A new state law to make mental health counseling available to first responders in Arkansas was one of the main topics of discussion at the 89th annual Arkansas Municipal League conference, which wrapped up a three-day gathering Friday.
Mark Hayes, executive director of the Arkansas Municipal League, Katie Bodenhamer, general manager and benefits counsel, and John Wilkerson, general counsel, gave a presentation and heard from state senators and representatives on Act 537 of 2023 on Wednesday.
Bodenhamer said first responders are the "most chronically exposed to stress" in the line of duty.
An estimated 30% of first responders develop behavioral health conditions like depression and PTSD compared to 20% of the general population, she added.
Some studies show that 37% of first responders have contemplated suicide, which is nearly 10 times more than typical, Bodenhamer explained.
Act 537 was made law this past legislative session in Arkansas, requiring public employers to provide mental health counseling to police officers and firefighters who suffered a traumatic event.
The counseling is limited to 12 visits per year, and employees can choose a provider that specializes in trauma.
The employer will reimburse the employee for any out-of-pocket cost related to the counseling visit, but Bodenhamer said this could be difficult to achieve.
The act requires the city to capture information like the number of employees that have sought care, the amount of work those employees missed and if the employee eventually found other care.
If the visits are not covered by insurance, the city will cover the co-pay or the deductible for the employee. But not all of the costs will be the same across the state, Bodenhamer said.
"Some health plans won't cover these services at all," she said. "Leaving the employers paying a much higher bill charge than others. So the cost of paying for treatment would vary widely."
Each employer also has a specific way of doing things, so first responders would likely have issues with the reporting requirements, Bodenhamer noted.
By submitting documentation for reimbursement, employers would be able to see the name of their employees and identify providers.
"I believe we would be dealing with possible protected health information," Bodenhamer said. "... This in turn could have a chilling effect on those first responders that need access to care the most. They're going to be nervous about doing so because they don't want their employer or supervisor or colleagues to know that they're seeking such care. There's still such a stigma about reaching out for mental health care."
Trauma specialist providers are "far to none" in Arkansas, Bodenhamer added.
The Municipal League hopes to have conversations with key stakeholders, including public safety employees, public employers and licensed mental health professionals to develop a centralized program for mental health services.
The program would include a vast network of providers in the state to provide services in person or virtually.
"Our aim is to collect as many trauma specialists as possible, and we would add providers to the network as requested by those employees as well," Bodenhamer said. "The program would be confidential and treated similar to a health plan or covered entity under HIPAA, thereby protecting employees."
Wilkerson said the passing of the bill was great, but "there's a better way to do this."
What I Need Family Health, a faith-based child and family mental health network, met with representatives from the league earlier in the week to discuss what changes could be made for a better program.
"I'm very optimistic that we're going to continue those dialogues, continue those discussions and come up with something that helps first responders," Wilkerson said. "We're dedicated to getting mental health health care for everybody, but first responders of course is a great way to start to emphasize our mission to get that service out there and get our folks healthy mentally, at all stages of their career."
He also pointed out that firefighters are not required to pass a psychiatric evaluation before being hired like police officers are. To identify the needs of firefighters and first responders, this would be a "good first step."
The Municipal League will research mental health access over the next 18 months before the next legislative session.
Sen. Dan Sullivan, R-Jonesboro, pointed out that the numbers the league currently has are not reflective of Arkansas and different rural and urban demographics, so it is hard to tell what the needs of first responders in the state are.
Sullivan also said that even though there is no cost to the first responder for mental health care, there is a cost to the county or the state.
Wilkerson said the cost would actually defer to the city to cover the 12 counseling sessions.
Rep. Carol Dalby, R-Texarkana, asked if the requirements for licensed professional therapists could be loosened so a volunteer or someone with a bachelor's degree could serve first responders, instead of a master's.
Bodenhamer said the league had a conversation involving these options with What I Need Family Health and discussed the limited number of professionals that are able to deliver the specific care first responders need.
"We will look to see how we can broaden that scope of providers," she said.
Hayes said that this is a "nationwide issue," and the league is working with a couple of national groups in other cities and states that are doing the same thing.
"I'll be going through a meeting later this summer where I will have this exact conversation with my peers and look at what they've built, what they haven't built, what's worked and what hasn't worked and [try] to implement that," he added.
Wilkerson said that due to the shortage of trauma-certified therapists, more conversations are being had as to how to increase certifications and add to the number of professionals able to provide this service.
Hayes added that the University of Arkansas for Medical Sciences has a program for trauma counselors, but there are only a handful available.
Hayes' son suffered from addiction and passed away a couple of years ago, provoking him to get involved in mental health initiatives.
"So when you have people in public safety jobs and they already have a predisposition because of whatever mental health issues they may have it becomes compounded ... So we have to, we have to look at all of those pieces of the puzzle and make sure it's provided across the state in a consistent way, in a way that actually works."
Bodenhamer said another goal is to provide care for volunteer firefighters as well.
Rep. Johnny Rye, R-Trumann, suggested adding more preparation in the mental health fields in state colleges to have more professionals in the future.