The Immense Value of the Mental Health Technician and How Psychologists Can Support Them

It is no secret that access to mental health services in the United States remains a challenge. The National Alliance on Mental Illness (NAMI) reports that almost half of adults in the United States dealing with mental illness do not receive care, with the lack of access to mental health providers being a major contributing factor. In line with this, a 2023 report from the American Psychological Association (APA) suggests that more than half of psychologists do not have openings for new patients, and of those who maintain a waitlist, close to one third (31%) maintained a waitlist longer than three months.

In the face of this provider shortage, it is incumbent on the mental health system to adapt and remain flexible to novel approaches to care. While a wider discussion could be had surrounding the roles of all levels of clinician (e.g. doctoral vs. master’s-level clinicians), this paper focuses on the role of mental health technicians in alleviating this burden.

Utilizing Mental Health Technicians 

Along with other paraprofessionals (e.g. peer recovery specialists and case managers), mental health technicians (sometimes referred to as psychiatric technicians, health service technicians, or behavioral health technicians) can serve an integral role in extending the reach of mental health professionals but often remain underutilized. While the reasons for this may be vast, one study of mental health providers and technicians found that providers’ lack of confidence and familiarity in technicians’ skills was a barrier to increased utilization. For example, more than 75% of providers in this study  agreed that further education on how to employ technicians could improve their effectiveness.

The central objective of this paper is to provide elementary education on how technicians can be employed in outpatient settings, as other settings (e.g. inpatient or intensive outpatient) already use technicians more readily. As a military psychologist, I typically have the opportunity to work closely with at least two technicians at any given time and view them as an extension of myself. It may surprise some psychologists to learn the wide range of tasks technicians can assist with while being given the proper supervision and training. In my role, technicians are empowered to do tasks such as aid with intakes, run skills groups, provide psychoeducation, administer psychological testing, and document clinical encounters. In concert with individual therapy, technicians often independently run groups covering topics such as mindfulness, values-based interventions, or DBT skills. When a patient walks into our clinic in crisis, technicians are often the first to attempt to alleviate patients’ distress and are trusted to appropriately triage, essentially functioning as a mental health paramedic. Technicians often give workshops to non-mental health professionals on mental health subject matters (e.g. how to support someone in crisis, alleviating mental health stigma). These roles might be expanded based on setting or situation; for example, a technician operating in a deployed military environment may educate service members on sports psychology principles to improve performance or respond to a tragedy by working as a vital member of a disaster mental health response team.  It’s worth noting that other entities readily employ mental health paraprofessionals in a similar fashion, particularly substance abuse facilities and state crisis service response teams. In general, as technicians have possible roles in therapy and assessment, they can be appropriately utilized across settings (e.g. hospital, university counseling center, forensic practice).

Training Mental Health Technicians

Mental health technicians come with a large range of educational backgrounds, and it can be difficult to identify qualifications for hiring. Some may have an undergraduate degree or have completed training programs to become a mental health technician. While these programs vary widely in scope and length, they commonly cover topics such as HIPAA, documentation, pharmacology, and psychiatric disorders. Additionally, multiple certifications exist (e.g., Mental Health Technician Certification or American Association of Psychiatric Technicians). In the military, many technicians are required to maintain additional certification as a substance use counselor. Regardless of background, as technicians do not often enter with formal clinical experience, they will require continued on the job training, something psychologists are particularly well-suited to handle. For example, the military trains technicians using a hands-on approach at their Education and Training Campus (METC), where they receive training in foundational topics such as psychopathology, interviewing skills, and psychological testing. A complete curriculum and competencies list can be found in the military’s training guide for technicians. This publication may serve as a wonderful resource in training technicians more broadly, as it also covers topics such as roles of the technician and supervision considerations. However, regardless of curriculum used, special attention is needed on fundamental topics such as reflective listening, theories of behavior change, and clinical interviewing. In my practice, this training occurs in multiple settings: supervision, formal classroom, or live observation. Further, similar to what often occurs with doctoral trainees, having an individualized developmental training plan can add helpful structure and sustain motivation for growth. As a board certified psychologist, I find the network and webinars offered by the American Board of Professional Psychology (ABPP) to be valuable in garnering ideas for enhancing training, subsequently benefiting those technicians working under my license. 

Supervising Mental Health Technicians

Psychologists are often intimately familiar with supervising doctoral trainees, and I find most of the same rules apply when supervising technicians. Guidelines set by APA serve as a great foundation. Both with individual and group care, I generally ask technicians to shadow my practice before conducting live observation. Live observation is the most direct means of supervision, but audio/video recordings have tremendous values as well. While supervision of technicians is fairly similar to the supervision of a doctoral trainee, there are some differences. As mentioned, I spend more time on the common factors of psychological care and less on any specific treatment modality than I might with a trainee who is learning an evidence-based therapy. Perhaps the biggest difference is an emphasis on teaching technicians their scope of practice; while technicians are wonderfully capable of contributing, they are still operating under a professional’s license. While I certainly welcome input on key determinations such as diagnosis and risk assessment, I provide formal training to technicians on their limits of practice. For example, while I educate technicians on the Diagnostic and Statistical Manual of Mental Disorders (DSM), I also ensure that they do not give their opinions on diagnoses to patients without first consulting me. Regardless of their assigned limits, in my experience, technicians are typically extremely motivated to learn and perform. Beyond clinical skills, psychologists can provide invaluable career mentorship as technicians often aspire to become licensed providers.

For cognitive-behavioral therapists, one tool that may be of particular help in supervising technicians is the Cognitive Therapy Rating Scale (CTRS). A popular supervision tool, this rating scale can be adjusted for working with technicians. Namely, the skills listed in Part I (General Therapeutic Skills) all apply to technician’s practice. While most of these rating scales do not need to be altered, the “Agenda” should include technicians emphasizing their role in the clinical process and when the patient should expect to interact with the provider. The skills in Part II (Conceptualization, Strategy, and Technique) are less relevant, but some can still be used depending on the situation. Namely, “Application of CBT Skills” is certainly applicable for informing technicians what kinds of questions to ask during assessment. Additionally, the homework section can be utilized for technicians running skills or psychoeducation groups.

Some psychologists may understandably be nervous about trusting a paraprofessional to act under their hard-earned licenses. While it’s vital that we train technicians to understand their limits and scope of practice, it’s worth remembering what decades of research have told us about treatment efficacy: factors such as empathy, warmth, and congruence best predict change and growth (Lambert & Barley, 2001; Stamoulos et al., 2016). Psychologists do not hold a monopoly on these qualities, and we can empower paraprofessionals to demonstrate them as well.