What about paraprofessionals in drug rehab and mental health?
March 1, 2019 8:55 PM   Subscribe

In the United States, would it make sense to use people with bachelor’s degrees in social work or psychology to a greater degree for drug rehabilitation and mental health counseling?

I think states license people only with master’s degrees and above. But would it make sense to change licensing laws, possibly to make a lower level for those with only bachelor’s degrees? Even if under supervision?

We have such a drug problem in this country. And many areas do not have enough mental health providers.

But in other fields, there are physician assistants, nurse practitioners, paralegals, various types of dental paraprofessionals, etc.

Is there something I am missing about this idea?
posted by maurreen to Home & Garden (13 answers total)
Also, I would be curious to know about lower-level licensing in other countries.
posted by maurreen at 8:59 PM on March 1, 2019

One example is a peer support specialist
Here is a list of jobs in recovery support ranging from doctors to nurses to sober companions.
posted by metahawk at 9:03 PM on March 1, 2019

It looks like a lot of states have a bachelors-level drug-counseling credential. https://www.addiction-counselors.com has requirements for each state.

I don’t think a lack of people with credentials is typically a problem; if there’s a shortage of counselors, it’s more often because of a lack of funding rather than candidates. Lowering the barrier to entry means you have less qualified people with less knowledge doing a delicate and important job. Fund programs better and you’ll be able to find qualified people.
posted by chesty_a_arthur at 9:21 PM on March 1, 2019 [5 favorites]

I'm only tangentally involved (on a grant management level), but yes, HRSA is and has been making a big push for this. All of our PA students (and Family Med residents) are getting MAT trained/certified, partially via government funding.
posted by Ufez Jones at 9:52 PM on March 1, 2019 [1 favorite]

This is a difficult question. American undergraduate degrees are generalist with a focus. For a UK-style specialist degree, where almost all of the time is spent on the primary subject, this becomes less of an issue.

Someone with a major in psychology will probably have very limited practicum experience within a campus or campus-adjacent setting. The masters level offers more extensive practicum experience in different settings with very different client profiles. At the doctoral level (for a Psy.D.) there's the one-year internship, typically at a hard facility like a state institution or a prison or a VA hospital. In that regard, the masters-level is the paraprofessional.

Within the US, the issues are licensing, panelling/billing, and liability. Those are addressed to some degree within a public or quasi-public entity like an LME, but outside of those frameworks, if you can't bill insurers or be insured then you can't see clients.

The sweet spot right now is for masters/doctoral psychologists working in tandem with psychiatry PA/NPs to get the balance right between meds and therapy, because most psychiatrists don't want to go near genuinely difficult clients for not much money. Yeah, this is about women doing jobs that men have decided not to do any more.

[Doctoral-level clinical psychologists and master's-level substance abuse counsellors who work with hard caseloads are paid shit money compared to peers who work in different sub-fields.]
posted by holgate at 11:04 PM on March 1, 2019 [1 favorite]

I really really feel that bachelor level counselors get assigned to our most vulnerable and well quite frankly poorest patients who have significant trauma histories, face significant stigma and discrimination, and have the severest forms of addiction and mental illness.

They deserve the same quality of care as everyone else (those with $$$), and getting bachelor level counselors (or in IL a GED plus 18 credit hours and lisensure for drug and alcohol counseling) to provide individual therapy because it is cheeper does not produce or provide the same quality of care. It is nowhere close. It fact in some cases it is terrifyingly awful based on what I've witnessed and seen in the field.
posted by AlexiaSky at 6:28 AM on March 2, 2019 [9 favorites]

The CADC 1 addiction counseling credential in Oregon doesn't even require an associate's degree. Check out the specs here.
posted by MonsieurBon at 9:26 AM on March 2, 2019

Also at some facilities I've seen around here in Portland, being a CADC 1 counselor gets you about $1 more per hour than hosing down the sobering-up cells.
posted by MonsieurBon at 9:28 AM on March 2, 2019

California has a lot of paraprofessionals in mental health and substance-use disorder treatment.
Mental Health Rehabilitation Specialist (pdf): A mental health rehabilitation specialist shall be an individual who has a baccalaureate degree and four years of experience in a mental health setting as a specialist in the fields of physical restoration, social adjustment, or vocational adjustment. Up to two years of graduate professional education may be substituted for the experience requirement on a year–for–year basis; up to two years of post associate arts clinical experience may be substituted for the required educational experience in addition to the requirement of four years’ experience in a mental health setting.

The substance-use disorder treatment certifications look like they often don't even require a bachelor's degree.
posted by lazuli at 10:21 AM on March 2, 2019

Yes, though I think drug treatment is already a more open field for this than mental health, if we’re making that distinction.

Degrees and licenses for counseling are a cynical system of guild-protection. I knew so many people in social work school who were blowing a great deal of time and money so they could get a credential and move up in jobs they already had and were good at. It’s shameful.

I’m not saying anyone can walk in off the street and be a good therapist or addictions counselor but I do think training for this work is vastly overdeveloped and over prioritized and it probably keeps a lot of good people who don’t want to jump through a lot of arbitrary and expensive hoops out.
posted by Smearcase at 11:18 AM on March 2, 2019

I'd recommend reading this Mother Jones article before getting too enthusiastic about the idea.
posted by praemunire at 12:41 PM on March 2, 2019

I really really feel that bachelor level counselors get assigned to our most vulnerable and well quite frankly poorest patients who have significant trauma histories, face significant stigma and discrimination, and have the severest forms of addiction and mental illness.

Yes, and the duty to warn / duty to protect aspect of mental health work is especially difficult at that level. Being placed in a position to decide whether to involve law enforcement or seek involuntary commitment is hard enough for practitioners with doctoral-level clinical training. (Not least because that training often takes them inside institutional settings.)
posted by holgate at 11:04 PM on March 2, 2019 [1 favorite]

Thanks for all the info.

A lot of these abbreviations are unfamiliar to me.
posted by maurreen at 6:49 PM on March 5, 2019

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