Mental Health Counseling Past, Present and Future

Dr. James Messina

How this all got started

1976 no existing division in APGA (now ACA) for counselors who worked directly in the mental health field-Nancy Spisso a colleague of mine at the Escambia County Mental Health Center pointed out a letter in the APGA Guidepost from a group in Wisconsin who were suggesting that APGA needed a division to address counselors who worked on non-traditional settings such as Mental Health Centers, Marriage and Family Counseling Centers and other Public Health Agencies with a Mental Health identity. When Nancy showed me the letter, I said let s make this thing happen.

I had been ASCA National Negations Committee Chair in 1972-75 and knew the then President of APGA Thelma Daly because of my work with ASCA when she was the President of ASCA

I also knew the Executive Director of APGA Chuck Lewis through my previous work with ASCA and felt comfortable working with both Thelma and Chuck to get the new Division request formulated and acted upon.

I immediately called Thelma Daly that day I read the Guidepost letter and asked her help to pursue formation of the new division, she then referred me to Chuck Lewis who immediately informed me of the steps to take and then sent me the required documentation to me by mail.

Nancy and I then wrote our letter to the Guidepost announcing our intention of forming a new division with APGA called The American Mental Health Counselor s Association. We chose the name since we believed that all counselors who do the type of work outlined in the Wisconsin letter to the Editor all fell under the rubric of Mental Health. We coined the term Mental Health Counselor that day and 31 years later is still the best term to describe counselors who are involved in the myriad of tasks which do not fit the rubric of school, rehabilitation, vocational, college personnel, or counselor education.

We unfortunately never realized that by using the term mental health we actually were bringing Developmental Counseling into a field which most of the then current counselor educators had no idea of what it entailed but more importantly we were based on training programs located in Colleges of Education around the country which were not in a political position to support the concept that students out of Schools of Education did clinical work which was considered behavioral medicine. We entered the field of behavioral medicine without any educational underpinning for our new professional identity.

Status of Early Goals of AMHCA

Although we just wanted to create a division within APGA for mental health counselors, early on we realized that we had begun a profession which now needed the hallmarks of such a profession. So the goals for AMHCA were to provide our profession with those hallmarks:

Code of Ethics: the First Code was written immediately based on the current APGA Code

Nationally recognized Credential: Creation of the National Academy of Certified Clinical Mental Health Counselors was the Goal of my year as President of AMHCA during 1978-79. The Academy was based on competency based assessment model and gained recognition for the first national certification body which required work samples from candidates.

State based Licensure for independent practice-In 1980 after the Academy was established I wrote the legislative language for the first Licensed Mental Health Counselors in Florida. In 1982 it passed the legislature and in 1983 over 1800 counselors become LMHC s today we now have over 6800 LMHC s with over 1100 MHC residents working on getting their license. There are only 14 states currently which license counselors with Mental Health Counselor in their title. There are however 49 states which license Professional Counselors which weakens the Mental Health Counselor identity.

Body of Theory and Research specific to the profession: the Journal of Mental Health Counseling was established in 1976 and Bill Weikel as the first editor. The first edition of the Journal came out in 1978 after AMHCA was formally recognized as a division of APGA. Unfortunately there has never been any theoretical model of counseling which was developed in the past three decades which had as its roots Mental Health Counseling. Also there has not been significant research done on the effectiveness of the work of Mental Health Counselors. This has weakened the impact of the profession among the other Mental Health Professions.

Educational Standards: This was the area of tension from the get go between APGA counselor educators and the young AMHCA leadership. Counselor Educators fought efforts to establish accreditation standards for Mental Health Counseling Programs. Today there are only about 48 CACREP programs which are accredited for Mental Health Counseling Training. 12 of these programs are in Florida! Community counseling was the politically less threatening term which Counselors Educators adopted and there are 100 s of these programs in counseling programs. This has weakened the growth and recognition of the Mental Health Counseling Profession and remains a contentious issue given that CACREP is trying to get rid of the Community Counseling Standards and replace them with Mental Health Counseling Standards of 60 graduate hours. Over 31 years and finally there may be unified accreditation standard for the training of Mental Health Counselors.

