In most rural Minnesota counties there is a critical shortage of mental health professionals.
A few years ago, the state Legislature tried to ease that shortage, creating some new mental health licensing categories. It was a deliberate effort to get more counselors in high-need areas.
The strategy has run into some big obstacles along the way, but observers say there are now signs it's paying off.
Park Rapids resident Katie Johanning thought her master's degree from Bemidji State University would qualify her for a professional level counseling license.
Johanning graduated in 2008 and became a Licensed Professional Counselor. But because of an oversight in the wording of state law, Johanning and other masters-level graduates found their degrees were not worth what they thought. That's because they have to be supervised by another professional when they provide mental health counseling.
"I was under the impression that a licensed counselor was equal to licensed social workers and LMFTs, which are Licensed Marriage and Family Therapists, and found kind of halfway into my program -- which at that point I really didn't want to start over -- that the licensure in Minnesota didn't let you work independently," Johanning said.
The problem is complicated. When lawmakers created a new Licensed Professional Clinical Counselor, or LPCC category in 2007, they left out some critical wording. The legislation did not officially name holders of the license "mental health professionals." Those key words are necessary for counselors to bill for their services to government programs like Medicare or Medicaid.
The good news is that last spring, lawmakers fixed the problem. By this fall, Johanning will be eligible to apply for the new Licensed Professional Clinical Counselor status.
"It just means that a lot of people with that LPCC licensure status can do, they have more freedom in what they can do and what they can do independently. They can serve a lot more people in our area," Johanning said.
That is a big deal for rural Minnesota. Louise Jackson is professor of psychology at Bemidji State University. Jackson said Minnesota is one of the last states in the country to allow masters level degree holders to counsel clients independently.
Because of the confusion over the past few years, Jackson saw a drop in students entering BSU's masters program. Some graduates left Minnesota to work in states that accepted their credentials. Now that the law has been changed, BSU will be able to serve as a pipeline for students who will hopefully stick around, Jackson said.
"Now if we graduate five to 10 a year, let's say two-thirds of them stay, then they'll be looking for jobs in the rural areas. So it will be a great boon to our area to have this program. We're enjoying an upsurge in our applications right now because of this new legislation," Jackson said.
It may be years before the new flow of counselors has a broad impact. Sixty counties in Minnesota are federally designated as critical mental health shortage areas.
Jane Hovland is a psychologist and professor of behavioral sciences at the University of Minnesota Duluth. Hovland said rural Minnesota is dangerously under served, and that means long waits.
"It can be three months in a northern area or a rural area. And maybe that wait is only two weeks in a metropolitan area. And often times when we wait to solve a problem, the problem gets worse," Hovland said.
The mental health worker shortage is a national problem.
Jim Boulger is director of the Center for Rural Mental Health Studies at the University of Minnesota Duluth. More people need to be trained in the field, but there are not enough training programs, he said.
UMD dropped its graduate level program about five years ago because of funding issues. Boulger said Minnesota offered financial incentives like loan forgiveness in the past for students entering the mental health field, but that was cut, too.
"Money in Minnesota, as you may have noticed, is getting a little tight. We can't expect the state to come up with a lot of bucks to train anybody anymore. It's just going to get tougher and tougher, I'm afraid," Boulger said.
Mental health access could get worse as health care policies change in the U.S. Right now, many people don't seek mental health care because they do not have insurance. If health care reform ultimately leads to broader insurance coverage, the lines to see a counselor will get much longer.