Coronavirus COVID-19

Lack of action from Tennessee’s state government is preventing local therapists from providing online care at a time when their clients need it more than ever. 

Over the last several weeks, many therapists have moved their practices online to protect clients and employees from the coronavirus, but they have run into some serious problems.

On Friday afternoon, a representative from the Tennessee Department of Health told the Refuge Center, a counseling center in Franklin, that a significant portion of its staff can’t provide therapy via video. 

Executive Director Amy Alexander said that means between 150 and 200 clients will lose access to care. 

“Those clients do not feel safe coming to our offices," she said. "They are going to be without any care as of Monday because of this, which is a huge ethical issue on our end.”

Fully licensed therapists can provide therapy via video in Tennessee, but counselors working towards full licensure—who routinely provide therapy in person—normally can’t. 

The board that oversees licensed therapists asked therapists working towards their license to email an employee at the Tennessee Department of Health and individually ask for permission to switch to video sessions.  

A representative from the health department told the Refuge Center in an email that therapists working towards their license can’t deliver therapy via video because Gov. Bill Lee has not issued an executive order explicitly allowing it. 

It’s not clear if that determination applies only to therapists at the Refuge Center, or all therapists working towards licensure in Tennessee. The language in the email appears to refer to all therapists in that category.  

If the decision does apply generally, Alexander estimated that it could affect thousands of patients across the state. 

Representatives from the Tennessee Department of Health and the Governor’s Office did not return calls asking for clarification.  

California has already issued clear guidance that allows counselors working towards full licensure to provide therapy via video.

The decision prevents about 20% of the Refuge Center's staff from delivering care via video. The center is still seeing a reduced number of clients in person, but Alexander said many patients don’t want to come into the office. 

That’s understandable because the Tennessee Department of Health is now reporting more than 1,200 cases of COVID-19, the disease caused by the coronavirus, in Tennessee.

Although, the true number of cases is likely much higher. Backlogs at labs have delayed reports of new cases, and many people who have the disease may not be able to get tested at all. Six Tennesseans have died from the disease so far.

Terry Casey, a licensed psychologist in Franklin who is consulting with therapists about the ethical and legal issues related to providing virtual care during the coronavirus pandemic, said therapists working toward licensure can represent even larger proportions of employees at other offices.

On Thursday, the Tennessean reported that the commissioners of the Tennessee Department of Mental Health and Substance Abuse and the Department of Children’s Services are asking for people who have earned a master’s degree to consider joining the workforce to bolster access to mental health treatment. 

That’s precisely the group that the Tennessee Department of Health is barring from using video to provide therapy. 

Ironically, many students in master’s level counseling programs—who also routinely provide therapy under some level of supervision from a licensed counselor—can deliver therapy via video, even though they have less training. 

The board overseeing licensed counselors doesn’t regulate students. Lisa Henderson, who teaches at Vanderbilt’s counseling program, said she believes it’s up to universities to determine if therapists can use telehealth.  

Alexander said there are student therapists working at the Refuge Center. All of their universities, with the exception of Belmont University, have allowed students to use telehealth during the coronavirus outbreak.

Henderson said she believes the board overseeing licensed counselors does have the power to grant therapists working towards licensure permission to use telehealth. That board is not scheduled to meet until April 2. 

Earlier this week, many therapists said the regulatory confusion about telehealth was making it difficult to move their practices online. The new communication from the health department provides clarity.

It’s clear that many people will lose access to counseling services. 

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