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 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.

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.