Originally published: . Volume 8, No. 5. Source pages: 1, 4, 5.
Slows down on way to Senate Floor SB38 Passes Senate H&W Unanimously
Senator J.P. Morrell’s bill to delete language requiring counselors to consult with someone under the medical board or nursing board, who prescribes psychiatric medications when treating individuals with serious mental conditions, passed unanimously out of the Senate Health and Welfare committee on April 26. It was scheduled for the Senate Floor for May 1 but is now scheduled for May 8 and subject to call.
The measure is opposed by the Louisiana Medical Association and the Louisiana Psychological Association. While not public, sources indicate that the Louisiana Academy of Medical Psychologists, are also lobbying against the measure. The wording to be deleted by SB38 is: “However, nothing in this Chapter shall be construed to authorize any person licensed under the provisions of this Chapter to assess, diagnose, or provide treatment to any individual suffering from a serious mental illness, as defined by this Section, when medication may be indicated, except when a licensed professional counselor, in accordance with industry best practices, consults and collaborates with a practitioner who holds a license or permit with the Louisiana State Board of Medical Examiners or an advanced practice registered nurse licensed by the Louisiana State Board of Nursing who is certified as a psychiatric nurse practitioner.”
The language was added in 2011 when Senator Willie Mount advanced a measure, Act 320, that clarified Licensed Professional Counselors (LPCs) to assess, diagnose and treat those with serious mental disorders. Then in 2012, a bill by Senator Fred Mills passed, amended the 2011 language by adding “when medication may be indicated” and removed wording that required the patient be under “active care” of the consultant. Also added in 2012 was language about best practices. Nurses and the state Board of Nursing were added.
Submitting green cards for support were Cindy Nardini, Jackie Mims, Howard Brownell, and Tom Moore, from the Louisiana Counseling Association and the Louisiana Association for Marriage and Family Therapy. Jamee Steel and David Tatam from Tatam Group, and Eric Sunstrom, also noted cards in support.
Cards in opposition were Kevin Hayes from the Louisiana Psychological Association, and representatives of the Louisiana Medical Society, Dr. Bill Clark, David Broussard, Jeff Williams and Jennifer Marusak.
Present for information only were Dr. Darla Burnett from the LSBEP and Mary Alice Olsan for the LPC board.
Introducing the bill at last week’s Senate Health & Welfare Committee hearing, Senator Morrell said, “Essentially what the bill seeks to do, is, we erroneously amended the practice act a couple of years back and restricted the ability of mental health counselors and family therapists to provide mental health services.
“As you know in the state we always have the challenge of having services available, and rather than create a funnel with gatekeepers to prevent people having direct access to mental health counselors, as well as qualified family therapists, this seeks to free them up to provide those robust services across the state as we need them.”
Senator Claitor asked, “Will this in any way, make access to care, particularly as to drug abuse issues, more accessible in the prison environment?”
Cindy Nardini, with Louisiana Counseling Association replied, “… Yes, we do believe that the language that Senator Morrell was speaking of that was put in 2011 and 2012, did in fact decrease access to care. So that would include especially the rural and uninsured, so that would be rural clinics, that would be prisons…” Sen. Claitor said, “My issue is that, we’ve, so far we’ve locked people up and that’s where you get your mental health treatment, but you really don’t get your mental health treatment there. And if we could improve access there this would be a step in the right direction, …”
Testifying on behalf of the Louisiana Psychological Association, Mr. Kevin Hayes said, “Mr. Chairman you know this issue very well, for many years you in the house and Senator Mount in the Senate worked on these issues, and what this bill attempts to do is concerning to us. And we appreciate the author, Senator Morrell, has agreed to work with us after this meeting to try and get the stakeholders together.
“What is concerning to us, that the two pieces of the bill that’s being repealed, what’s being repealed is the provision that mental health counselors may not assess, diagnose, provide treatment to any individual suffering from a serious mental illness––that provision is being repealed, as well as the definition of what serious mental illness is.”
Mr. Hayes then listed some of the conditions––schizophrenia, bipolar, autism, and others. “So in fact what the bill is going to do, it’s going to allow mental health counselors to diagnose and treat those severe mental illnesses,” he said. “So our concern is, like I know it is in this committee to make sure the qualifications and training of these providers are sufficient to treat.” Chair Senator Mills invited Senator Morrell to close.
