Wyoming considers joining interstate mental health care compacts

Lawmakers, looking to alleviate Wyoming’s mental health professional shortage, are considering measures that would make it easier for practitioners to work across state lines. 

The Joint Labor, Health and Social Services committee considered two draft bills this month that would allow the state to join interstate psychology and counseling compacts. By enabling professionals licensed in one compact state to practice in all compact states, advocates say the agreements would give Wyoming patients access to more counselors and psychologists, and give Wyoming providers access to larger markets.

Wyoming residents could connect virtually with a counselor in Denver, for example, or a University of Wyoming student going home for the summer could continue treatment with a Laramie-based psychologist. The expansion of mental health care options is especially appealing in a rural state where the per-capita suicide rate is often the highest in the nation. 

Advocates of the bill say state licensure requirements can be prohibitively time consuming, costly and ultimately discourage psychologists and counselors from going through the process. Skeptics, however, are concerned joining the compacts could wrest regulatory control away from the state and cost mental health professionals clients. 

A deepening crisis 

The non-profit advocacy group Mental Health America ranked Wyoming last in its 2022 state of mental health report because of a dangerous combination of factors: a high prevalence of mental illness and poor access to care.

There’s been a shadow pandemic of behavioral health issues taking place across the country, said Julia Harris, senior policy analyst for the health policy project at the Bipartisan Policy Center. “There’s been some of the highest rates of overdose that have ever happened in this country during the pandemic. There’s growing anxiety and depression because of the pandemic pressures.”

“The demand is way up,” said Casper-based psychologist and Wyoming Psychological Association president Donald Benson. “Part of that has been the pandemic and the stress people have been under.”

“My phone’s ringing off the hook,” Cheyenne-based counselor Lindsay Simineo said. It’s been a long time since she’s had an opening in her schedule. 

“We do not want our Wyoming counselors getting to the point where they are so burned out by the overwhelming need, they walk away from the profession,” Simineo said. “So that additional workforce from out of state is going to be hugely important in supporting our current mental health workforce.”

Simineo also lobbies on behalf of the Wyoming Association of Counselors, which supports joining the counseling compact. 

Filling in the gaps

Need is outstripping the supply of mental health professionals, but the two compacts provide a potential way to alleviate that stress. Plus, joining them could make Wyoming a more attractive place for specialists to live and work. 

Utah joined both the psychology and counseling compacts in the last few years. 

Anna Lieber, licensed clinical mental health counselor and president of the Utah Mental Health Counselors Association, points to Logan, Utah’s proximity to the Idaho border as a prime example of the compacts’ benefits. “Most therapists in Logan have to be licensed in both Idaho and Utah,” Lieber said. “Which is a financial burden.”

“With COVID, we realized we could use telehealth a little more efficiently and better,” said Amanda Alkema, assistant director of substance abuse for the Utah Department of Health and Human Services. “It’s really helped in our rural areas to expand that.” 

She noted that Mountain West states are often competing for the same workforce, and the compacts allow for more collaboration and shared expertise. 

Wyoming has joined several compacts in the past few years, noted Wyoming Hospital Association president Eric Boley. Physician and nursing compacts proved particularly helpful during the pandemic. Nurses and physicians from participating compact states were able to work in Wyoming without going through an arduous licensing process.  

“We haven’t seen any downside to this at all,” Boley said. “It’s all been really positive.”

Not a ‘panacea’

The Wyoming Psychological Association has yet to take an official position on the compact, Benson said.

“There absolutely are people that worry that the people in other compact states will cherry pick patients from Wyoming,” Benson said. “And that will cut into the livelihoods of psychologists here.”

Additionally, some worry about states losing regulatory control over their counselors and psychologists. 

“And when it comes to the Legislature,” Boley of the Hospital Association said, “there’s always concern about oversight and who’s ultimately responsible for making sure that they’re good practitioners, and they’re adhering to all the rules and regulations and guidance.”

However, he also said that the previously enacted physician and nursing compacts haven’t resulted in substandard care. “There’s still oversight and they’re still licensed in their home states,” Boley said. 

The compact is just one important step forward, said Wyoming Association of Mental Health and Substance Abuse Centers executive director Andi Summerville. “But we still need people on the ground in Wyoming. Telehealth is wonderful, but it’s not a panacea.”

She says the state should still focus on growing the number of counselors who live and work in Wyoming and improving pay. 

Summerville is supportive of the psychology and counseling compacts and the potential for more telehealth options. 

“It’s important to recognize that that’s the way the country is moving in general,” Summerville said. “And without being part of the compact, it creates barriers for folks to come practice in our state.”

The Joint Labor, Health and Social Services committee voted to move forward with the draft bills and formally finalize them in its next meeting.