If I Were President: Creating Access to Mental Health Care

Guess what – I’ve just been elected President of the United States. (Just kidding, this election year is crazy enough already.) But if I were, here are three things I would change about access to mental health care in this country:

Provide universal coverage. You need mental health care. You have insurance coverage. So you go out and get mental health care and pay for it with your insurance coverage, right?

Wrong. Often people are limited to closed lists of in-network providers (many of whom are full), can’t see certain classes of therapists such as LMFTs (like me) or LMHCs, or face other roadblocks to care. And the worst offenders are often taxpayer-supported programs like Medicare, Medicaid, or the VA.

My solution would be to pass a nationwide Any Willing Provider law. If you are a licensed psychotherapist, you can provide services to anyone. Period. And insurance must pay for it. Period.

Let psychotherapists practice nationwide. Therapists can now technically practice anywhere, thanks to online technology. But there is one huge roadblock standing in the way: a stupid and outdated crazy quilt of state licensing laws.

If I practice outside of New York or Arizona, where I am licensed, I could actually face felony charges in some states. My malpractice insurance would also become void. It would literally be easier and legally less risky for me to treat someone in Uzbekistan than in, say, Ohio.

Worse, every state has its own incompatible requirements. Many have different course and credit hour requirements, forcing you to go back to school. Some will not accept a distance learning degree. And California, because they are special, makes everyone start all over again as an intern and then take their own exam. State requirements not only dramatically limit access to online therapy, they often trash the careers of good therapists who must move to another state for personal or family reasons.

If I were President, I would create national licensure for therapists. Or at least require the easy fix of license reciprocity. If you have been practicing therapy for, say, five years and haven’t killed anyone, there should be no good reason you cannot practice in any state of this great country.

Mandate coverage of telepractice. Finally, the last piece of the puzzle is providing financial coverage for online therapy. Telepractice is now legal in most if not all states. The problem is that insurance usually won’t cover it, so you can’t have it unless you can afford it yourself. This in turn denies care to people who could really use online therapy, like the housebound, people in remote communities, shift workers, and areas with few therapists or long waiting lists.

Legislating this has turned out to be extremely slippery. New York, for example, now has a Telehealth Parity Law mandating such coverage – but it is limited to specific types of therapists (not including LMFTs, unfortunately), and is full of loopholes: for example, it does not mandate how much insurers would reimburse for such sessions, requiring follow-up legislation. As President I would order everyone to cut the comedy and just cover online therapy at par with regular in-office therapy.

Of course, I am not going to be President anytime soon – thank goodness. So instead of wasting your vote on me, I am going to ask you to do the next best thing: become aware of legislation affecting access to mental health care in your state, and make your voice heard so that everyone gets the care they deserve. Thank you!