Most of the staff at the nonprofit Utah Navajo Health System are Native American, and Behavioral Health Director Rick Hendy wants to keep it that way. Though he’s not Indigenous himself, he understands why it’s important.
“It's critical to have professionals who understand the culture, some who can speak the language,” he said. “I think they can relate to their patients in a way that is difficult for a non-Native person.”
He gave the example of a high school student who stopped going to classes. A traditional counselor reached out and spoke to the grandparents in Navajo. It turned out the child was embarrassed because “their clothes were old.” Plus, the family was out of wood to heat their home, and the grandma needed some herbs for an ailment.
The next day, they were able to get them those things, and the therapist started meeting with the student. To Hendy, it was another example “of the good that's coming about from having Navajo therapists, Navajo traditional counselors in our local schools.”
Like the rest of the state, there’s a growing and great need for mental health care serving cultural communities, including among Native Americans. But Native Americans in these roles are hard to come by. Many aren’t able to pass the national licensure test. Hendy has had two therapist jobs open for a year.
Now Utah has made it so prospective therapists don’t have to pass that licensure exam — they must attempt it and can instead meet other requirements if they don’t pass. The new law went into effect May 1, 2024. Hendy said this change will “absolutely” help get more people in care and fill the two therapist positions he’s been struggling to fill — he said he has “some staff right now that this will directly impact.”
Before the change, the challenges prospects faced with the licensure test included cultural barriers and logistics. The Navajo Nation spans 27,000 square miles of rural land across Arizona, New Mexico and Utah. The nearest urban locations that offer the exam are Salt Lake City, Albuquerque, Phoenix or Las Vegas. When she took her exam, UNHS Navajo therapist Autumn Secody studied in the car on the hours-long drive to Vegas.
Before she left her home on the Utah portion of the Navajo Nation, she had to take care of her horses, cows, sheep and children. She arrived just in time for the exam.
“I'm already tired and this is a four hour test,” she said. “So I tried to muddle through.”
The questions were difficult because, she said, they’re geared toward someone in an urban area. For example, a test question might ask what to do in a crisis situation, but she said “there is no crisis response” where she lives.
“So I'm a crisis response worker. I'm a therapist. I'm a case manager.”
In one real-life scenario she offered on the challenges of the rural environment, she had a crisis team ask to talk to a patient by phone. But the patient was in a remote, inaccessible area “and I'm like, ‘No, there's no [cell] service out there.’”
Secody ran out of time on that Vegas test and failed by just four points. It took a second try at a later date and another trip, this time in Albuquerque with an overnight stay, for her to pass, unlike a lot of her peers.
“Native Americans — historically we're just overcoming barriers that someone that lives in non-native, urban areas don't even have to imagine,” she said.
Despite the headwinds, Secody, however, is skeptical that Utah altering this licensure requirement is the way to go. She would like to see accommodations like more time and closer testing locations for Native Americans, or even waivers on a case-by-case basis.
“Because we want to provide great service here to our patients,” she said. “And to be able to say that, ‘Hey, I passed that test just like every social worker that is in Maine and the East Coast and the West Coast.’”
The new law requires candidates to attempt the test. If they don’t pass, then they must complete other requirements to get licensed — like more client and supervision hours.
But even these changes don’t solve all the issues on tribal lands.
“There's a lot of things that our Native American students face in terms of, housing, food insecurity,” said Racheal Holiday, victim services program manager at UNHS and a Master of Social Work student at Utah State University in Blanding.
She’s Diné, or Navajo, and said a lot of these students aren’t working during their programs. Travel for schooling is also a struggle. In the first year of her program, Holiday drove an hour each way to classes from Monument Valley and wouldn’t get home until almost midnight.
But Holiday is optimistic about the testing change.
“I think that it's going to be helpful in bringing more licensed clinical social workers in rural tribal areas.”
And that is the first step in addressing the mental health needs of people across the Navajo Nation.
If you or someone you know is struggling or in crisis, help is available through the national suicide hotline at 988.