“Just one point of clarification,” Morrell said. “The reason why this language was so problematic, when it, that was passed in 2012 was that, prior to 2012, in the practice act of these groups, they could already address these issues.
“What happened in 2012 is we put language in the law that created a conflict between their practice act and their ability to address those different mental issues.
“And as Senator Mills knows, because we both have this, we’ve both dealt with this in nursing field. I take great umbrage at instances in which I believe one group creates a gatekeeper effect, where in order for a group to provide services they’re qualified to provide to do, they have to go through somebody else.
“And what I feel like this language did in 2012, I feel like it created it. It said, ‘Hey, you counselors can provide these services, but if you want to, you have to collaborate with psychologists.’
“It is very similar, and you guys know my position on this, where dealing with doctors and nurse practitioners. That we’ve created a system of clinics across the state where nurse practitioners are doing what they are trained to do, but they have to collaborate with a doctor that basically gets paid some cash just to sign off on what they normally do.”
Senator Morrell said he was committed to working with Mr. Hayes, but also indicated that the issue might not be resolved. He said he challenges groups to give him an example of a negative outcome. “They always say, ‘So and so is not qualified to do it.’ ‘Give me a case–give me a case where you had a counselor treat someone for schizophrenia and there was a bad outcome. In reality these don’t exist. It’s a boogeyman effect.”
According to documents from the Louisiana Psychological Association, members of the Legislative Affairs Committee have voiced concerns that the “recommended” training of an LPC is not sufficient to establish the privilege of diagnosing serious mental illnesses. Current law requires only one semester of abnormal psychology in order to become an LPC, noted the statements from the association. An LPC is currently able to function and perform to the full scope of their training and ability under their current statutory authority and there is no need to change it, according to the Committee members. There are also concerns related to psychological testing.
LPA representatives were not available for comment.
Dr. Mary Feduccia, past President of the Louisiana Counseling Association and Government Relations chair for LCA said, “Our bill, SB38, seeks to amend current law and remove the requirement that we consult and collaborate with a medical professional, either a psychiatrist, medical psychologist, psychiatric nurse practitioner, or a regular physician, when we have a client with one of 12 “serious mental illnesses”. This has created an access to care issue for citizens needing to avail themselves of the services of an LPC or LMFT. It takes the client's wishes out of the process of treatment.”
Mr. Howie Brownell, LAMFT Government Relations Chair explained, “This law has not improved the welfare of clients or the therapists and counselors who serve them. The LPC Board gets regular calls dealing with the confusion and misperceptions generated by the SMI language. This law will not stop collaboration among mental health professionals on the client's behalf. That consultation and collaboration is required by their respective professional ethical codes. This bill will just allow the therapist and their client to decide what's in the client's best interest, together.
Some of the objections to SB38 are related to misinterpretations of the intent of the bill, Dr. Feduccia said. “Some psychologists have opposed the bill because they are not convinced that LPCs and LMFTs have the competencies to deal with clients with serious mental illnesses. This bill has nothing to do with the competency level of the counselor. The authority to assess, diagnose, and treat clients with one of the twelve identified serious mental illnesses will not be changed by passage of this bill.
Another misinterpretation relates to psychological testing. “This bill is not intended to provide the capability to use psychological tests for diagnosis, nor do counselors want to do that,” Feduccia said. “It is realized and accepted that psychologists will continue to provide the psychological testing when needed.”
Some psychologists who are not prescribers, have expressed complaints about the language that Morrell hopes to delete. One remarked that the LPC that works in their office is required to consult with a medical psychologist but not with a regular psychologist, who is qualified to make decisions about when to refer for medication consults.
Senator J.P. Morrell speaks to Senator Fred Mills about removing clause requiring Counselors and Marriage & Family Therapists to consult with prescribers under the medical board. LPC Board Executive Director Mary Alice Olson (L) and Ms. Cindy Nardini (R) listen to discussion. The bill passed out of the Senate committee last week. Senator Fred Mills listens to Mr. Kevin Hayes, who serves in governmental relations for the Louisiana Psychological Association. In the top left, Senator Morrell and Ms. Cindy Nardini, who spoke for the Louisiana Counseling Association.
This article is part of a historical newspaper archive. Read the original issue for its original layout, photographs and graphics.