New study examines barriers to obtaining mental health licensure among Minnesota graduates

A new study released today shows that mental health providers face numerous barriers during the licensure process. Licensure challenges threaten to exacerbate a severe shortage of mental health providers in Minnesota and the ability to meet demand for services. Wilder Research and the Blue Cross and Blue Shield Center for Rural Behavioral Health at Minnesota State University, Mankato conducted the study. This is one of the first studies to specifically examine the licensure process.

The report, Unfinished Business: Examining Barriers to Obtaining Mental Health Licensure Among Minnesota Graduates, identifies several challenges graduates face during licensure, including: financial strains; burdensome application and administrative processes; strict requirements; misalignment between licensure types and between states; lack of attention to work well-being, diversity and equity concerns; supervision quality; and exams that ineffectively assess knowledge and skills.

Previous research shows that about half of graduates in the state who complete a master’s degree necessary for mental health licensure do not complete the process. The study was based on a survey and interviews with graduates from master’s programs in Minnesota that lead to licensure in social work, counseling, or marriage and family therapy. 144 recent graduates completed the survey and 41 completed in-depth interviews.

“Understanding that we have a critical workforce shortage coupled with the knowledge that we have a significant number of individuals who do not pursue licensure after investing considerable time and resources in degrees has emphasized the importance of determining barriers in the licensure process. If we can better understand the barriers that exist, we will be better equipped to help individuals to achieve licensure and serve the mental health needs of Minnesotans,” said Roy Kammer, one of the report’s authors.

Graduates were asked to identify and describe the challenges they encountered during the licensure process. Most commonly, these included high costs, low pay, unpaid work time, excessive administrative requirements, high workloads, burnout or compassion fatigue, diversity and equity issues, finding a supervisor, and poor supervision quality. Additionally, respondents described how many of the challenges are particularly problematic for providers in rural areas and providers from marginalized backgrounds.

“We’ve known for years that we don’t have enough mental health providers to meet the need, and we found several actionable and relatively simple ways to improve the licensure process and better support graduates and ultimately increase the number of providers in the state,” said Melissa Serafin, another author of the report.

The report also identifies several recommendations for licensure boards and regulatory agencies, insurance payers, employers, and graduate programs, including:

• Increase reimbursement rates and reduce or eliminate licensure application, renewal, and exam fees
• Reduce tuition and create new opportunities for student loan forgiveness
• Provide one-on-one assistance to graduates throughout the licensure process and more resources to help graduates find and select a qualified supervisor and prepare for exams
• Streamline the application process and increase flexibility of licensure requirements
• Increase alignment between licensure types and allow licensure portability between states
• Minimize administrative tasks and paperwork and ensure reasonable caseload expectations

The full report here is available at: https://www.wilder.org/UnfinishedBusiness