Issue:
Congress should direct the Department of Veterans’ Affairs (VA) to
improve access to mental health services provided by licensed Marriage
and Family Therapists (MFTs) at VA facilities by eliminating specific
bureaucratic obstacles.
Background:
An
average of 22 Veterans commit suicide daily, and an increasing number
of Veterans have mental-health needs consequent to extended active-duty
deployments. These needs often also affect Veterans’ family members. In
2006, Congress enacted Public Law 109-461 establishing 38 USC § 7401(3)
to permit VA to hire MFTs to help serve the increasing number of
veterans with mental-health needs. On September 28 2010, VA finally
issued MFT Job Specifications (VA Handbook 5005/41), required in order
for VA to hire MFTs. The VA amended the MFT Job Specifications in 2018.
VA employs 24,000 mental-health
professionals, of which approximately 100 (0.5%) are now MFTs. Yet MFTs
comprise about 13% of all U.S. mental-health professionals. (Similarly,
only about 0.05% of VA mental-health professionals are Licensed
Professional Counselors, who comprise about 26% of all U.S.
mental-health professionals). While MFTs’ underrepresentation in VA
mental-health staff is partly due to MFTs’ relative newness within VA,
the American Association for Marriage and Family Therapy (AAMFT)
believes it also is due to unnecessarily bureaucratic VA
obstacles:
-All advanced MFT students are barred from VA internship stipends, despite Psychology and Social Work students being eligible.
After mental-health students complete their academic training, in order
to be licensed they must successfully complete clinical internships of
at least one year. Many of these students depend on financial stipends
in order to live during their internships. But VA bars MFT students –
even those in COAMFTE degree programs – from receiving stipends, while
Psychology and Social Work students in corresponding APA and CSWE degree
programs are stipend-eligible. Because many VA healthcare professionals
start their careers through VA clinical internships, barring all MFT
interns from stipends reduces the number of newly-licensed MFTs working
at VA.
-VA’s MFT jobs to date are concentrated in Vet Centers, despite major mental-health needs in VA Medical Centers and Clinics.
VA operates about 150 Readjustment Counseling Centers (“Vet Centers”)
for recently-returned veterans, the sites of most MFT jobs to date. Vet
Centers generally are reported to be working well. In contrast, most of
the widespread reports of VA mental-health service problems are at
Medical Centers (VAMCs, i.e. hospitals) and clinics. Unfortunately, some
VA Medical Centers falsely believe MFTs are ineligible for jobs in
those facilities. Although AAMFT is pleased that VA recognizes MFTs’
familial and other relationship-based clinical skills in its Vet
Centers, we believe MFTs can be part of the solution in VAMCs and
clinics. Like other mental-health professionals, MFTs are licensed in
all states to diagnose and treat behavioral disorders.
Recommendation:
Improve
access to VA mental health services by urging VA to hire more LMFTs to fill open positions at VA Medical Centers, Clinics, and Vet Centers, to create more internship sites for MFT interns, and to create an Occupational Series for MFTs.
Have questions?
Contact AAMFT at familyteam@aamft.org