s already a shortage of mental health services. I think we’re moving in the right direction, but to lose something in the current system would be detrimental to anybody seeking mental health care now or in the future.”
Miller says that shortage is most acute in rural parts of the state and, especially in northern Michigan. Miller’s bill is working its way through the Legislature, and, if adopted, would have to be signed by Governor Gretchen Whitmer. The Department of Licensing and Regulatory Affairs reports to the governor.
There is a public hearing on these new rules on Friday in Lansing.