Texas Mental Health Crisis: Intern Supervision and Underserved Areas

Texas supervisor training program, speaking, consulting

Texas We Have a Problem

Here’s the thing. In light of recent events I want to speak to all of the problems Texas has when it comes to providing excellent, accessible, and affordable mental health care. I want to outline solutions, propose law changes, and rally the troops. Texas seems to enjoy competing for 49th or 50th place when it comes to quality mental health care in America and this little blog post probably won’t change that. So, as a counselor supervisor, counselor educator, and practicing clinician, I will talk about what I know. This post is about counselor intern supervision and supervisor training.

For those readers who aren’t familiar with Texas rules governing licensed professional counselors:

  • Every Licensed Professional Counselor (LPC) in Texas must spend 3000 hours as a Licensed Professional Counselor Intern under the supervision of a Licensed Professional Counselor Supervisor (LPC-S).
  • There are places in Texas where there are no licensed professional counselors or supervisors (see the white areas in the map below).
  • There are strict limits on the number of supervision hours interns can accrue using technology.

Training more supervisors in rural areas and lifting the restrictions on webcam supervision would be easy first steps to helping Texans gain access to quality mental health care.

Texas supervisor training program, speaking, consulting


Counselors and Webcams

Increasing allowable intern supervision hours via technology is a no-brainer. The Telemedicine Wellness, Intervention, Triage, and Referral Project at the Texas Tech University Health Sciences Center is pioneering the use of technology to screen junior high and high school students, identify those most at risk for committing violence in schools, and intervene before anything happens. Data are already showing that the screenings have helped avert violent incidents and provide students the help they need. Why can’t interns attend supervision using the same technology? Counseling graduates on the fence about where to practice might choose underserved areas if they did not have to travel long distances to receive face to face supervision. Arguments against using technology in mental health are archaic and have become a roadblock to care.

Counselor Supervision Training

Changing the rules about technology and supervision is only a start. Long story short, we need seasoned counselors and counselor supervisors in underserved areas. One LPC Supervisor Course attended by five participants who agree to take on just two interns can impact hundreds of people in need of quality mental health care. Recently I, along with Dr. Christopher Taylor offered a six hour course to twenty participants in El Paso interested in offering their own 40 hour training. How exciting is that? Twenty seasoned licensed professional counselor supervisors near one of the most underserved areas in the state are now trained and willing to provide their own courses. Their impact alone could be a game-changer for interns who feel called to work in underserved areas.

Texas supervisor training, speaking, consulting

Lifting limits on technology and increasing the number of supervisors won’t solve everything but it’s a start. We still need to give interns the ability to bill Medicaid. We still need to convince the military and Tricare to hire licensed professional counselors. And we need to help Medicare understand that refusing to allow counselors to be credentialed under their plans makes them part of the problem. Texas, we need counselors and supervisors more than ever before. And we need them now.

We Need You Counselors and Supervisors!

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Texas, we have a problem.

Our state has over 15 universities with CACREP accredited counselor education programs. There are almost twenty thousand licensed professional counselors at this writing and almost four thousand counselor interns. Counselor supervisors are ready to offer consultation and supervision. We have active state organizations, a legislature that is open to hearing us if we choose to speak, and one of the hottest business demographics in the United States.

So why is the Texas prison system our biggest mental health provider? According to NAMI 2010 statistics Texas spent just $35 per capita on mental health agency services in 2006. This was just 1.1 percent of total state spending that year in the state of Texas. Nationally, approximately 70 percent of youth in juvenile justice systems experience mental health disorders and in 2008, approximately 37,700 adults with mental illnesses were incarcerated in prisons in Texas.

It’s not easy being a counselor.

Potential counselors enter universities with dreams of helping, but the reality is, the job market doesn’t offer much. LPC Interns, after having completed a sixty-hour master’s degree program, still cannot bill insurance for their time. As a result, they compete for lower paying bachelor’s level Qualified Mental Health Provider positions, gain low quality hours in hospital settings, or volunteer. That is tough to do when you are paying a supervisor and student loans every month.

When fully licensed counselors get a job, the situation is less than ideal. Counselors who seek me out for consultation tell me they are overworked, underpaid, and forced to do paperwork on their own unpaid time. Not only that, they are often placed in dangerous situations, and required by third-party payers to apply ineffective treatment modalities that are inconsistent with their training. Counselors in private practice face the daunting task of running a business, a skill that was missing from their counseling.

