Texas therapists balk at restrictions to long-distance care

AUSTIN, Texas (AP) — Licensed professional counselors in Texas are objecting to a proposed rule that would require an in-person session with a client before using teleconferencing for long-distance counseling sessions.

The Texas State Board of Examiners of Professional Counselors would also require counselors and their clients to reside in Texas, unless the client is in the military.

The board is scheduled to discuss the proposed changes Wednesday and may vote on them, the Austin American-Statesman reports. More than 130 counselors have signed a petition in opposition.

The action comes at a time of widespread shortages of psychiatrists and other mental health workers in Texas. In September 2014, 201 of the 254 counties in Texas had provider shortages, according to a state report. In 174 counties, there wasn’t a single psychiatrist. A recommendation from the Statewide Health Coordinating Council even suggests expanding distance therapy services.

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Austin counselor Donna Rose criticizes the board’s actions.

“I feel strongly about this because this is for people who wouldn’t otherwise get to access this care,” Rose told the newspaper. “Some of these people are professionals who travel every week. Some are rural residents who are really strapped.”

Rose counsels about 20 percent of her clients using secure videoconferencing and, in special circumstances, a phone, she said. Others have disabilities or they’re veterans, single moms, low-income or elderly folks who don’t drive, she said.

Board members did not return calls by the American-Statesman. In publishing the proposed rules in January, the board’s interim executive director, Sarah Faszholz, outlined potential benefits.

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“Specifically, proposed requirements regarding distance counseling are designed to allow licensees to better assess the client using non-verbal cues at the initial session, following which the licensee may determine which method of counseling to use and the frequency of subsequent sessions,” she said.

In vast swaths of America, patients face lengthy drives to reach the nearest psychiatrist, if they can even find one willing to see them. Some states are promoting wider use of long-distance telepsychiatry to fill the gaps in care. In Texas, lawmakers recently voted to pay the student loans of psychiatrists willing to work in underserved areas. A bill in Congress would forgive student loans for child psychiatrists.

Even with such efforts, problems are likely to persist nationally. A recent survey by the Association of American Medical Colleges found that 59 percent of psychiatrists are 55 or older, the fourth oldest of 41 medical specialties, signaling that many may soon be retiring or reducing their workload.

The Texas proposal for an initial face-to-face meeting is similar to one the Texas Medical Board approved last year. But a judge barred the rule from taking effect until a civil trial can be held. Texas-based Teledoc sued the Texas Medical Board in that case, arguing the rule would hurt its business, reduce patient access to care, drive up costs and fly in the face of a national movement to expand telemedicine.