Nebraska part of initiative to change mental health care in America
SCOTTSBLUFF — Nebraska has joined several other states who are working together to make it easier for clients to receive mental health services.
Approved in February 2015 by the ASPPB Board of Directors, the Psychology Interjurisdictional Compact (PSYPACT) has been created to facilitate telehealth and temporary in-person, face-to-face practice of psychology across jurisdictional boundaries. PSYPACT is an interstate compact, which is an agreement between states to enact legislation and enter into a contract for a specific, limited purpose or address a particular policy issue.
Nebraska was the fifth state to sign into PSYPACT after Arizona, Nevada, Utah and Colorado had already signed. Missouri and Illinois signed on after Nebraska. Six other states and Washington, D.C., have been endorsed by the Psychology Licensing Board. Illinois enacted PSYPACT on Aug. 22, but it does not become effective until Jan. 1, 2020. PSYPACT becomes operational when seven states enact PSYPACT.
Nebraska Sen. Carol Blood introduced LB 686 with Sen. Tom Brewer cosigning. Blood contacted the Nebraska Psychological Association in 2017. The NPA, the American Psychological Association and Association of State and Provincial Psychology Boards got together to question how PSYPACT would work, what it would mean for licensure, costs and how it would affect state statutes on the practice from one state to another. On Nov 8, 2017, NPA agreed to help. PSYPACT would not be unusual in Nebraska. Nebraska is already in the top tier for interstate compacts in nursing and physician compacts. Nebraska’s government has stressed the need to break down barriers to over-regulation of professions.
LB 686 was eventually folded into LB 1034 by amendment.
Brewer, of Gordon, signed on to the original bill with Blood because he had learned firsthand the struggles veterans and their spouses face.
“It started with my work with veterans and the inability of the Department of Veteran Affairs to have enough mental health specialists to get where the veterans are,” Brewer said.
He learned about the multiple restrictions placed on psychologists and thought there would be a better way to help.
“I thought, ‘Let’s figure out a way to have a secure network so patients could share their issues and concerns,’” he said. “If you’re going to do it, you need to do it for everyone and not just veterans.”
Blood represents the third legislative district in the Nebraska Unicameral, which includes Offutt Air Force Base. While her initial motivations were toward her constituents, PSYPACT also benefits psychologists who are not in the military.
Benefit to all
PSYPACT benefits all Nebraskans because it will increase access to client and patient care by providing continuity of care when clients travel or relocate. It certifies psychologists will meet acceptable standards of practice and a higher degree of consumer protection across state lines. It also allows psychologists to provide services to underserved or geographically isolated populations.
Brewer has concerns about closures of veterans hospitals and the large distances veterans are forced to take to receive care.
“The idea of closing Hot Springs makes the distances incredible,” Brewer said. “Sometimes, even when they can get there, it may still be a while before they can find a mental health specialist.”
Under PSYPACT, psychologists would work under an E. Passport Certificate or an Interjurisdictional Practice Certificate.
An E. Passport promotes standardization in the criteria of interstate telepsychology for licensed psychologists to provide telepsychological services across state lines in states that accept the E. Passport. An E. Passport provides consistent regulation of interstate telepsychology practice and allows consumers to benefit from regulated practice.
The Interjurisdictional practice certificate promotes standardization in criteria for short-term practice and interjurisdictional mobility by allowing psychologists to provide services without obtaining an additional license. Psychologists would then be able to provide temporary psychological services for up to 30 work days per year without obtaining a full license in that jurisdiction.
Positives for military families
Blood has worked with military liaisons who focus on what military families need as they move from state to state and then try to make that happen. Many families move every two to three years, which is stressful. Each time, they have to find a new home, job and friends.
“We need to do everything possible we can to make it better for their spouses to hit the ground running and get a job,” Blood said.
The difficulties lie in getting licensed because getting a new license in a new state can take up to a year, during which time the spouse is not working.
“It’s a lose-lose for all involved, including Nebraska, because we have a severe shortage, especially in health care.”
LB 88 removed most of the obstacles for those in the medical field for spouses, PSYPACT addresses other professionals, such as psychologists.
“The farther out west we go, the greater issue we have in finding qualified people for those in need,” Blood said.
Working across state lines
Anyone in a PSYPACT state can practice in another state, which can be a vital lifeline to clients.
“Say you have a client who suffers from PTSD or incest or rape and they have to go home for the holidays in another state and they have another incident where they need immediate communication with their psychologist,” Blood said. “Legally, they (psychologists) can’t even pick up the phone and talk. The compact will help with these.”
Anne Talbot, president of the Nebraska Psychological Association, said she receives referrals from Wyoming, but the law prevents her from providing direct services through telepsychology to people in Wyoming because she isn’t licensed there. A client would need to travel to Scottsbluff to receive services. Even though Torrington, Wyoming, is a short distance away, if a client were to call for assistance, they would technically be receiving service in Wyoming and the professional must be licensed there. The current laws raise a lot of issues. If someone has children that go to college in another state or one parent lives in another state and the psychologist wants to work with both parents, it becomes difficult to impossible to manage.
A blanket bill covering all professions, such as was brought up in past legislative sessions would eliminate governing boards which maintain the standards that must be met within each profession in order to provide quality care. That fear of deregulation is a legitimate concern, but a compact, such as PSYPACT, offers protection and solidifies a national definition of a psychologist while protecting patients.
“Under the compact, it requires collaboration and coordination across states to protect patients under the terms and standards we operate,” Talbot said.
One of Brewer’s concerns was over security of patient data. His fears were allayed when he was shown how PSYPACT would work and protect HIPAA data. The bill was passed in April, but Brewer has continued to spend time researching the issue. Last week, he visited UNMC where a neuropsychologist showed him how current telehealth services work and how PSYPACT may work along those lines.
“You have to make sure it’s secure where the person will actually talk with another person,” he said.
Brewer said he thought the idea of PSYPACT was a good enough one that he hopes neighboring Wyoming and South Dakota will eventually sign on as well.
“We’re trying to get ahead of this as much as we can,” he said. “It’s nice to be the good guy ahead, but you need to have the resources, too.”
Blood and Brewer are looking forward to the implementation of PSYPACT and its potential impact in improving the mental health of others.
Blood said she was a strong supporter of PSYPACT because she has always felt psychologists are the unsung heroes in care. On television, people see doctors jumping on patients and performing CPR, but we don’t see psychologists helping people to overcome trauma and succeed in life.
“It drives me crazy because we buy into what we see on TV,” Blood said. “The only psychologist I saw on TV was in the ‘Sopranos.’”
Blood said most people also do not think of the mental health community in times of crisis, but they are there working behind the scenes.
“I feel like they are our quiet heroes,” Blood said. “It’s important people realize how important mental health professionals are in the world.”
To learn more about PSYPACT, visit https://www.asppb.net/page/PSYPACT.