NYAPRS Note: NYAPRS has joined with leading behavioral health and human service organizations to “break the barriers to care” to fully utilize our trained and expert mental health recovery workforce. The Campaign For New York’s Well Being is ready to launch grassroots advocacy around the clinical practice exemption. See “How New York Stacks Up” and “Take Action Now” at https://thecampaignfornewyorkswell-being.org/protecting-the-mental-health-workforce/
Protecting New York’s Mental Health Workforce
Each year, hundreds of students graduate with degrees in mental health counseling, family therapy and psychology from some of the most prestigious colleges and universities that located right here in New York State. The University of Rochester, Syracuse University, Iona College, Hofstra University, Medaille College and Manhattan College, to name a few, have all invested to educate a workforce that is dedicated to providing mental health services in what has become a most challenging time. The Governor’s proposal to change how mental health services are provided in New York can result in hurting the people who need the help as well as our workforce–present and future.
For the past 14 years, a diverse, supportive, caring and effective workforce has provided needed mental health services to many of New York’s most at-risk children, teens, families and adults. Together, these team-based professionals have paved the way for progressive and positive change in how behavioral health services are provided at state-authorized organizations. Many of them work under the supervision of a licensed Psychologist, Social Worker or Nurse Practitioner in order to accrue the hours needed to become professionally licensed. In fact, two licensed professionals have to sign off on any treatment plan developed by these unlicensed professionals. Professional oversight is already built into providing mental health services in New York State.
Eliminating the practice exemption, as the Governor has proposed in his FY2019 budget, will adversely impact the delivery of mental health care at organizations/facilities licensed under the following state Mental Health Laws:
- Article 31 (Mental health Clinics),
- Article 32 (Office of Alcohol and Substance Abuse Services),
- Article 16 (Office of Developmental Disabilities) and
- Article 7 (State Operated Hospitals)
The change would also effect behavioral health delivery at the Office of Children and Family Services Detention Centers (Article 19-G of the State Executive Law).
Simply put, the proposed change to the practice exemption would add another layer of bureaucracy to the diagnostic process–a layer people in need of mental health services do not need. Instead of relying on the supervision of licensed professionals overseeing the work of unlicensed professionals, eliminating the practice exemption will mean that one of five different licensed individuals would “directly observe each patient in person or by electronic means.”
Who are these five licensed professionals?
- Social worker
- Registered Nurse
- Licensed Practical Nurse
- Physician’s Assistant
Social workers and psychologists have always been a part of the diagnostic and treatment process through direct supervision of unlicensed mental health professionals. However, leaving the responsibility to diagnose and treat in the hands of a registered nurse, licensed practical nurse or physician’s assistant who may have no mental health training whatsoever puts the patient at risk and undermines the credibility of the mental health profession.
If the practice exemption is eliminated, supervised unlicensed mental health professionals will no longer be able to provide needed clinical services. In essence, they will no longer be able to diagnose, assess and/or evaluate patients, provide psycho-therapeutic treatment or develop and implement assessment-based treatment plans as they have done for the past 14 years.
Currently, unlicensed professionals in certain settings work to create, develop and/or implement a service or recovery plan. These are not diagnosis and treatment plans. However, they provide a solid framework that help those in need of mental health services to build a solid, productive lives for themselves.
Among the services unlicensed professional can provide are:
- General counseling that is not psychotherapy
- Coordinating, evaluating or determining the need for or the provision of
- Job training
- Homeless services and shelter placement
- Refugee services
- Residential, day or community habilitation services
- General public assistance
- In-home services and support
- Home-delivered meals
- Recovery support
- Adult or child protective services including investigations
- Domestic violence services
- Runaway and homeless youth services
- Foster care and adoption including home studies and assessment, family service plans and transition plans
- Case management
- Residential rehabilitations
- Home and community-based services, and
- De-escalation techniques, peer services or skills development