Under new bill, Wisconsinites could seek mental health services from out-of-state providers via telehealth

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

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

The Institute for Reforming Government, a conservative, nonprofit organization that lobbies for bipartisan "kitchen-table issues," is championing the bill, according to Alex Ignatowski, its director of state budget and government reform, who spoke at the public hearing.

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

"As a provider myself, whatever you can do to lower barriers to enhance compliance, you need to do that," Cabral-Guevara said.

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

But those licenses — and many of the relationship forged between patient and provider — expired when the state public health emergency ended in May.

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

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

The need for mental health services has been steadily increasing since the Wisconsin Department of Health Services started documenting service needs in 2014. Between 2014 and 2021, there was a 25% jump in people seeking services.

As of 2021, nearly 70,000 people in Wisconsin have received mental health services. But treatment gaps far exceed this number, with nearly 340,000 Wisconsin adults in need of mental health support not being treated and another nearly 75,000 of Wisconsin youths experiencing similar service gaps.

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

"Stress caught up to me. In an effort to stop my panic attacks, I started looking into therapists. The vast majority of therapists were booking out months, weeks if you're lucky," Garbedian said.

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

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

Rural areas, Ignatowski said, have the greatest ratios. Buffalo County, for example, has a whopping 13,300 people for the single mental health provider serving the county. Florence County, which also has a single mental health provider in the county, serves the entire 4,590 population.

"There's no clinical difference between treating Wisconsinites and citizens in any other state," Garbedian said. "So there shouldn't be a legal difference either."

Who would benefit from mental health treatment via telehealth services?

College students attending school in Wisconsin could benefit from mental telehealth services. For students who have already built a relationship with a counselor prior to their freshmen year or during breaks, this would be an ideal situation for them.

Telehealth services are also useful for those who buzz from errand to errand, attempting to juggle too many things. Cabral-Guevara shared that many of her family members, in their hustle and bustle, have benefited from mental health treatment options via 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 would the new bill require of out-of-state providers?

In order for out-of-state mental health providers to practice in Wisconsin, those providers would need to 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 authorizing or licensing board; and
• Report to the Department of Safety and Professional Services within 30 days of practicing in the state. The bill was amended to include this.

The bill was also amended to exclude physicians, physician assistants and nurses from the scope of mental telehealth providers. Mental health providers included in this bill are psychologists, counselors, therapists or social workers who, by education, training and experience, are qualified to provide mental health services to patients.

Who's against the bill?

One criticism of the bill, from National Alliance on Mental Illness Wisconsin, concerns safeguards and the interstate complaint process in cases of malpractice. That put a question mark over whether the organization would support the bill, meaning it hasn't gone one way or another on its position.

Cabral-Guevara, in response, said this issue hadn't come up when mental telehealth was available during the emergency order, but would look deeper into this potential issue.

In a similar vein, the Wisconsin Medical Society also had a question mark over their position, stating that adequate responses to negligence claims should require the physician to have a Wisconsin license to practice medicine and surgery.

Those concerns may no longer be relevant, however, following the bill's amendment on which providers would fall under the umbrella of "mental health provider."

What's next for the bill?

The hope for Senate Bill 515, Ignatowski said, is that it makes its way to an executive session where it can be given a floor vote by the state Senate.

If or when that happens, it would make its way to Evers's desk, where it could potentially be signed into law.

"During the pandemic, Wisconsin and a lot of other states opened up their borders and got rid of barriers simply because people needed help," Ignatowski said. "Right now is no different. Mental health needs in Wisconsin are the same as they were during the height of the pandemic."

Similar bills, further along, would widen mental health access

During Tuesday's public hearing, state Sen. Joan Ballweg, R-Markesan, questioned whether counseling compacts would be considered this session. Ballweg is referring to licensure compacts, agreements between states to allow professionals to travel across state lines to provide services.

Such services would go beyond telehealth and allow additional access to in-person services.

A counseling compact is indeed in the works and headed to Evers' desk. Akin to traveling nurses, the compact would allow counselors to provide mental health services in other compact states. The Wisconsin Counseling Association has been "spearheading this effort for years," Jeff Nerone, its treasurer, wrote via email.

Neighboring states Indiana and Iowa are among the 30 states that have already enacted legislation. Wisconsin is one of four states with pending legislation.

Natalie Eilbert covers mental health issues for USA TODAY NETWORK-Wisconsin. She welcomes story tips and feedback. You can reach her at neilbert@gannett.com or view her Twitter profile at @natalie_eilbert. If you or someone you know is dealing with suicidal thoughts, call the National Suicide Prevention Lifeline at 988 or text "Hopeline" to the National Crisis Text Line at 741-741.