Congress should direct the Department of Veterans’ Affairs (VA) to
improve access to mental health services provided by licensed Marriage
and Family Therapists (MFTs) at VA facilities by eliminating specific
bureaucratic obstacles. In particular, S 1155 (Tester, D-MT), S
1581 (Sanders, I-VT; passed Senate VA Committee), S 1950 and S 1982
(Sanders, I-VT; includes S 1581), and HR 3499 (Kirkpatrick, D-AZ)
would (among other provisions) require VA (at no net cost) to improve
use of MFT clinical interns by providing those interns with financial
stipends, as is done for all Psychology and most Social work interns. On
February 27, 2014, the full Senate considered S 1982, but voted to
re-commit this bill back to the Senate VA Committee due to funding
issues unrelated to the MFT intern provision (Motion to Waive All
Applicable Budgetary Discipline, Vote 46).
average of 22 Veterans commit suicide daily, and an increasing number
of Veterans have mental-health needs consequent to extended active-duty
deployments. These needs often also affect Veterans’ family members. In
2006, Congress enacted Public Law 109-461 establishing 38 USC § 7401(3)
to permit VA to hire MFTs to help serve the increasing number of
veterans with mental-health needs. On September 28 2010, VA finally
issued MFT Job Specifications (VA Handbook 5005/41), required in order
for VA to hire MFTs.
VA employs 24,000 mental-health
professionals, of which approximately 100 (0.5%) are now MFTs. Yet MFTs
comprise about 13% of all U.S. mental-health professionals. (Similarly,
only about 0.05% of VA mental-health professionals are Licensed
Professional Counselors, who comprise about 26% of all U.S.
mental-health professionals). While MFTs’ underrepresentation in VA
mental-health staff is partly due to MFTs’ relative newness within VA,
the American Association for Marriage and Family Therapy (AAMFT)
believes it also is due to three unnecessarily bureaucratic VA
-Half of all licensed MFTs are barred from eligibility for VA jobs
because they do not hold advanced MFT degrees from academic programs
that were specialty-accredited (by the Commission for the Accreditation
of Marriage and Family Therapy Education, COAMFTE) at the time those degrees were granted, with no alternative deemed acceptable by VA. This is despite the following:
-Speciality accreditor COAMFTE was not established until 1978, so paradoxically MFTs with the most clinical experience are ineligible for VA.
states (e.g. California) condition licensure on a “deemed status” for
MFTs’ educational requirements in lieu of COAMFTE, so about 95% of California MFTs are ineligible for VA jobs.
states (e.g. New York) set MFT licensure eligibility to include persons
with degrees in related fields (e.g. psychology), so about 90% of New York MFTs are ineligible because they lack COAMFTE degrees.
-All advanced MFT students are barred from VA internship stipends, despite Psychology and Social Work students being eligible.
After mental-health students complete their academic training, in order
to be licensed they must successfully complete clinical internships of
at least one year. Many of these students depend on financial stipends
in order to live during their internships. But VA bars MFT students –
even those in COAMFTE degree programs – from receiving stipends, while
Psychology and Social Work students in corresponding APA and CSWE degree
programs are stipend-eligible. Because many VA healthcare professionals
heir careers through VA clinical internships, barring all MFT
interns from stipends reduces the number of newly-licensed MFTs working
-VA’s MFT jobs to date are concentrated in Vet Centers, despite major mental-health needs in VA Medical Centers and Clinics.
VA operates about 150 Readjustment Counseling Centers (“Vet Centers”)
for recently-returned veterans, the sites of most MFT jobs to date. Vet
Centers generally are reported to be working well. In contrast, most of
the widespread reports of VA mental-health service problems are at
Medical Centers (VAMCs, i.e. hospitals) and clinics. Unfortunately, some
VA Medical Centers falsely believe MFTs are ineligible for jobs in
those facilities. Although AAMFT is pleased that VA recognizes MFTs’
familial and other relationship-based clinical skills in its Vet
Centers, we believe MFTs can be part of the solution in VAMCs and
clinics. Like other mental-health professionals, MFTs are licensed in
all states to diagnose and treat behavioral disorders.
access to VA mental health services by urging VA to: 1) establish an
alternative to VA’s COAMFTE degree requirement (such as licensure for
three or more years); 2) make MFT interns in COAMFTE degree programs
eligible for VA stipends, as provided by S 1982 (Sanders, I-VT) and HR 3499 (Kirkpatrick, D-AZ);
and 3) urge VA’s Regional Networks (VISNs) to include MFTs as eligible
for more clinical positions, such as by making MFTs eligible for the
same positions open to Social Workers. We hope the unrelated concerns
with S 1982 can quickly be resolved, and so the Senate
will pass an amended version of that bill, and then the House will pass a
similar bill with an MFT intern stipend provision.
Contact James Morris, PhD, LMFT
Director of Professional and Public Affairs