Utah faces a behavioral health care crisis. A recent report from Utah’s Office of Professional Licensure Review says as many as half a million Utahns aren’t getting the care they need.
Director Jeff Shumway doesn’t mince words. The situation is “really bad.”
To illustrate just how bad, he told the story of one family trying to find treatment for their teenager following emergency inpatient care. The family “literally could not find a therapist [and] someone to do the prescribing for them,” he said.
“So imagine having a child in your home who you think could be struggling or attempting suicide at any time. It feels like a life or death situation that you're dealing with day in, day out.”
It took almost a year for the family to find the care they needed. Shumway has heard many stories like this. The average wait time to get outpatient care in Utah is a little more than two months. The federal guideline is 10 days.
If people can’t get the help they need, Shumway worries there will be more suicide attempts and people on the streets.
Plus there’s the economic consequences. He said there will be “massive increases” in the burden on the health care and the criminal justice systems “from people who don't get behavioral health care in a timely or a high quality way.”
How the Legislature is tackling the problem
The behavioral health care field looks like an inverted pyramid right now. The problem is that it’s top heavy with providers who have advanced degrees, Shumway noted.
“It sort of begs the question, why don't we have more extenders or paraprofessionals like nurses in physical health care?”
A proposed legislation solution (which has already cleared the Senate) would create a pathway for behavioral health coach or technician licenses. The bill also includes a path for clinical social workers to get licensed without passing the final exam. Instead, alternative requirements like more client and supervision hours would be needed.
Many can’t pass the exam, Shumway said, “even when they've been practicing for many years, and their supervisor and others feel that they're definitely safe.”
For his part, there are no fears that this would leave some therapists as being not as well-trained or as qualified.
“We looked for any evidence that the national standardized exams were predictive of, you know, practitioner skills, patient safety, patient outcomes,” he said. “And we couldn't find it.”
Getting rid of the requirement is also another way, he said, of opening up the profession to non-native English speakers.
Insurance carriers have a say too
Salt Lake City-based therapist Jasmine Fitzsimmons worries about the licensure changes making it easier for people to enter the field. She’s not worried about the caregivers themselves, but the unintended consequences with insurance.
Getting in-network and credentialed with insurance companies is “a really tricky process,” Fitzsimmons said. There are specific industry regulations and criteria for therapists.
“Just because you are a skilled professional doesn't mean that they're going to accept you into their network,” she said.
If insurance doesn’t pay for the services of the new therapists in the pipeline, “then the clientele just foot the bill.”
Fitzsimmons is hopeful about expanded opportunities for people to enter the behavioral health field, but would also like to see the Utah Legislature address the power of insurance companies.
Education is part of the solution
To Utah State University social work professor Derrik Tollefson, the changes would remove some unnecessary licensure roadblocks. But he said the problem can’t be solved without a strong education component. Mental health care can’t be de-professionalized, in his words.
“You're still going to need really high quality, well-trained master's or doctoral level people.”
Tollefson founded USU’s master of social work extension program as a way to address that. They have campuses in several parts of rural Utah. And the program is “very much a success story,” he said — with increased access to mental health care in those areas.
Started in 2008 with state funding, the program is unique because classes can be virtual. Faculty are also on the ground in places like Blanding, Vernal and Moab. Tollefson said that makes it better than programs that are purely online because “social work training is so practice-oriented.”
“So we have to continue to invest in [our] programs,” Tollefson said. “And not relying on out-of-state programs that just, frankly, don't have the kind of infrastructure and support that we can provide here in our local universities.”
The Utah System of Higher Education has requested $3 million in the state’s 2025 budget to hire more faculty in behavioral health care.
Tollefson applauds the state’s investment efforts.
“We hear a lot of pessimism about government and what they're doing,” he said. “But I can tell you that this is very much a success story.”