Mental Health Counselors Today in Florida

Mental Health Counseling as a profession is best established and recognized in the State of Florida. 12 Schools of Graduate Education provide a CACREP approved Mental Health Counseling Training program of 60 graduate credit hours or more along with 1000 hours of internship. There are 6800 LMHC s and 1100 Residents for Licensure in Florida.

LMHC s are employed in a variety of settings: Private Practice, Public and Private Mental Health Agencies, Schools, Junior Colleges and Universities.

LMHC s as of 2005 have been recognized as legal agents of the Baker Act

LMHC s are reimbursed by most private health insurance companies. LMHC s are not covered by Medicaid.

Where is Mental Health Counseling Going in Florida and the US?

The market for LMHC s is changing in Florida as it is in the USA. There is a shift in population growth and priorities among third party payers and these changes require that LMHC s begin to prepare for change in settings where they will be practicing their professional trade.

1. Due to the aging of the American Population there is an increasing need for Behavioral Medicine Interventions in:

Family Practice and Internal Medicine Settings

Rehabilitation Centers and Practices

General Hospitals

Elderly housing settings: Assisted Living and Nursing Home

Mental Health Counselors are ideally situated to provide Behavioral Medical Interventions based on their training and background.

2. Due to the decreasing or increasingly complicated reimbursement from medical insurance companies there is a financial reality to be faced that solo or group private practices of LMHC s or any other mental health profession for that matter is greatly challenged which will require a grouping together of multiple licensed mental health professionals into large group practices which can negotiate for contracts not only with insurance companies but also with public and private Mental Health Agencies, the courts, DJJ treatment facilities, Hospitals, Nursing Homes, etc.

3. Due to major natural and human disasters there has been a growth in the need for experts in Trauma and mental health counselors are positioned well to work in such settings as: family court appointed domestic violence programs, FEMA, SAMSHA and State Departments of Mental Health subsidized mental health recovery centers post disasters such as after 911 and Katrina.

4. Due to the aging of America and the growth of Palliative Care programs such as Hospice there is a huge need for mental health professionals to provide behavioral medical supports for the chronic and terminally ill in such settings as Hospice, Hospitals, Nursing Homes, Bereavement programs around the state.

5. Due to the growth of State Regulations surrounding the welfare of children due to divorce there is an increased need for Mental Health Professionals who are versed and skilled in the process of providing Mediation of disputes in such settings family courts, law practices, and children serving agencies

These changes will require Mental Health Counselors to be on parity with the other Mental Health Professions in terms of understanding and being conversed in the following domains:

1. Evidence Based Practices for the Treatment of Mental Disorders: There is a glaring lack of emphasis on Evidence Based Practices in the CACREP standards for Mental Health Counselors nor does the 491 Board Standards in Florida require such an emphasis for the course work required for the LMHC. There are no current Mental Health Counseling Texts which emphasize Evidence Based Practices which in the main are Cognitive Behavioral in approach with a time limited target and solution focused. Rather most Mental Health Counselors are still being taught in the old traditional developmental counseling model of Interviewing with the Rogerian Model, counseling with a whole host of models with no researched based validity, and entering their practicum and internships to learn on the job the Evidenced Based Practices which are recognized in the Mental Health Field.

2. Psychopharmacology: There is also a glaring lack of emphasis on teaching Mental Health Counselors about Psychopharmacology. CACREP does not require a course in Psychopharmacology nor does the 491 Board Standards in Florida requires such training. This is a major area of deficiency in the training of Mental Health Counselors since it put them at a disadvantage of being on an equal footing with their fellow mental health professional colleagues and lessens their ability to interface effectively with medical practitioners as the field enters the challenges of becoming more Behaviorally Medicine oriented.

3. Traumatology and Bereavement Training: There is a glaring lack of emphasis on teaching mental health counselors to be on the front lines for recovery from trauma and for dealing sufficiently with bereavement. CACREP does not require a course in Traumatology or Bereavement Counseling nor does the 491 Board Standards in Florida require such training.

4. Mediation Training: There is no discussion currently in Mental Health Counseling Programs about the growth of Family and or Organizational Mediation Practices and yet there are many LMHC s who are trained and working as mediators for family courts etc. CACREP does not require a course in Mediation nor does the 491 Board Standards in Florida require such training. However this is an area which LMHC s need more direction and education on.

