On Monday, the Texas MFT licensure board and TAMFT filed for a rehearing with the state supreme court. The motion requests a reconsideration of the recent denial of TAMFT’s petition for review. In the meantime, Texas, and our profession, needs your voice.
As providers, we frequently work with clients to advocate for their needs – whether with a partner, their family, or in their community. Now, we must advocate for our own needs, and for our profession’s. As a group smaller and younger than other mental health professions, we’re getting picked on. But, as a concerned colleague recently asked me, “don’t they know it’s a house of cards? Once we go, don’t the counselors and psychologists see we’ll all go?”
Consider our need to speak out systemic advocacy: we must advocate for our ability to practice as we always have and are qualified to do, and demand our mental health colleagues with alternate licenses do the same, in order to ensure that we’re still around to help clients in need of our care. We must work together, as advocates for self, other, and group, to change attitudes and policies that contribute to a dire mental health crisis, in Texas and elsewhere. For a profession with grass roots origins, solidarity and a unified voice will be critical.
Following the notice that the Texas Supreme Court had denied TAMFT’s petition for review, I stewed. I was frustrated, and felt unappreciated; isolated, in a world where I’m outnumbered by every other kind of mental health provider. But, a colleague shared a reframe I needed: “What are the options? Stay frustrated, feel like we can do nothing? I can’t stay there; that becomes hopelessness. I choose to speak louder.” As I’ve recommended to clients many times before, I decided to write my frustration out of my system. At the end, I had a piece that expressed my frustration with the Texas Medical Association, discussing the mental health crisis in Texas, and the need to continue to allow MFTs in the state to do what we are qualified to do. I submitted it to the Dallas Morning News as an OpEd, expecting to hear nothing, but able to sleep. Next day, it was published.
If you’ve never written an OpEd, now’s the time. You do not need to have ever done something like this before to be successful – but, we must try. It’s time to advocate for the profession and for those in need of our care broadly, on bigger stages than many of us are used to. Use your voice. Loudly, and often. Talk to friends, family, colleagues, mental health providers in other disciplines, and medical providers about what we do. Tell them 1 in 5 adults has a mental illness, fewer than half get the care they need. Sign up for AAMFT’s Family TEAM. Be ready and willing to volunteer to advocate, and respond quickly when called. Donate to TAMFT's political action committee, Family PAC, or AAMFT's Practice Protection Fund. Participate in social media, and use Twitter to connect with MFTs and a broader audience. More importantly, fight hopelessness, and combat threats to our profession and the growth of a worsening mental health crisis, by doing anything to walk the walk.
Material below previously published in Dallas Morning News, as How Texas is Creating a Mental Health Care Crisis (June 13th, 2016):
The state of Texas is experiencing a health care workforce crisis, and the most severe shortage is in mental health. So why, then, has the Texas Medical Association taken legal action to ensure that marriage and family therapists in Texas may no longer diagnose and treat mental health disorders?
Marriage and family therapists (MFTs) have effectively and efficiently been diagnosing and treating mental health disorders in Texas for years. In 2008, the Texas State Board of Examiners of Marriage and Family Therapists sought to edit the state regulatory code to more clearly indicate the profession’s ability to independently diagnose. Then, in a grand overreach, but for what appears to be typical for the organization (they have done similarly with chiropractors, podiatrists, and dentists), the Texas Medical Association sued the board to prevent diagnosis as part of the scope of practice of MFTs in the state.
On May 27th, the Supreme Court of Texas denied a petition to review a Court of Appeals decision supporting TMA’s assertion that MFTs can not diagnose. The Texas Medical Association describes the outcome of the Supreme Court’s decision as favorable. But, favorable for whom?
It certainly isn’t favorable for the enormous percentage of the population that requires mental health care but can not access it. Approximately 80 percent of Texas counties are designated Health Profession Shortage Areas for mental health. The Department of State Health Services has said that one-third of adults with serious and persistent mental illness receive the services they need, while the percentage is worse for children with a severe emotional disturbance. The crisis is more severe for underserved populations, including people in rural areas, those who don’t speak English, minorities, and those without adequate financial resources or health insurance.
Rather than taking a step to improve access to care by continuing to allow MFTs to appropriately diagnose mental health conditions independently, the Texas Medical Association and the state supreme court have removed this resource. Who do they propose do all the work to diagnose and treat serious mental illness? The physicians that don’t take Medicaid, don’t see people who pay $5 for each appointment, don’t have any training or experience in mental health? Primary care physicians and psychiatrists who are willing and able to help mental health patients literally do not exist in the numbers needed. Further, it’s doubtful the official position of TMA is held by many practicing physicians. Rather, most doctors welcome assistance in caring for patients with mental health concerns.
Patients frequently visit their primary care physician for mental health concerns. But, the number that do is well below the number that should. Some research suggests as many as 43 percent of adult primary care patients meet criteria for a psychiatric disorder. However, few of these patients’ diagnoses are captured by primary care physicians, for many reasons – little time to interview patients, a lack of knowledge about diagnostic procedure, and patients’ fears of stigma.
To be very clear, marriage and family therapists are required to complete specific training and supervised clinical experience in assessing, diagnosing, and treating mental illness. These standards are set by the state, and the national association, and exceed physicians’ general training requirements. Not only are MFTs entirely qualified to perform this task, they have been competently doing so for many years. This decision affects the recruitment of qualified mental health professionals from other states, as well as the retention of MFTs in Texas. Texas is already in a mental health workforce crisis, with a growing, diverse population and limited legislative action taken to address the shortage.
Further, the Texas Medical Association will next pursue removing diagnosing from counselors and psychologists, and provides precedent for other states to alter MFTs’ scope of practice, affecting tens of thousands of mental health providers, and the clients they serve.
Preventing minor changes in a state code that allows the continuation of a practice that assists people most in need of mental health care is hubris. Greedy. Shortsighted. And certainly hypocritical to TMA’s stated mission to fight for patients’ needs through providing adequate and coordinated care. While the rest of the country is moving towards an integrated care model, with physicians working together with behavioral health providers to provide adequate care for patients most in need, Texas is moving backwards.
Sarah Woods, PhD, LMFT-Supervisor, is an Assistant Professor and Program Coordinator of the Family Therapy Program at Texas Woman’s University in Denton, Texas. She specializes in medical family therapy and researches connections between family relationships and health, especially for underserved populations. See her TED talk on diagnosis with fellow Clinical Fellow Connie Cornwell here. Email: firstname.lastname@example.org Twitter: @swoodsieb