An outstanding article appeared in a Virginia newspaper this week discussing mental health counseling in Virginia and the very long process of being licensed. Here are a few excerpts. (See also –– Virginia governor’s extensive mental health legislation now law (June 2023)

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On college campuses in Virginia and nationwide, students are increasingly reporting struggles with mental health. 

Now, Virginia is trying to harness campuses’ soaring demand for mental health services to meet another goal: get more young professionals in the pipeline to provide them.

In 2022, lawmakers added $1 million to the state’s two-year budget for a pilot program that would pay salaries and benefits for counseling and social work graduates pursuing state licensure to work at campus student health and counseling centers.

Among nearly all age groups, there’s a rising demand for mental health services nationwide. In Virginia, policy discussions have mainly centered on the state’s troubled behavioral health system, the network of community services boards and state-run facilities that provide treatment to people who are in crisis or experiencing the most severe mental health challenges. 

But while the overburdened public system deserves attention, said Deborah Oswalt, executive director of the Virginia Health Care Foundation (VHCF), the majority of Virginians who seek mental health treatment are in search of more “basic” services. Those include treatment for conditions such as depression, anxiety and panic disorder, as well as help dealing with difficult circumstances like a death or traumas linked to situations like abuse. 

Even as demand has risen, the number of professionals available to meet that demand has fallen in Virginia, with data showing it could shrink ever further as a wave of behavioral health providers prepare to retire. 

The workforce was also nearing what the VHCF called a “provider cliff”: Among psychiatrists, 61% of providers were aged 55 and older, as were 36% of licensed clinical psychologists, 37% of licensed clinical social workers and 32% of licensed professional counselors. Furthermore, the majority of providers were white, even as Virginia becomes more diverse. 

“As more people get comfortable with seeking out mental health treatment there’s not going to be enough providers,” said Lusk. “In reality, pretty much all of us could use someone to talk to at some point in our lives.”

Despite the aging workforce, getting new professionals into the field has been difficult because of the steep requirements many graduates face to achieve licensure in Virginia. 

The largest sectors of Virginia’s behavioral health professions are clinical social workers and professional counselors, who in 2021 made up almost three-quarters of the workforce, according to VHCF data. While roughly 4,000 of the 12,000 current professionals in those fields are nearing retirement age, colleges and universities in the commonwealth are only producing approximately 400 graduates per year — not enough to offset the exits. 

More crucially, those graduates still lack licensure. While both professional counseling and clinical social work require graduate-level degrees, licensure requires graduates to undergo thousands of hours of clinical and supervised practice. Professional counselors must undergo 3,400 hours of clinical work experience, of which 2,000 must be direct client contact and 200 must be supervised. For clinical social workers, the requirement is 3,000 hours of experience, including 1,380 clinical hours and 100 supervised hours. 

“That’s one of the big hurdles a lot of [licensed professional counselors] have,” said Ritchey. “I think there’s a lot of people who want to be in higher education who are LPCs that the doors need to be opened to.”  

Supervised hours are particularly tricky for graduates, as most are forced to pay experienced practitioners an average rate of $100 per hour for the supervision. 

The state’s steep licensure requirements, in the absence of other mechanisms to offset the burdens, may also be weeding out candidates with graduate degrees in their field but without the resources to navigate a prolonged and expensive process. 

“Given the low salaries available to these pre-licensees ($42,000 – $47,000/year) and the high student debt load they carry, many cannot run the financial gauntlet of paying for the required supervision hours,” the VHCF report found. 

Virginia has “some of the strictest and highest standards to get licensure,” said Lusk. “We have to be gatekeepers of our profession, right? But sometimes we have such high standards in Virginia, it really puts a barrier up.” 

‘Exactly what we’ve been trying to do for such a long time’

Over the past few years, Virginia has become increasingly interested in putting state support toward licensure of counseling and clinical social work graduates. VHCF’s Boost 200 program, which aims to speed up the licensure of 200 behavioral health professionals by paying for their required supervision hours, has received funding from the General Assembly and Virginia Department of Behavioral Health and Developmental Services. 

            “Virginia Counseling and Mental Health.” Virginia Mercury (June 12, 2023)