As stigma around mental health continues to decrease, demand for mental health services continues to rise.

"What we’ve seen in the mental health profession is a huge uptick in people who are requesting services, especially after the Pandemic,” said Dr. Maddie Stevens, chair of the government relations board with the Pennsylvania Counseling Association.

In turn, the need for counselors and therapists has never been greater.

"There was one point in my practice where I have 9 licensed marriage and family therapists— I still had my waiting list up to 400,” said Amy Tielemans, the legislative chair for the PA Association of Marriage & Family Therapists. "I’m down to about 150-200 at this point, but that was never the case [before the pandemic]."

One key to meeting the growing need is the next generation of mental health professionals; but they face challenges when trying to get a full license with the state.

Enter Act 4.

Originally introduced by Rep. Melissa Cerrato (D-151) as HB 1564, the bill was signed into law by Governor Josh Shapiro on March 28.

Act 4 creates an associate license for professional counselors and marriage and family therapists. The goal? Give more structure- and chances at better pay- to those seeking counseling as a career.

 

A Numbers Note

By the numbers, Pennsylvania has risen to the challenge of mental health needs. The state ranks well nationally in access to care. There’s been significant increases in licensed professional counselors (LPC) and licensed marriage & family therapists (LMFT).

The Commonwealth jumped from 802 LMFT in 2019/20 to 1,112 in 2022/23. That’s a 38% increase.

Likewise, there were 8,915 LPCs in 2019/20 and 11,887 in 2022/23, a 33% increase.

Act 4 addresses vagueness in existing law that will meet the needs of new professionals and expand who can access insurance in a field that is unaffordable out-of-pocket costs for those most in need.

 

 

License Perks

When operating as a counselor in Pennsylvania PRIOR to Act 4, professional could fall into two categories:

licensed.

unlicensed (commonly referred to as pre-licensed).

When you are a Licensed Professional Counselor (LPC) or Licensed Marriage & Family Therapist (LMFT), you are held accountable to the state board. You must meet certain continuing education requirements. And- you can get reimbursed by insurance companies.

"The insurance companies care that someone is licensed, has a credential of some sort,” said Tielemans. “They wanted to know there was some sort of regulation."

Now. Counselors do not graduate with a full license. They have to work 3000 hours with clients, WHILE under qualified supervision- which takes about two years. It’s during this time counselors were dubbed a ‘pre-licensed’ clinician.

“In that time frame, its difficult for clinicians to find employment that actually pays them well."

Because they are unlicensed, these counselors cannot get insurance reimbursements.

Pennsylvania having an associate license instead of just being ‘pre-licensed’ legitimizes these new professionals for insurance agencies.

"This law is really going to open the doors to ensure that we can we can get people in seats in counseling offices,” said Dr. Stevens, "and that we can compensate our professional counselors in the state of Pennsylvania for the really important work that they're doing.

 

Other Structure Benefits

Past insurance issues, Act 4 also cleans up structure around obtaining a full license.

While anyone practicing counseling in Pennsylvania must be licensed or working towards licensure, there were not always clear expectations on how to get there.

For example, Tielemans shared that some pre-licensed counselors would work at an agency with multiple clinicians. They would be assigned a supervisor, put in their two years of low pay work; only to learn when applying for a full license that their supervisor was not themselves qualified.

None of the 3,000 hours would qualify.

With Act 4, anyone applying for an associate license must get their supervisor approved during their application; thus avoiding issues when it comes time to apply for their full license.

Without an associate license option… Faced with low pay and unclear expectations, some pre-licensed clinicians would leave the industry. Some stall on their licensure, setting up their own practices and accepting out of pocket pay.

Some left the state.

“Delaware, New York and New Jersey and Ohio, all have associate licenses. So here we are with Drexel, La Salle, Chestnut Hill, all graduating these amazing marriage and family therapists,” said Tielemans. "And they all leave because they can get better jobs in New Jersey, Delaware and New York.”

Tielemans notes that now Pennsylvania has the standing to compete with other states; bettering the chance of keeping young professionals in the Commonwealth.

 

 Implementing

Act 4 was signed to go into effect immediately. With that deadline before them, the Department of State has confirmed they are working on getting a web page and other details for the application process set up. A spokesperson with the department confirmed that “some parts will soon be operational”.