Get The Gavel
A weekly SCOTUS explainer newsletter by columnist Kimberly Atkins Stohr.
There is a remedy, though. Commercial insurance companies must forgo the expectation of large profits and ever-increasing CEO salaries and step up the level of reimbursement. Last year, Illinois passed a law creating a minimum reimbursement floor for behavioral health providers. Massachusetts should, too.
In addition, Massachusetts should expand the program that provides stipends to eligible social work students in practicum placements, allow social workers at higher licensing levels to earn continuing education credits for providing supervision, and remove the high-stakes exam at the entry level of social work licensure. Rhode Island removed the exam at the entry level, and according to our analysis of data from the state there has been a huge jump in new licensed social workers — and zero additional corresponding complaints to the licensing board over three years.
These are common-sense steps. For the sake of consumers in need and a workforce on the brink, they should be adopted now.
Rebekah Gewirtz
Executive director
National Association of Social Workers, Massachusetts and Rhode Island chapters
Boston
News flash: Mental health care is medical care
The Globe’s editorial about a lack of mental health professionals cited a finding of a Behavioral Health Workforce Center report that “medical care is reimbursed at a higher rate than mental health care.”
Actually, mental health care is medical care.
In many cases, some unreported, whether someone has access to such care is a matter of life and death.
Social workers and nurse practitioners are vital in the pipeline to meaningful interventions and recovery. As a person in recovery from severe mental illness, I can attest that treatment has been a lifeline and has vastly improved my quality of life.
Linda Larson
Cambridge
While demand for care rises, reimbursement rates fall
I read with interest your editorial on the shortage of mental health clinicians, and specifically those who accept insurance. I can attest that reimbursement rates continue to fall while demand for care steadily rises.
I own a practice in West Newton, and on average we see nearly 200 clients a week, almost all with insurance. The need for mental health services is not abstract to us — it is visible every day in the people seeking help, waiting for appointments, and struggling to find ongoing care for some of the areas in which we provide specialty care, such as perinatal mental health.
Yet insurance companies continue to reduce reimbursement rates, or they keep them stagnant despite inflation, rising administrative burdens, and increasing operational costs. Most recently one insurer decreased reimbursements for the second year in a row and refused to negotiate despite our highlighting the range of evidence-based approaches and specialty care we provide.
The system makes it harder and harder for clinicians to sustain a living wage while accepting insurance. Many providers are forced to take on unsustainable caseloads, move to private-pay models, or leave clinical work entirely. Clients then experience this as only a provider shortage, when in reality it is also a reimbursement and policy failure.
If we genuinely want to improve access to mental health care, we must address not only workforce numbers but also the economic conditions that drive clinicians away from insurance participation. Mental health care cannot remain undervalued while we simultaneously expect clinicians to absorb ever-growing demand.
Until insurers reimburse mental health treatment fairly and consistently, taking into account regional pricing, access problems will persist no matter how many new clinicians enter the field.
Mara Acel-Green
West Newton
The writer, a licensed independent clinical social worker, is the owner of Strong Roots Counseling.
Exam requirement is poor policy — removing it would be a boon
The mental health system does need money, but there are policy reforms that would cost the state relatively little that can be passed now. One of the policy proposals the Legislature is considering is the SUPER Act, which would continue funding placement stipends and remove the exam requirement for licensed certified social workers — people at the entry master’s level — who have completed hundreds of hours of practicum, graduated from a school of social work accredited by the Council on Social Work Education, and will be supervised for an additional 3,500 hours before being able to seek independent licensure.
The editorial rejects the idea of removing the exam requirement. Yet Massachusetts only adopted the licensure exam in 1983 and grandfathered in social workers who were already doing this work, exempting them from taking the standardized exam. Several states don’t have an exam at this entry master’s level, and others have removed it without seeing negative effects.
You know what makes social workers great at their job? Their systems theory education, practicum, and coursework, which explore the complexity of working with humans and factor in the many things that make them unique, not a standardized exam where they have to pick option A, B, C, or D.
Brianna Silva
Peabody
Why does the Globe editorial board support a national standardized exam over a social work degree? As the editorial notes, the Health Policy Commission reports that around one-quarter of positions for behavioral health clinicians and clinical supervisors are vacant. The HPC calls for eliminating the exam requirement at the master’s entry level because it would immediately bring more qualified social workers into the profession.
Rhode Island and Illinois saw major increases in licensed, qualified social workers after they removed the exam. Massachusetts could see the same at little cost. Instead the editorial recommends that regulators should “reject attempts to water down licensure qualifications by removing exam requirements” but should consider subsidizing test fees. This is ludicrous. Exam subsidies would require state dollars, and given the current economic climate, the idea that the state would fund exam fees is a fantasy.
Social workers complete years of education and thousands of supervised hours. Eliminating the exam would remove a costly barrier to entry and patient care.
Kathryn Janiuk
Wellesley Hills