Improve Veterans’ Access to Mental Health Services

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Issue: Congress should direct the Department of Veterans’ Affairs (VA) to improve access to mental health services provided by licensed Marriage and Family Therapists (MFTs) at VA facilities by eliminating specific bureaucratic obstacles. In particular, S 1155 (Tester, D-MT), S 1581 (Sanders, I-VT; passed Senate VA Committee), S 1950 and S 1982 (Sanders, I-VT; includes S 1581), and HR 3499 (Kirkpatrick, D-AZ) would (among other provisions) require VA (at no net cost) to improve use of MFT clinical interns by providing those interns with financial stipends, as is done for all Psychology and most Social work interns. On February 27, 2014, the full Senate considered S 1982, but voted to re-commit this bill back to the Senate VA Committee due to funding issues unrelated to the MFT intern provision (Motion to Waive All Applicable Budgetary Discipline, Vote 46).

Background: An average of 22 Veterans commit suicide daily, and an increasing number of Veterans have mental-health needs consequent to extended active-duty deployments. These needs often also affect Veterans’ family members. In 2006, Congress enacted Public Law 109-461 establishing 38 USC § 7401(3) to permit VA to hire MFTs to help serve the increasing number of veterans with mental-health needs. On September 28 2010, VA finally issued MFT Job Specifications (VA Handbook 5005/41), required in order for VA to hire MFTs.

VA employs 24,000 mental-health professionals, of which approximately 100 (0.5%) are now MFTs. Yet MFTs comprise about 13% of all U.S. mental-health professionals. (Similarly, only about 0.05% of VA mental-health professionals are Licensed Professional Counselors, who comprise about 26% of all U.S. mental-health professionals). While MFTs’ underrepresentation in VA mental-health staff is partly due to MFTs’ relative newness within VA, the American Association for Marriage and Family Therapy (AAMFT) believes it also is due to three unnecessarily bureaucratic VA obstacles:

-Half of all licensed MFTs are barred from eligibility for VA jobs because they do not hold advanced MFT degrees from academic programs that were specialty-accredited (by the Commission for the Accreditation of Marriage and Family Therapy Education, COAMFTE) at the time those degrees were granted, with no alternative deemed acceptable by VA. This is despite the following:

-Speciality accreditor COAMFTE was not established until 1978, so paradoxically MFTs with the most clinical experience are ineligible for VA.

-Some states (e.g. California) condition licensure on a “deemed status” for MFTs’ educational requirements in lieu of COAMFTE, so about 95% of California MFTs are ineligible for VA jobs.

-Other states (e.g. New York) set MFT licensure eligibility to include persons with degrees in related fields (e.g. psychology), so about 90% of New York MFTs are ineligible because they lack COAMFTE degrees.

-All advanced MFT students are barred from VA internship stipends, despite Psychology and Social Work students being eligible. After mental-health students complete their academic training, in order to be licensed they must successfully complete clinical internships of at least one year. Many of these students depend on financial stipends in order to live during their internships. But VA bars MFT students – even those in COAMFTE degree programs – from receiving stipends, while Psychology and Social Work students in corresponding APA and CSWE degree programs are stipend-eligible. Because many VA healthcare professionals start their careers through VA clinical internships, barring all MFT interns from stipends reduces the number of newly-licensed MFTs working at VA.

-VA’s MFT jobs to date are concentrated in Vet Centers, despite major mental-health needs in VA Medical Centers and Clinics. VA operates about 150 Readjustment Counseling Centers (“Vet Centers”) for recently-returned veterans, the sites of most MFT jobs to date. Vet Centers generally are reported to be working well. In contrast, most of the widespread reports of VA mental-health service problems are at Medical Centers (VAMCs, i.e. hospitals) and clinics. Unfortunately, some VA Medical Centers falsely believe MFTs are ineligible for jobs in those facilities. Although AAMFT is pleased that VA recognizes MFTs’ familial and other relationship-based clinical skills in its Vet Centers, we believe MFTs can be part of the solution in VAMCs and clinics. Like other mental-health professionals, MFTs are licensed in all states to diagnose and treat behavioral disorders.

Recommendation: Improve access to VA mental health services by urging VA to: 1) establish an alternative to VA’s COAMFTE degree requirement (such as licensure for three or more years); 2) make MFT interns in COAMFTE degree programs eligible for VA stipends, as provided by S 1982 (Sanders, I-VT) and HR 3499 (Kirkpatrick, D-AZ); and 3) urge VA’s Regional Networks (VISNs) to include MFTs as eligible for more clinical positions, such as by making MFTs eligible for the same positions open to Social Workers. We hope the unrelated concerns with S 1982 can quickly be resolved, and so the Senate will pass an amended version of that bill, and then the House will pass a similar bill with an MFT intern stipend provision.

If you have questions or need additional information, please contact:

Brian Rasmussen, PhD

AAMFT Government Affairs Manager

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