Bill allows Wisconsinites to seek mental health services outside the state

The State Capitol in Madison

MADISON ‒ At a time when Wisconsinites must wait weeks and months to see a mental health professional, a new state Senate bill would expand access to out-of-state providers. state through telehealth services.

The Senate Committee on Mental Health, Substance Abuse Prevention, Children and Families held a public hearing on Senate Bill 515 last Tuesday. The bill would enable out-of-state providers to practice via telehealth without having to be licensed within the state, as long as their license is in good standing. Before the public hearing, it went through two changes and passed the Assembly in a voice vote.

The Institute for Reforming Government, a nonprofit organization that lobbies for bipartisan “kitchen table issues,” is promoting the bill, according to Alex Ignatowski, its director of state budget and government reform, which spoke at the public hearing.

State Sen. Rachael Cabral-Guevara, R-Appleton, introduced the bill by highlighting Wisconsin’s ongoing mental health crisis, a crisis that reveals a shortage of providers in the state.

“As a provider myself, whatever you can do to lower barriers to improve adherence, you should do that,” Cabral-Guevara said.

This is not the first time Wisconsin residents have had access to out-of-state mental health providers. Wisconsinites have a short window to access telehealth shortly after Democratic Gov. Tony Evers declared a state public health emergency on March 12, 2020. Under Emergency Order 16, issued on March 27, 2020, any health care provider outside of Wisconsin may work with patients in Wisconsin, as long as they register a temporary or permanent license with the Department of Safety and Professional Services within 10 days of working with the patient.

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But those licenses — and many of the relationships created between patient and provider — expired when the state’s public health emergency ended in May.

“For now, (out-of-state) is not an option. This bill adds similar safeguards to the original order from the governor,” said Cabral-Guevara.

Why do we need out-of-state mental health providers?

The need for mental health services has continued to increase since the Wisconsin Department of Health Services began documenting service needs in 2014. Between 2014 and 2021, there will be a 25% jump in people seeking services.

By 2021, nearly 70,000 people in Wisconsin will receive mental health services. But treatment gaps far exceed this number, with nearly 340,000 Wisconsin adults in need of untreated mental health support and another nearly 75,000 Wisconsin youth who experienced similar gaps in service.

Benjamin Garbedian, a 22-year-old Waukesha resident who works with the Institute for Reforming Government, used the public hearing as an opportunity to talk about his recent experience with panic attacks. Her search for a therapist last year opened her eyes to the difficulties many Wisconsinites face when trying to find help.

“The stress got to me. In an effort to stop my panic attacks, I started seeing therapists.

Ignatowski, the director of the Institute for Reforming Government, noted that Wisconsin ranked No. 32 in the United States for the number of mental health professionals.

That ranking is based on 2021 data from County Health Rankings & Roadmaps, a program of the University of Wisconsin Population Health Institute. Data from 2023 shows that there are 420 people for every mental health provider registered in Wisconsin. The national ratio is 340 people per provider.

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Rural areas, says Ignatowski, have the highest ratios. Buffalo County, for example, has as many as 13,300 people for the only mental health provider serving the county. Florence County, which also has one mental health provider in the county, serves a total population of 4,590.

“There is no clinical difference between the treatment of Wisconsinites and citizens of any other state,” Garbedian said. “So there shouldn’t be any legal differences either.”

Who can benefit from mental health treatment through telehealth services?

College students attending Wisconsin can benefit from mental telehealth services. For students who have already established a relationship with a counselor before their freshmen year or during breaks, this is an ideal situation for them.

Telehealth services are also useful for people who are multitasking, trying to juggle many things. Cabral-Guevara shared that many of her family members, in their turmoil, have benefited from mental health treatment options through telehealth services.

“In a crazy world of working full-time and school, telehealth has been a godsend for my family members,” Cabral-Guevara said.

What does the new bill require of out-of-state providers?

In order for out-of-state mental health providers to practice in Wisconsin, those providers must do or have the following:

  • Licenses in their home state;
  • Out-of-state licenses in good standing;
  • Provide the client with contact information for their permit or licensing board; and
  • Report to the Department of Safety and Professional Services within 30 days of state practice. The bill was amended to include this.
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The bill was also amended to exclude physicians, physician assistants and nurses from the scope of mental health telehealth providers. Mental health providers included in this bill are psychologists, counselors, therapists or social workers who, through education, training and experience, are qualified to provide mental health services to patients.

Who is against the bill?

A critique of the bill, from the National Alliance on Mental Illness Wisconsin, concerns safeguards and the interstate complaint process in malpractice cases. It puts a question mark on whether the organization will support the bill, meaning it hasn’t gone one way or another on its position.

Cabral-Guevara, in response, said that this issue has not yet come up when mental telehealth is available during the emergency order, but it will be examined more deeply on this potential issue.

In the same vein, the Wisconsin Medical Society stood as an organization against the bill, saying that adequate responses to claims of negligence should require the physician to have a license in Wisconsin to practice.

What’s next on the bill?

The hope for Senate Bill 515, Ignatowski said, is that it heads into an executive session where it can be given a vote on the state Senate floor.

If or when that happens, it will go to Evers’ desk, where it will be signed into law.

“During the pandemic, Wisconsin and many other states opened their borders and removed barriers simply because people needed help,” Ignatowski said. “Today is no different. Wisconsin’s mental health needs are the same as they were during the height of the pandemic.”