It seems the Mental Health profession is still in its infancy and has been developing since 1979. While mental health counseling was being practiced before 1979, it was at this time that members of the AMHCA, the American Mental Health Counselors Association, decided that Mental Health Counselors should be recognized as a core profession in the field. This decision caused the members to select several steps that they felt would need to take place in order to make this happen. The AMHCA spear headed this development piece by piece in order to ensure the continuation of each process. They decided a membership association would be needed, they felt standards should be built on a national level so members who successfully passed would hold national certification, they had a vision that the education these members received would be accredited and training programs would be readily available. These members also felt that licensure should be available in all 50 states and that the competencies in order to gain the licensure should be standard.
These visions started to become reality in 1980 when certifications became available nationally and shortly after that the National Board for Certified Counselors which is now known as the Clinical Academy of NBCC or “The Academy”. The certifications offered by this organization are completely voluntary and in 1999 around 2,000 counselors were Certified Clinical Mental Health Counselors or CCMHC’s, to date that number is over 1,000. We have gotten as far as to have license recognition in every state. In 1999, only a handful of states had licensing or certification requirements, by 2004 licensure was recognized by 48 states, as well as in the District of Columbia, and Puerto Rico. In 2007 Nevada recognized licensure and by January 2012 California counselors, both grandfathered and new will have their licenses recognized. Getting the Mental Health Counselor recognized as an actual profession has taken over 30 years and is as of now an ongoing procedure. The movement by the states to recognize licensure is a great one, but the titles of the professionals are varied by state and national certification by the NBCC is voluntary and does not provide the counselor a license to practice.
National licensure either in lieu of or required in addition to the state requirements would be a step in the right direction because the requirements would be more stringent and a counselor would be able to move states without having to find out and adhere to new state requirements.
In 1986 and 1987, comprehensive training standards were set for Clinical Mental Health Counselors in order to help them gain creditability and clinical skills. A Clinical Counselor would need to have a minimum of 60 semester credit hours and a minimum of 1,000 clock hours of clinical supervision. There are literally hundreds of programs that will train counselors but most are not accredited by the Council for Accreditation of Counseling and Related Educational Programs, or, CACREP. The standards set for a Clinical Counselor will not help them qualify for payment from a third-party payer such as private insurance or Medicare. The standards for this privilege are much higher. Third party payment wasn’t even a reality for the Mental Health Counselor until 1993 and was a strong concern until that time. The standards were developed by the AMHCA and include having at least 3,000 hours of clinical experience, a minimum of 100 hours completed face-to-face supervision, a counselor must adhere to their appropriate association’s code of ethics, they have to achieve a passing score on the clinical exam, and submit an actual counseling session as well as have the appropriate licensing. The certifications, education and licensing requirements have helped to make the Mental Health Counseling field strong but there are some concerns that we will need to address sooner or later.
In the world today, online counseling is gaining strength, which could be a threat to the traditional counselor. If online counseling grows into something that is more acceptable or used more often than traditional services, counselors with state licensing would be forced to adjust and begin practicing this way, causing even more competition than before. At this time in our lives, through this media anyone can be a counselor, the qualifications can range anywhere from a Dear Abby wannabe to a highly licensed and trained counselor. The only proof generally offered is on the “About” page. This type of counseling claims to be faster, but is it really?
Is sending an email about a problem you are having and then waiting for an answer completely comforting? Of course, it is faster than having to research counselors and then wait for an appointment. The draw would be that it is useful for people who are comfortable writing out their feelings and they would rather have the anonymity that comes with the internet. If you have difficulty getting out of your house or have physical limitations or if you are uncomfortable with traditional counseling this would be a good solution. Some concerns would be, first and foremost is the fact that a person’s non-verbal cues are not visible, this would include body language, facial expressions, hand gestures, and sitting positions, not to mention tone and inflection in a person’s voice cannot be heard. How many times have you sent an email and then had to explain because the receiving party misinterpreted what you were trying to say? This could be a big deal because this is at least half of how you learn about the person you are counseling. Another concern would be the ability to understand what the counselor’s background is. In order to be sure you are getting what is posted on a counselor’s website the minimal you would need to do would be to check with the Better Business Bureau, which is recommended no matter who you choose to help you. You could also go as far as to check the counselor’s credentials with their respective schools or perform a background check which would cost even more money than what you are already spending on counseling. In reality, most people will not check the credentials of the counselor, they will take what is given and run with it.
Lastly, since each state has their own regulations for licensing, if you get a counselor online who is not licensed in your state, they could be considered to be practicing illegally, so there is no recourse if you feel that you should be able to file a law suit for any reason. The most logical solution to this would be that online counselors should be regulated and licensed as well, this will take a lot of legislation as well as time to make this happen, but it will be a reality in the years to come.
Salary seems to be another threat in the mental health field. Once licensed, an entry-level salary is in the low $30,000 level. This seems to be due to employment mainly in non-profit organizations where individuals are responsible for payment, which calls for a lower, more competitive fee. It does seem like there is more movement into specialty areas of counseling which could be a solution to this problem. Areas such as developmental disabilities, addiction disorders, chronic or fatal health conditions, and sex abuse victims, but at the same time this carries a threat of its own. The risk of this would be that the counselor could end up in a niche that doesn’t suit him or her. They may have a hard time getting into another specialty which could cause them to leave the field all together. This is a double edged sword and it seems like to succeed in this field it would be a good idea while you are still in school to work or volunteer closely with counselors who are already in the profession you think would be a good fit. This could enable a counselor starting out to begin at a higher level of salary.
It is very evident that the face of mental health is not a positive one. This is a threat not only for the counselors because it is considered taboo for a person to seek help, but also for the clients because they are easily labeled abnormal or crazy. It seems that in order to try to move past the stigma we face as a mental health community, we need to focus more on awareness and sensitivity so that the people who aren’t currently undergoing any kind of treatment will understand why others feel the need to find ways to help themselves. We could accomplish this by speaking publicly in middle schools or high schools and definitely in colleges and participating more on a community level. The more we can make people aware that the services we offer do not necessarily mean that our clients are insane, the better the communities around our clients will feel, and the better our clients will feel about what they are doing to help themselves.
With issues like these it is easy to tell the counseling field is still in the beginning stages of development where Mental Health Counselors are concerned. Even though the mental health counseling field still has a long way to go it has made great strides in the recent past.
We have gained recognition in each state with licensure; we have come to a point where we can get paid through third-party payers, albeit with some pretty lengthy requirements, we have even entered the technological world with online counseling. Will the salary ever catch up with the other advancements we have made? Will public opinion ever move past the stereo type that because you have chosen to seek help, instead of go it alone, there must be something drastically wrong with you? We will make these advancements as well, but only with hard work and persistence and it will definitely take longer than it should.
Mental Health Counseling: Past, Present, and Future. Journal of Counseling & Development; Current Issues Medicare Coverage of Licensed Professional Counselors. www.counseling.org;
Defining the mental health counseling profession: Embracing historical and contemporary perspectives at the interface of theory, practice, research, and professional exchange. Journal of Mental Health Counseling;
What’s Next for the Profession of Mental Health Counseling?. Journal of Mental Health Counseling;
The American Mental Health Counselors Association: Reflection on 30 Historic Years. Journal of Counseling and Development : JCD