What you can do to position Mental Health Counselors to be better prepared for the future?

1. Get your SMHCA Legislative Committee to get FMHCA to begin to advocate with the 491 board to do the following:

a. Require that all curriculum for LMHC s be Evidenced Based Practices for Mental Health Disorders

b. Require that LMHC must have at least one course in Psychopharmacology

c. Require that LMHC must have at least one course which covers the principles of Traumatology and Bereavement Counseling

d. Require that LMHC training programs work aggressively to become more focused on providing the LMHC a Behavioral Medicine orientation

2. Get your SMHCA Executive Board to get FMHCA, AMHCA, and ACA to advocate with CACREP to include the same directives being advocated with the Florida 491 Board

a. Require that all curriculum for MHC s be Evidenced Based Practices for Mental Health Disorders

b. Require that MHC programs must have at least one course in Psychopharmacology

c. Require that MHC programs must have at least one course which covers the principles of Traumatology and Bereavement Counseling

d. Require that MHC training programs work aggressively to become more focused on providing the MHC a Behavioral Medicine orientation

3. Get SMHCA and FMHCA to work with the Mediation Training Center at FMHI to provide LMHC s and LMHC s in this region or state with Training a specialized Family Mediation Training program so that more Mental Health Counselors in the State are provided an opportunity to understand the impact of such a service on their professional practice.

Conclusion

My wife Connie and I called our son Steven the AMHCA baby because he was born in 1976 just as we initiated AMHCA allowing Connie to be our secretary that first year of Steven s life. Today Steven who was 31 this year is married and in his Radiology Residency at University of Florida. Steven has grown up to be a very responsible and mature young man. Yes he still has challenges ahead of him like two years of Neuro-oncology Fellowship after he completes his last two years of his radiology residency but soon he will be independently practicing his profession. AMHCA s growth parallels closely the AMHCA Baby. Mental Health Counseling is entering a new era of Behavioral Medicine and for that reason it needs to tighten up its standards and gain more training for itself to face the challenges ahead. I stand ready to assist SMHCA help its membership to advocate for those things needed to help prepare itself for the next thirty years.

Chronological Reference

Messina, J. J.; Breasure, J.; Jacobson, S.; Leymaster, R.; Lindenberg, S.; & Scelsa, J. (1978). Blueprint for the advancement of the counseling profession. Unpublished text, AMHCA: Washington, D. C.

Seiler, G. & Messina, J. J. (1979). Toward professional identity: The dimensions of mental health counseling in perspective. American Mental Health Counselors Association Journal, 1, 3-8.

Messina, J. J. (1979). Why establish a certification system for professional counselors? A rationale. American Mental Health Counselors Association Journal , 1, 9-22.

AMHCA Certification Committee (1979). The Board of Certified Counselors procedures. American Mental Health Counselors Association Journal, 1, 23-28.

AMHCA/NACCMHC Blue Ribbon Task Force (1980). Standards and procedures for competency based mental health counselor training programs. Unpublished Text, AMHCA: Washington, D. C.

Weikel, W. J. (1985). American Mental Health Counselors Association. Personnel and Guidance Journal , 63, 457-60.

Messina, J. J. (1985). The National Academy of Certified Clinical Mental Health Counselors: Creating a new professional identity. Journal of Counseling and Development, 63, 607-608.

McCormick, N. J. & Messina, J. J. (Eds.) (1987). Professionalization - the next agenda for the mental health counseling profession: The proceedings of the 1987 AMHCA think tank. AMHCA: Washington, D. C.

Seiler, G. Brooks, D. K. & Beck, E. S. (1990). Training standards of the American Mental Health Counselors Association: History, rationale and implication. In G. Seiler (Ed.) The mental health counselor s sourcebook (pp. 61-77), New York: Human Sciences Press, Inc.

AMHCA Board of Directors (1993). Standards for the clinical practice of mental health counseling. In AMHCA leader handbook, AMHCA: Washington, D. C

Covin, T. M. (1994). Credentialing - an Orlando model project report. Unpublished Text, AMHCA: Washington, D. C.

Copyright SMHCA, 2004.

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