Amid mental health crisis, new compact allows social workers to practice across state lines

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Stefani Goerlich, a certified sex therapist and social worker with a private practice in Detroit, sees several dozen clients a month, most of them from underserved and minority backgrounds. She speaks to them about sensitive matters such as gender-affirming care, and building trust takes time.

Those hard-won relationships often are upended when clients move away from Michigan, because most states bar social workers from providing telehealth services across state lines. Finding another therapist who is a good fit isn’t easy, especially since many areas of the country have a shortage of mental health providers.

“It takes them such a long time to find somebody that they feel safe with,” Goerlich said. “To have a spouse get transferred in their job and to lose all of that? Statistically, people are more likely to just stop therapy entirely, because they don’t want to have to go through that again.”

Amid what many Americans are calling a mental health crisis, an increasing number of states are trying to address the problem by empowering social workers to practice across state lines.

Under the Social Work Licensure Compact, social workers can get a multistate license, which clears them to care for patients in a participating state, even if they don’t live there. Social workers must abide by the laws of the state where the patient resides.

Missouri was the first state to approve compact legislation, in July 2023. Since then, 14 other states have signed on. And at least 17 more are considering bills to do the same, according to the nonpartisan Council of State Governments, a nonprofit organization that promotes the exchange of ideas across state lines.

The compact is the result of a collaboration among the council, the U.S. Department of Defense and the Association of Social Work Boards, which develops social work licensing exams. The National Association of Social Workers and the Clinical Social Work Association, both membership organizations for social workers, are partners in the effort.

The Defense Department is involved because military families move frequently, and many of them include social workers. Getting a new license every one or two years is burdensome. The social work compact is one of 10 multistate licensing agreements the Defense Department agreed to fund a few years ago, ranging from teaching to cosmetology, according to Matt Shafer, a deputy program director at the Council of State Governments.

Shafer told Stateline it likely will take one to one and a half years until licenses are issued under the social work compact.

This isn’t the first compact to allow mental health providers to practice across state lines. Thirty-six states have passed legislation to allow psychologists to practice elsewhere by joining an interstate compact known as PSYPACT.

“It works,” Robin McLeod, a senior director at the American Psychological Association, said of PSYPACT. “It allows for people who have specialized practice to provide care, or for people who need specialized practice to receive care.”

For example, McLeod said, a therapist might specialize in serving patients with autism and also speak Arabic. Under the interstate compact, a practitioner could serve more people with those specific treatment and language needs, via telehealth.

However, McLeod noted, therapists practicing under the compact still have to navigate differing state laws. She pointed to Texas, where providers need to be aware of laws prohibiting abortion and gender-affirming medical care.

“Those are times where it can be really tricky,” she said. “If you’re practicing in that state from another state, it’s the Texas health and safety laws that you would have to follow.”

But Alabama Democratic state Rep. Kenyatté Hassell, who sponsored successful compact legislation in his state, thinks the benefits outweigh the potential complications. A 2023 report from Mental Health America, a nonprofit that focuses on issues of mental illness, ranked Alabama 48th among the states in its effectiveness addressing mental health and substance use issues, citing its high prevalence of mental illness and limited access to care.

“I know, as a state, we need to put more money into the health department to deal with mental health, from schools to workplaces,” Hassell told Stateline. “We defunded some of the mental health hospitals that we had in the state. And it became a problem.”

In Colorado, where a bill that would allow the state to join the compact is on the governor’s desk, Democratic state Rep. Emily Sirota — a social worker herself — noted the issue is bipartisan. Compact bills also are awaiting governors’ signatures in Minnesota, New Hampshire and Tennessee, according to the Council of State Governments.

“It’s not a partisan issue to recognize a need in the workforce,” Sirota told Stateline. She said the licensing compact is a way to make connections between patients and social practitioners “more streamlined and more effective.”

For Goerlich, who sees clients in at least four states, anything that can make licensure easier for therapists is a good thing. In addition to Michigan, Goerlich went through the licensing process in Arizona and Ohio so she could continue to treat patients who moved to those states. She also works in Florida, where she says she doesn’t need a full license because she is a registered telehealth provider.

“I went through all the hoops, I got licensed,” she said. “But that ended up costing me money. And I’m fine with it, because I’m able to help people. But if we had something like a compact, I would have been able to see them without needing to do that.”

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