We need counselors and supervisors.

We need passionate people who will advocate in the legislature and supervise the interns. We need generous people who will give time because not every client has the means to get the help they need. We need balanced people who will focus on their own attitude and mental health so we don’t lose them to burnout. Good training, consultation, and opportunities to grow will help counselors keep the passion that got them started. Counselors who train to become supervisors can expand their knowledge, grow their practice, and impact the next generation.

So consider supervising. Remember, we need you.


After Sunset: Still Work To Do

Last week the Texas legislature ended its special session and voted to extend the life of the Texas LPC/LMFT boards. By extending Sunset two more years, the boards got some time to reorganize, fix some problems, and prepare for the next Sunset review in 2019.

As this process has unfolded I have noticed confusion and agitation among the affected mental health professionals. I have heard the arguments for and against organizing a special Behavioral Health Advisory Board and I have seen the posts in social media about what is really ‘good for us’ as licensed mental health practitioners in Texas. Rather than tackle this issue myself, I have invited someone more knowledgable to write the blog this week.

Katherine Bacon Ph.D., LPC-S, NCC is an assistant professor of counselor educationinternship coordinator for graduate counseling students, project director for experiential earning in integrated behavioral health, project director for CMHC scholarship for disadvantaged students, and she is the legislative liaison for the Texas Counseling Association. August 4, 2017 Dr. Bacon testified at the Texas Senate Health and Human Services Committee hearings. She spoke eloquently about our current situation and what still needs to be done. Please read her comments below and see why TCA and TACES are so passionate about the work ahead of us.

Katherine Bacon’s Testimony

My name is Dr. Katherine Bacon. I am testifying in support of SB 114 on behalf of the Texas Counseling Association.  In consideration of the committee’s time, I will be the only person testifying on behalf of the 7,000 members of TCA. 

Thank you for this opportunity and for your work on this committee.

As a mental health counselor and business owner, I know the impact of the delays to licensure due to our current system.

So although, I have been able to bring over 3.5 million dollars into Texas to train mental health counselors to work with Veterans and to address the mental health workforce shortage; it’s been difficult for these new counselors to get to work due to the limitations of the board because they are housed at the Department of State Health Services. Staff shortages, the inability to hire or fire staff, and the low priority of regulation within the DSHS mission, all contribute to those challenges.

As the TCA volunteer liaison to the LPC board, I have been attending LPC Board and Committee meetings for at least six years. I observe the diligent efforts of the Board to manage regulation of the more than 22,000 Licensed Professional Counselors in Texas without an adequate infrastructure to support their work.

Without SB 114, these challenges will persist for at least another two years for all licensing boards. Simply extending their sunset date to 2019 will cause Texas to lose momentum

This is why we support SB 114.

This model allows each licensing board to develop substantive rules on standards of care, licensure, educational requirements and disciplinary guidelines for their respective professions.  This model would NOT allow the Executive Council or any mental health licensing board to impose standards or modify the scope of practice for any other profession.

SB 114 will not change the composition of any of the licensing boards.  It will simply allow for consistency in administration for all mental health boards. It will create a one-stop shop for those who hold dual licenses.  It will make it easy for the public to know where to go to find a licensed mental health professional or to file a complaint against one.

I chose a career in mental health because Texas was on the cutting edge. We need to act now, we can’t wait two more years, SB 114 creates the opportunity for Texas to establish a model that will create unity across all mental health professionals. This unity will enhance the delivery of mental health services in Texas.

Thank you.

Where Are the New Rules?

According to the LPC board website November 19, 2015 https://www.dshs.state.tx.us/counselor/lpc_rules/

“The proposed rules posted in the May 15, 2015 issue of the Texas Register have been withdrawn by the Texas State Board of Examiners of Professional Counselors for further review and editing. The notice of withdrawal of the proposed rules will be published in the July 3, 2015 issue of the Texas Register.”

So where are the new rules?

When board members visited the Texas Counseling Association Professional Growth Conference November 4-6 2015 in Corpus Christi, Texas this was a very popular question. With so many things from distance counseling to continuing education for board members up for grabs, counselors wanted to know when the rules would be available again for discussion and input. Like any good bureaucracy, it might take some time, so watch the Texas LPC website and stay connected to your professional organizations like the Texas Counseling Association for the most up-to date information.