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Submission For The Record of American Association for Marriage and Family Therapy, National Board for Certified Counselors, California Association of Marriage and Family Therapists, American Counseling Association, and American Mental Health Counselors Association

Chairman Miller, Ranking Member Filner, and Members of the Committee, our groups represent more than 160,000 Professional Counselors and Marriage and Family Therapists (MFTs), who are licensed in every state to provide behavioral-health services such as psychotherapy.

This Committee is well aware of the large and rapidly growing number of veterans with long-term behavioral health needs, as current conflicts have produced “signature wounds” of Post Traumatic Stress Disorder as well as Traumatic Brain Injury, which also has major behavioral symptoms. Repeated deployments, including of Guard and Reserve forces, also have increased the prevalence of separation anxiety and depression. Several hearing witnesses have detailed the extent and severity of these needs.

Indeed, in 2006, Congress enacted Public Law 109-461 establishing 38 USC § 7401(3) to permit VA to hire MFTs and Counselors to help address veterans’ mental-health needs. It took until September 30, 2010 for the VA to issue Counselor and MFT Job Specifications (VA Handbook 5005/41 for MFTs and 5005/42 for Counselors) implementing the law.

Meanwhile, on May 10, 2011, the 9th Circuit Court of Appeals (Veterans for Common Sense v. Shinseki) ruled that “unchecked incompetence” by the VA has led to inadequate mental health care. According to the panel, “(M)any veterans with severe depression or post-traumatic stress disorder are forced to wait weeks for mental health referrals and are given no opportunity to request or demonstrate their need for expedited care….The delays have worsened in recent years, as the influx of injured troops … has placed an unprecedented strain on the VA, and has overwhelmed the system that it employs to provide medical care to veterans...”

While we are pleased that the VA is finally taking steps to implement the 2006 statute, we are concerned with the pace and extent of implementation. We understand that most VA postings for MFTs and Counselors are for Readjustment Counseling Center (“Vet Center”) jobs, rather than at clinical facilities. We appreciate the integration of our professions into these facilities, but do not believe that they reflect the full intent of the law, which was to employ MFTs and Counselors throughout the health system.  The nominal employment opportunities for MFTs and Counselors in the medical facilities since the release of the Standards, while hundreds of Social Work positions are advertised, shows a systemic failure to implement. 

As an example of the problem, the VA’s testimony at this hearing stated “VA is adding licensed family counselors to over 200 Vet Centers that do not currently have a family counselor on staff.” The fact that the VA incorrectly characterized these professionals as “family counselors,” thereby combining the two distinct professions into one inaccurate title, does not inspire confidence that the VA understands how either MFTs or Professional Counselors can aid its mission.  Further, the VA only references the use of these professionals in Vet Centers, reinforcing  our concerns that they are not considered for positions throughout the system. This language demonstrates a lack of understanding about who these professions are and why Congress passed the law.  It is clear that more education needs to be done at all levels of the VA and a proactive integration plan needs to be developed.  The VA national office needs to spearhead this effort and ensure that it is adopted by local facilities.  We urge Congress to recommend such action.

In addition to our concerns with the pace and extent of implementation, we have concerns  with the rigidity of the eligibility criteria.  Specifically, the fact that the new Qualification Standards for both professions exclude a significant portion of qualified  MFTs and Professional Counselors from VA employment.  While we appreciate the need for high standards, the lack of flexibility in the standards restrict access to many MFTs and Counselors who have been practicing effectively for decades. We estimate that roughly 80,000 Counselors and MFTs nationwide, including up to 95% of California MFTs, are barred from VA jobs by these requirements. We believe this severely undermines the VA’s ability to hire qualified behavioral-health personnel.

These requirements provide that job candidates must hold an advanced degree awarded by an academic program that, when the degree was granted, was accredited by a specialty accrediting body. (For Counselors, this is the Council for Accreditation of Counseling and Related Educational Programs, and for MFTs, it is the Commission on Accreditation for Marriage and Family Therapy Education.) This fails to recognize that there was a time when accreditation by these specialized bodies was not a widespread practice, even though the degree-granting institutions themselves were accredited by a Regional accrediting body.   There are some professionals who may have graduated prior to the creation of these accrediting bodies and many who may have had limited or no accessible accredited programs.  These MFTs and Counselors have been practicing for many years and should not be excluded from employment by the VA.

In response to this concern, we formally requested that the VA establish an alternate means to recognize qualified MFTs and Counselors with strong credentials and significant clinical experience who may not otherwise meet the Qualification Standards.  The VA denied this request to Counselors and a response is pending for MFTs.  We believe that this flexibility will increase the number of qualified professionals available to serve our veterans and help address the access problems identified by the 9th Circuit Court of Appeals.  We ask Congress to urge the VA to develop alternatives to the existing standards that allow for employment of experienced and qualified MFTs and Counselors.  

Finally, we agree with several hearing witnesses that the Committee should question why VA has not implemented Public Law 111-163, Section 304, regarding mental-health and support services for OEF/OIF veterans and their families.

We would be pleased to work with this Committee and VA to address these challenges, and to respond to any questions this Committee may have.