Montana has a dire shortage of mental health care providers. Here’s how lawmakers tried to help.

HELENA — Buried within the mountain of bills debated during this year’s legislative session, Republicans and Democrats endorsed a slate of policies meant to tackle a widespread problem: the shortage of qualified mental and behavioral health care workers in a state that desperately needs them.

An estimated 90,000 teens and adults in Montana have a substance use disorder, according to the most recent federal data. Roughly 1 in 10 residents say they experience “frequent mental distress” — a statistic from the state health department that aligns with Montana’s consistently high rate of suicide. Exacerbating the crisis of need, providers and health care associations say, is an ineffective pipeline for putting professionals where they need to be. 

“Our numbers are off the charts in terms of people who are asking us for help,” said Janet Woodburn, CEO at Sapphire Community Health in Hamilton, in testimony before lawmakers in February. “And we can’t provide it because we don’t have enough professionals to do that.”

Woodburn and other proponents, including medical associations and regulatory boards, threw their weight behind roughly half a dozen bills to address the workforce shortage this year, largely by revising licensure requirements for psychologists, social workers and licensed addiction counselors. The Republican-sponsored bills consistently garnered unanimous support from lawmakers, a rare trend in a session plagued by polarization. 

“This was just good, solid legislation. It wasn’t provocative, it wasn’t the kind of stuff where you’re going to have disagreement,” said Sen. Jason Small, R-Busby, who sponsored four proposals that have since been signed into law, in a recent phone interview. “I can’t believe the thank-yous I got from other legislators on some of this stuff.”

One of Small’s policies, Senate Bill 90, eases the standards for licensed psychologists from other states to relocate to Montana by requiring five years of recent experience instead of 20. The policy would also allow post-doctoral graduates to bill insurance when working under the supervision of a licensed psychologist, a change that proponents say will help attract early-career professionals to the state.  

“Right now, we have about one psychologist for every 4,000 Montanans. I get overwhelmed just thinking about the number of people I need to serve today,” said Sara Boilen, a board member of the Montana Board of Psychologists, in testimony supporting SB 90. “Without compromising our rigorous licensing standards, this bill allows us to remove some unnecessary barriers that are likely disincentivizing qualified psychologists from relocating their practices to our state.”

A similar measure sponsored by Rep. Frank Garner, R-Kalispell, gives the Board of Behavioral Health rule-making authority to evaluate the equivalent experience of applicants who are missing specific requirements to obtain various licenses. The bill includes provisions for people seeking licensure in marriage and family therapy, addiction counseling, clinical professional counseling and clinical social work. 

Proponents of Garner’s House Bill 177, including the Montana Primary Care Association, said it allows the board to assess an applicant’s unique qualifications and educational background rather than disqualifying them from licensure.   

“What this board doesn’t have is any rule authority to have flexibility for thinking about equivalency from out-of-state applicants,” said Stacey Anderson, policy director for MPCA, in public testimony. “So if someone has 20 years of experience being a licensed addiction counselor in another state, if they’re missing one element of the statute in Montana, they either have to go back to school or take a new test, whatever the case may be.”

That inflexibility, Anderson and other bill supporters said, clogs up the process for getting capable providers with clean professional records to serve patients in need. In a rural state working to decrease stigma around mental health and substance use treatment, the space for more professional clinicians is growing.

In Small’s hometown of Busby, roughly an hour and a half east of Billings on the Northern Cheyenne reservation, access to mental health care professionals is strained.

“At the end of the day, it’s just a question of making stuff work out for working Montanans,” Small said, noting how inconvenient it is to travel to Billings for an appointment in the middle of a work week. “I lose a whole day if I have to go up there and do something.”

Establishing a strong cohort of psychiatrists and other behavioral health experts in Busby and other rural Montana towns may not happen immediately. An intermediate step, however, could come from a third Small-sponsored bill, Senate Bill 217, which changes the process for billing insurance in collaborative psychiatric care settings featuring treatment plans coordinated between a primary care provider and a psychiatric consultant. With fewer than 100 licensed psychiatrists working in Montana, the legislation intends to make psychiatric care more accessible to remote patients. 

Small and other proponents of the new laws acknowledged that they received minimal public attention during the jam-packed 90-day session, in part because of the obscure and technical nature of the changes. 

“It’s unsexy, it’s not interesting,” Anderson said about the policy fixes. “They’re just real wonky, nitty-gritty bills.”

The often unanimous votes, however, signalled that legislators from both parties and across the state believe the professional shortage deserves creative solutions. 

“It really is about digging deep into the policy that governs these professions and saying, ‘where are the barriers?’” she said. 

Some mental health professionals expressed optimism and hope at the idea that help may be on the way. Dr. Sara Baxter, a clinical psychologist in Ravalli County, supported many of these policies during the session based on the health care strain she sees in her own community. 

“We have a pretty populous county and a lot of need,” Baxter said in a recent phone interview. While there are licensed social workers and clinical psychologists in the county, she said, “frankly, right now it’s very hard to get people seen. If I want to make a referral, most people tell me they’re not taking new patients.”

Baxter, one of the legislative representatives for the Montana Psychological Association, also supported other bills that did not pass this session, including a tax-incentive for opening psychiatric care practices in rural areas designated as “psychiatric opportunity zones.” In the end, though, Baxter said she was glad to see many significant reforms survive the political process. If that trend continues, she said, the state may start to close the gap between providers and Montanans in need of care.

“People, just at a very common-sense level, understand that it’s an exceptionally stressful period of time in our history,” she said. “And everybody knows somebody who is struggling.”