Texas board moves to cut cultural training for therapists

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The Texas Behavioral Health Executive Council voted unanimously on Tuesday to give preliminary approval to remove language that requires cultural competency as part of continuing education requirements for several licensed mental health professions.

This move has prompted support from those who are against diversity, equity, and inclusion programs and opposition from mental health providers who say it will hurt the experience for patients, particularly those of color. However, officials with the state’s mental health licensing authority say people have misunderstood their motives, as political discussions surrounding DEI have turned a simple rule change into something more.

Texas requires marriage and family therapists, professional counselors, psychologists, and social workers to complete 24 hours of continuing education to renew their licenses. This must include six hours in ethics and three hours in “cultural diversity or competency.”

The proposed change by the Texas Behavioral Health Executive Council would replace the latter with three hours designed to “ensure competency when providing services to a distinct population, defined as a group of people who share a common attribute, trait, or defining characteristic of the licensee’s choice.”

“It’s about making sure the continuing education rule actually reflects the needs of Texans and the expectations the boards have of their respective professions,” said John Bielamowicz, a public member of the state psychologists’ licensing board. The council voted based on recommendations from its four licensing boards that cover psychologists, social workers, therapists, and professional counselors, said Darrel Spinks, the council’s executive director.

The way the requirement is worded right now suggests mental health providers must be competent in all backgrounds and cultures, a statistic they can’t track or enforce, according to Robert Romig, deputy executive director for the council.

“I am not going to reflect on whether (the confusion around the current rule) has been genuine or even in good faith, but it has led to this long conversation about what does the rule actually require,” he said. “(The proposal is) the staff’s effort to really pin that down and a deep desire to keep the requirement rather than abandon and cede to the voices that were saying it should simply be repelled.”

Melody Marin, an Austin-based psychologist who opposed the decision, said the proposed rule doesn’t necessarily eliminate the cultural diversity requirement but waters it down so that almost any course would satisfy it.

“It allows people to bypass cultural diversity training for continuing education. It de-emphasizes its importance in our field, which is a central and critical aspect of providing ethical and responsible mental health care,” Marin said. “By allowing providers to bypass this education on marginalized communities, we are doing a disservice.”

The aim of diversity and competency programs in mental health training is to equip providers with the knowledge and skills to effectively serve clients from diverse backgrounds, cultures, and genders by understanding and respecting their unique experiences and beliefs.

The need for such programs, according to some providers, is particularly acute in Texas where more than 80% of mental health providers are white, according to 2023 data from the licensing board, but 60% of the state’s population are people of color.

Less than 20% of the state’s 10,440 mental health providers who responded to the 2023 workforce survey said they offer mental health services in a language other than English.

Recent discussion to remove the words “cultural diversity or competency” from required provider training caught the attention of many across the state.

A Change.org petition to protect cultural competency in Texas mental health care has received more than 1,450 signatures, as of Wednesday. Supporters and opponents of the rule change also spoke at Tuesday’s council meeting for more than an hour before the body took a vote.

Brittany Hudson, a licensed professional counselor, told council members that the proposed rule change was unnecessary.

“The proposed language is so broad that it fails to distinguish the requirement from any continuing education on counseling and therapy. The lack of specificity weakens professional guidance instead of strengthening it,” Hudson said.

Phillip Crum, co-founder of the Association for Mental Health, a professional organization for right-leaning mental health providers, applauded the council’s proposed rule change, saying ideology and emotion have taken over their profession for far too long.

“We have had enough, and we want our sanity back. Either we do it today, or the governor’s office will do it for us,” he said. “Our hope is that the four boards and the council recognize what is going on out there in the trenches and openly deal with it. You have that duty to the citizens of Texas.”

In January, Gov. Greg Abbott issued an executive order directing all Texas state agencies to eliminate any forms of DEI policies and to treat all people equally regardless of race. He said in a statement that Texans must reject race-based favoritism or discrimination and allow people to advance based on merit.

“DEI agendas divide us rather than unite us and have no place in the state of Texas,” said Abbott. “These radical policies deviate from constitutional principles and deny diverse thought.”

In 2023, Texas lawmakers passed Senate Bill 17, which took effect last year, prohibiting public universities from having DEI practices. Abbott has also recently suggested expanding the ban to K-12 public schools.

“I think the council is aware of the political pressure out there. There was an executive order from the governor that could, in some people’s opinion, be applied to this. I think they are just trying to get ahead of it,” Marin said.

Bielamowicz said their focus has been on making the rule clear and practical, not on DEI or other controversial topics.

“It has always been about ensuring mental health professionals have the knowledge they need to provide effective care. Every individual who walks through a practitioner’s door, whether rich or poor, urban or rural, no matter your race or religion, deserves to be understood and treated with dignity and care,” he said.

The proposed rule change will go back to the boards for approval before returning to the council for final approval. The next council meeting is scheduled for June.

For 24/7 mental health support in English or Spanish, call the Substance Abuse and Mental Health Services Administration’s free help line at 800-662-4357. You can also reach a trained crisis counselor through the Suicide and Crisis Lifeline by calling or texting 988.

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