Mental Health Licensure Barriers in Minnesota: A Closer Look at Supervision
There is a critical workforce shortage of mental health professionals in Minnesota, with 72% of Minnesota counties federally designated as mental health provider shortage areas. The licensure process appears to contribute to the shortage, as the Minnesota Department of Health’s Healthcare Workforce Survey (2017) found that about half of graduates in the state who completes a master’s and/or doctoral-level mental health degree necessary for licensure do not complete the process.
This brings up the question: what is happening to graduates during the licensure process? As someone who was interested in becoming a therapist and ultimately decided not to, I was curious to find out what types of challenges I would have had to overcome.
My colleagues and I at Wilder Research and the Blue Cross and Blue Shield of Minnesota Center for Rural Behavioral Health at Minnesota State University, Mankato investigated this question by collecting input from graduates of mental health provider programs. Graduates identified many challenges similar to those that contributed to my decision to not pursue this career, such as the general high cost of pursing licensure, burdensome process and difficulty level of the licensure exam, and the low pay and burdensome workload once in the profession. While there were many interesting findings, I found graduates’ supervision experience to be the most surprising.
Supervision barriers highlight cost, options, quality, and confusion
Supervision is a requirement of the licensure process and refers to the process where a licensed and approved mental health professional oversees and evaluates the work of another practitioner. Through regular meetings, they provide guidance, support, and feedback to ensure ethnical conduct and quality care are provided to clients, while also promoting the supervisee’s professional development and competency. In our study, graduates spoke to several challenges regarding supervision.
Cost
Graduates often have to pay for supervision out of their own pockets. Supervision fees can range from $50 to $250 per hour, depending on several factors such as the type of supervision (e.g., individual or group), the supervisor’s level of licensure (e.g. doctorate or master’s level), and whether the supervisor is in public or private practice. A conundrum that graduates encountered was spending unpaid time for supervision, which took time out of their billable client hours and reduced their earnings.
Difficulty finding high-quality supervisors
Graduates voiced challenges in identifying supervisors that could provide high-quality supervision, particularly because graduates are generally responsible for securing their own supervisors with little to no guidance. They expressed that finding information about potential supervisors, such as availability or specialization, was difficult and time-intensive, even more so in rural areas. While some employers offer supervision, graduates stated that this option introduces other types of concerns, including not being able to choose supervisors with specific specialties, the assigned supervisor’s limited capacity for supervision, and potential conflicts of interests between serving as both clinical and work supervisors. Challenges finding a supervisor are further exacerbated by the lack of diversity, availability, and specialization.
One revelation that came from graduates was the need to strengthen oversight of supervisors to ensure supervisory credibility and accountability. Some graduates reported unpleasant or unprofessional experiences with supervisors who didn’t complete paperwork on time, provided incorrect information, weren’t familiar with their responsibilities as a supervisor, or exhibited inappropriate or discriminatory behavior. This urge for oversight would balance the accessibility of becoming a supervisor and ensure well-trained supervisors.
Confusing and strict supervision requirements
Graduates expressed being constrained and confused by strict parameters in which they had to meet requirements, including specific requirements for eligible supervisors, how supervision can be received, completing hours with specific populations, and the rigid timeframe to complete the required number of hours.
In addition to the aforementioned difficulty of finding supervisors, graduates must also make sure supervisors are board approved and have the specific license type that makes them eligible to provide supervision. Graduates also voiced frustration with having to meet in-person for supervision, which usually required travel and having to make time in their busy schedules. There is also a time constraint that graduates face as they are required to complete supervision hours within a timeframe and making sure to obtain hours working with specific populations, even if they don’t plan on working with them after licensure (e.g., families, youth, adults). Moreover, graduates described how different requirements for different licensures also contribute to confusion.
Recommendations
These challenges with supervision, along with many others listed in our report, it is no wonder there is a shortage of mental health professionals: there are too many barriers preventing interested individuals in achieving licensure. Based on our findings and input from graduates, below are some recommendations to alleviate or remove supervision barriers that can be addressed by licensure boards or regulatory agencies, payers, employers, and graduate programs. All other findings and recommendations can be found in the full report.
- Reduce costs associated with becoming a mental health provider, increase wages for providers, and provide financial assistance for pre-licensed providers to pay for supervision.
- Provide support to help graduates find supervisors and prioritize supervision quality by creating a database or directory of approved supervisors with detailed information to help guide graduates’ choice, strengthen oversight of supervisors to ensure accountability, and making sure supervisors engage in continued education, trainings, and additional testing.
- Increase the flexibility of licensure requirements by lengthening the amount of time allowed to complete requirements or reducing the number of hours serving specific populations.
- Streamline licensure application processes and provide graduates with comprehensive resources and real-time support throughout the licensure process to better understand supervision requirements and troubleshoot challenges.
- Address diversity, equity, and inclusion issues within the behavioral health field and support providers from marginalized backgrounds by providing resources tailored to providers from marginalized backgrounds and assistance in finding a supervisor who holds a specific identity.