How can interstate compacts expand access to mental health care?

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Interstate compacts expand access to mental health care. The United States is facing a mental health crisis. Rates of anxiety, depression, and suicide are rising, while mental health workforce shortages limit access to care across the country.¹ Interstate licensure compacts for mental health professionals make it easier to deliver care where it’s most needed.²

The current landscape

• Each year, one in five adults in the U.S. experiences a mental illness, affecting nearly 60 million Americans.^3,4
• As of March 2023, 160 million Americans live in designated Mental Health Professional Shortage Areas – regions with too few mental health providers to meet the needs of the population.⁵
• By 2030, the country will face a projected deficit of 350,000 mental health professionals.⁶ Some states have about 220 behavioral health providers per 100,000 people, far below the national target of 345 providers per 100,000.⁷

Interstate licensure compacts for mental health professionals

Interstate licensure compacts are agreements between states that streamline the process for professionals to be eligible to practice in other participating states. Licensure is the process states use to ensure that health professionals meet required training and safety standards before they are allowed to treat patients, often varying by state. Compacts shorten approval timelines, reduce unnecessary paperwork, and allow providers to work in multiple states while maintaining safety and professional standards.

States can now join four major interstate licensure compacts for mental health professionals:

• The Counseling Compact, adopted by 37 states, enables licensed professional counselors (LPCs) to deliver care in-person or via telehealth (virtual care such as video or phone appointments) across state lines.⁸ LPCs hold a master’s degree in counseling or a related field and provide therapy for a range of mental health concerns in participating states.
• The Psychology Interjurisdictional Compact (PSYPACT), adopted by 40 states and two territories, permits psychologists to provide telehealth and limited in-person care across member states after an application process.⁹ Licensed psychologists must hold a doctoral degree and are trained to provide specialized mental health services.
• The Social Work Licensure Compact, enacted by 22 states, allows licensed clinical social workers (LCSWs) to provide in-person and telehealth services across state lines after obtaining a multistate license.¹⁰ LCSWs have a master’s degree in social work and often focus on both therapy and connecting clients to social support or community resources.
• The Interstate Medical Licensure Compact (IMLC), adopted by 41 states, the District of Columbia, and Guam, allows eligible physicians to obtain expedited licenses to practice in other member states.¹¹ This license supports both in-person and telehealth care. Psychiatrists hold medical degrees and are eligible to practice under the IMLC.

Currently, there is no active interstate compact for licensed marriage and family therapists (LMFTs). While discussions about establishing such a compact have occurred, no formal agreement has been enacted to date. LMFTs hold a master’s degree in marriage and family therapy and specialize in treating individuals, couples, and families with a relational focus.

Most of the mental health licensure compacts – including PSYPACT, the Counseling Compact, and the Social Work Compact – were launched between 2020 and 2025.^12,13,14,15 Because they are relatively new, formal evaluation studies have not yet been published. However, a survey across several states on the Nurse Licensure Compact (NLC), a similar compact in a different health profession operating since 2000,¹⁶ found that 96% of nurses practicing with multistate licenses believed the compact was beneficial – making it easier for them to accept travel nursing and telehealth positions, relieve staffing shortages across state lines, relocate for work, and avoid duplicative fingerprinting and background checks.¹⁷

Benefits of interstate licensure compacts

Interstate licensure compacts for mental health professionals benefit patients, providers, and states:

• Patients: These compacts can improve access to care and continuity of care. Patients benefit from having easier access to providers across state lines, especially when traveling, relocating to a new state, or for those living near a state border and receiving care in a different state. In addition, patients living in rural and other underserved areas benefit from greater access to more providers when state lines are not a limiting factor.

• Mental health clinicians: Providers benefit when they can continue working with their clients even when the provider or client travels or moves. Interstate licensure can also make the licensure process simpler for providers who are licensed in one state and are moving to a new state, allowing them to begin seeing new clients there more quickly.
• States: States benefit from collaborative tools that help them improve patient access to care by streamlining how new providers become authorized to practice across state lines. This process typically includes verifying credentials, processing applications, and integrating providers into state systems. While the specifics vary, states are formalizing these steps through licensure compacts and infrastructure such as centralized licensing databases, reducing duplicative processes and related costs.¹⁸

Early implementation

Though relatively new, mental health licensure compacts are already being adopted by many states, and states are investing in changes that help licensed providers gain approval more quickly to practice across state lines.

• Aligning approaches: To join an interstate licensure compact, states must pass the compact’s model legislation, agreeing that licensees will meet participating states’ standards of care. In some cases, state efforts to realign their governance structures to improve the licensing process also could make implementing interstate licensure compacts easier. For example, Utah passed a new law that replaces multiple behavioral health licensing boards with a single, centralized Behavioral Health Board. This consolidation streamlines oversight and policy decision-making and may make it easier to update rules and apply compact requirements across different mental health professions.^19,20,21

• Developing shared infrastructure: Some states are adopting shared systems that help each state verify provider credentials, flag disciplinary actions, and track licensing status across jurisdictions.^22,23 In some cases with support from national partners^24,25 shared infrastructure can help reduce costs and speed up licensing processes across compact members.

• Improving licensure timelines: The Interstate Medical Licensure Compact (IMLC), which covers physicians, including psychiatrists, offers a model of how compact participation can improve the licensing process. Member boards use the IMLC process to confirm information and issue licenses in an average of 7 to 10 days – faster than traditional timelines that can stretch to several weeks or months.^26,27 In the mid-Atlantic region, for example, licensure processes to enable psychiatrists to practice across Maryland, Virginia, and D.C. had been taking over three months – but under a new licensure compact, that timeline was reduced to just a few weeks.²⁸

Recommendations

Interstate licensure compacts for mental health professionals offer a promising solution to help address the workforce crisis. Kaiser Permanente supports states’ adoption of such compacts to increase access to care. While compacts alone cannot resolve all workforce challenges, they are a meaningful step toward building a more connected and responsive mental health system.

To truly address workforce shortages and improve patient care, states should pursue a multi-pronged approach. In addition to compact participation, states should consider expanding access to telehealth and

digital therapeutics, supporting collaborative care models that distribute workload across teams, and investing in education, training, and retention programs.

References

Full citations for this document can be found at: kpihp.org/references-ics.