As Utah emerges from the depths of winter, its communities bear the increasingly heavy burden of mental and emotional struggles. Utah faces a drastic shortage of mental health professionals, and those needs are only increasing.

“Utah ranks 11th highest among states in terms of the share of adults with any mental illness,” the Kem C. Gardner Policy Institute at the University of Utah reports. “[Utah is] 3rd highest for adults with serious mental illness, and 4th highest for adults with serious thoughts of suicide. The share of young adults in Utah with poor mental health more than doubled over the last 10 years.”

Regulatory barriers in health care

Three years ago, in the opening act of his tenure, Gov. Spencer Cox signed executive order 2021-01, requiring Utah industries to review the regulations of certain occupations and remove any that are excessive or unnecessarily preventative. The overall goal is “to reduce barriers to working while still protecting the health, safety, and well-being of Utah residents.”

Margaret Woolley Busse, executive director of the Utah Department of Commerce, quickly assessed that Utah is over-regulated. “About a third of our workforce is regulated by the state in their individual professions,” she says. “Which is huge. It didn’t use to be that way. … There’s been a gradual encroachment onto professional licensing—usually driven by the professions themselves.”

Industry self-regulation purportedly aims to enforce public safety, but it comes at the cost of access to services—such as behavioral and mental health services. Utah’s shortage of qualified mental health professionals is directly tied to its stringent licensure requirements. 

“We realized that in order to really make an impact, we needed to set up something that would look at these regulations in an ongoing, systematic way—to ensure that our regulations were relevant—and that we were creating economic opportunity for people to get into these professions,” Busse says. “As more people get into the profession, the consumer has greater access to that profession because there are more people, and inevitably costs come down.”

Previous attempts to reform industry regulation were hit-and-miss. “Any change would galvanize the entire industry to say ‘stop, don’t do it,’ and the legislature didn’t have the resources to do the deep research needed.” 

To address this disparity, the Department of Commerce, with the support of Cox and other divisions, formed the Office of Professional Licensure Review (OPLR), under the direction of Jeff Shumway. OPLR, which aims to “[strengthen] trust in occupational licensure through objective research and policy recommendations,” immediately sprang into action and dug into Utah’s regulation data. 

What they found formed an astoundingly clear picture.

According to OPLR’s report, Federal data from the Substance Abuse and Mental Health Services Administration revealed that only half of Utahns with pressing behavioral health care needs are receiving services—530,000 out of 750,000 to 1 million. At the same time, surveys from the National Practitioner Databank demonstrate that Utah features above-average instances of adverse action reports and malpractice claims.

OPLR found the state in a quandary: Utah had a strong need to deregulate and increase access to health services while simultaneously improving its safety record—which is normally associated with increased regulation. How would it bridge that gap?

“There are elements of current regulation that are more geared toward safety than others,” Shumway says. “We’re trying to ramp up those elements and ramp down the others. A couple of low-cost ways to increase safety include requiring background checks for all therapists. We’re also going to require some client disclosures—disclosing to your clients your regulation status, who your supervisors are, what you’re allowed to do and what you should never do.”

Most therapists become licensed after passing a rigorous national exam, but data shows that exams do not make for safer therapists, Shumway explains. “We’re going to create alternative pathways for people to come into the profession. … Supervised hours, on-the-job training has a long academic history affecting patient outcomes.”

Innovative solutions for licensure

Under OPLR’s proposal, therapists seeking licensure could forego taking the exam by completing more supervised hours. “We think that makes you safer, and it gives people who have a hard time with that standardized exam a way to become fully licensed,” Shumway says.

Similarly, OPLR hopes to expand options to another overlooked source of interested health care providers: psychology majors. Traditionally, psychology majors have had very few options for transitioning into psychiatric work without committing to extensive graduate programs. OPLR hopes to enable thousands of undergraduates to launch into the field in the near future. 

The changes would transform the behavioral health workforce to resemble Utah’s medical field. Medical undergrads make up two-thirds of the medical workforce—nurses, techs and physician assistants. Meanwhile, in behavioral health, 73 percent of the workforce has a master’s degree or higher. OPLR recommends creating assistant positions for certified undergraduates in behavioral health: peer support specialists, certified crisis workers and certified case managers.

For the most part, industry leaders and stakeholders have been supportive, though they are learning to adapt to new legislative realities. “We believe very strongly that the Utah public is at the heart of licensure,” Shumway says. “It’s their safety that we care about; it’s their access to services that we care about. And yet, they’re not really represented on the licensure advisory boards. So we are slamming the [psychiatric health] industries together into a policy board and then adding a bunch of people to represent consumers and public health. [The] industry doesn’t love that; they like having their own board.”

Mark Steinagel, director of the Division of Public Licensing, explains, “The legislature, because it has so many bills, relies on the experts and special interest groups to educate them. For decades, the incentives were to become a voice early on, and then you’re a voice when the decisions are made. Influencers thought they could be an active touchpoint throughout the public policy process—but this report is, for the most part, apolitical. It’s meant to be based on evidence.”

Busse reinforces this. “Before, we only ever got one perspective. Now, when we come to the legislature and we have a very well-researched set of recommendations, it’s hard to gainsay those. … We have a mental health crisis.”

According to Busse, OPLR has finished compiling its recommendations for the Utah State Legislature. Its findings have spurred State Senator Curtis Bramble to submit SB26 to the Legislature to amend behavioral health licensing requirements.

On January 9, 2024, Governor Cox commented on the developing crisis. “It’s tough to see someone struggle with depression, anxiety or substance abuse. We know seeking help is crucial—and in some cases, it’s lifesaving,” he says. “The reality is there aren’t enough people to provide mental health care. We must work together as state government, providers and educators to remove barriers and ensure everyone can receive the care they need and deserve.”