Florida: The Birthplace of the Clinical Mental Health Counseling Profession

Hi, my name is Jim Messina and my story begins in 1973 after I got my PhD in Counselor Education from the State University of New York at Buffalo. 12 days after we got married on August 4, 1973, my wife Connie and I moved to Gainesville Florida for my NIMH Post-Doc Fellowship at the University of Florida’s Health Center. We loved Gainesville, loved being in Florida and near the end of my post-doc, I applied and got a job with the federally funded Escambia County Community Mental Health Center in Pensacola, Florida. I was at the Escambia County CMHC from 1974 through 1978. Eventually a friend and colleague from UF got a position at the center as well. This linking up with Nancy Spisso a 1974 graduate of the UF Counselor education program resulted in the following impactful events.

How the Clinical Mental Health Counseling Profession Began in Florida

The earlier incarnation of the American Counseling Association—the American Personnel and Guidance Association (APGA)—did not include a division for counselors who worked exclusively in the mental health field. The letter that sparked the creation of AMHCA appeared in the February 1976 APGA Guidepost Newsletter suggesting that APGA needed a division dedicated to counselors who worked in mental health centers, marriage and family counseling centers, and other community agencies and mental health settings. The day Nancy Spisso and I read that letter, we were counselors at the Escambia County Mental Health Center in Pensacola, Fla. We talked about it and agreed on the spot to make this possibility a reality. I had served as chairof the National Negotiation Committee of the American School Counselors Association (ASCA) from 1972–75 and already had a working relationship with Thelma Daley, the president of APGA at the time, and Chuck Lewis, APGA’s executive director. After our impetuous decision to create the division, Nancy and I contacted Daley and Lewis, who gave us a list of the steps to take. Before any dust could settle, Nancy and I formally applied for creation of a new division and created the name forAMHCA on the spot. The March 1976 Guidepost announced APGA’s intention to form a new division called the American Mental Health Counselors Association (AMHCA).

Overcoming Hurdles

More than 500 respondents to the notice in the Guidepost requested formal development of AMHCA. Unfortunately, at its spring 1976 board meeting, APGA put a hold on developing new divisions for at least a full year. This moratorium spurred Nancy and me to file in Florida to establish AMHCA as a nonprofit corporation, and my wife, Connie, became our first administrator. When the moratorium was lifted in spring 1977, AMHCA’s board asked its 1,500 members whether to continue as a freestanding organization or become an APGA division. When voting closed Dec. 30, 1977, by the slimmest of majorities—51 percent—voting members chose to become an APGA division. A formal application was submitted to APGA, and APGA welcomed AMHCA as a division at its spring 1978 board meeting. The original leaders of AMHCA also came from Florida specifically from UF they were Bill Wiekel the first editor of the AMHCA Journal and 6th President of AMHCA (Weikel, 1985), Jim Hiett the first editor of the AMHCA Newsletter and Gary Seiler the 3rd President of AMHCA was also instrumental in the formation of the association (Seiler & Messina, 1979; Seiler et al., 1990).

Some of AMHCA's Presidents & Past-Presidents

41 Past Presidents with AMHCA retiring executive director, MArk Hamilton at the 2013 Washington D.C. Conference

Formation of the Profession of Clinical Mental Health Counselors

In 1978 at the time of the first AMHCA National Conference held in Columbia Maryland the AMHCA Board of Directors wrote up a blueprint for the advancement of the clinical mental health counseling profession which included the call for National Certification Standards for CMHC’s, State Licensure, Accreditation for CMHC’s, Code of Ethics, Research in CMHC’s clinical work (Messina et al., 1978).

AMHCA Foundational Pillars for the Clinical Mental Health Counseling Profession

To expand upon our attempt to create a new profession of Clinical Mental Health Counseling the Blueprint (Messina et al., 1978) identified the need for a strong foundation to build on. AMHCA was tasked to build a solid professional foundation and so, formulated the Six Foundational Pillars for the Clinical Mental Health Counseling Profession. These foundations were re-emphasized in 1979 under the 11th President of AMHCA Nancy McCormick also from Florida along with Jim Messina (McCormick & Messina, 1987). These foundational pillars comprise the following elements: The professional association, the code of ethics, the national certification process, licensure in each of the fifty states of the U.S., competency-based educational accreditation standards, and the promotion of research in the field of clinical mental health counseling.

Pillar 1: Professional Association: AMHCA became a division of ACA in 1978. In 1998, AMHCA opened an independent national office in Washington with its own executive director.

Pillar 2: Code of Ethics: The first AMHCA Code of Ethics was quickly formulated in 1978 based upon the existing APGA (ACA) code. Since then, additional codes which affect mental health counselors were written and updated for the American Counseling Association, the National Academy of Clinical Mental Health Counselors and the National Board for Certified Counselors.

Pillar 3: Accreditation & Educational Standards: This element was an area of tension between APGA counselor educators and the young AMHCA leadership from the outset. Counselor educators fought efforts to establish accreditation standards for mental health counseling programs. In 1994 under the AMHCA presidency of Roberta Driscoll Marowitz (also from Florida and the 17th President), I agreed to spearhead the effort to identify a means to accredit mental health counselor training programs. Robert and I suggested a competency-based model called the Orlando Model which created the National Commission for Mental Health Counseling (Covin,1994). In 1995, this commission published a monograph titled Mental Health Counseling in the 90’s (Altekruse & Sexton, 1995). This publication reported on national research comprised of fifteen hundred CCMHCs to identify the competencies needed to provide mental health counseling and the competencies needed in counselor education programs.

In 1995, the AMHCA Board of Directors chose to transfer their funding from the National Commission toward efforts to establish its freestanding office in Washington D.C. The effort to accredit Mental Health Counseling programs diminished until the new Mental Health Counseling Training Standards from CACREP were formed fourteen years later, in 2009. Today, over three hundred CACREP programs are accredited for CMHC training. “Community Counseling” was the politically acceptable term that counselor educators adopted in 2001 which inspired 160 of these courses of study in counselor training programs. This development weakened the growth and recognition of the Mental Health Counseling profession and became a contentious issue in 2009 when CACREP eliminated the Community Counseling Standards and replaced them with Clinical Mental Health Counseling Standards. Finally, after thirty-six years, a unified accreditation standard for the training of Mental Health Counselors existed. New standards for CACREP came in 2016 and did not differ greatly from the 2009 version. There are now over 300 graduate programs accredited by CACREP in Clinical Mental Health Counseling (CACREP, 2009).

Pillar 4: Nationally Recognized Certification: As president of AMHCA (1978-1979) under the Blueprint (Messina et al., 1978) my board and I fulfilled the goal of creation of the National Academy of Certified Clinical Mental Health Counselors (NACCMHC) (Messina, 1979). The Academy devised a competency-based assessment model and gained recognition for the first national certification body which required work samples from candidates. The National Academy then allied with the National Board of Certified Counselors (NBCC) making the CCMHC one of a number of advanced certifications open to the 48,000 Nationally Certified Counselors (NCC) (Messina, 1985). Today AMHCA is now promoting a new designation: the AMHCA Diplomate. The Diplomate and Clinical Mental Health Specialist (DCMHS) credentials are based on graduate training, licensure, work experience and advanced training. The attainment of the CCMHC will be one significant prerequisite for such designations.

Pillar 5: State-Recognized Licensure for Independent Practice: In 1980, after the NACCMHC was established, I wrote the legislative language for the first Licensed Mental Health Counselors in Florida. In 1981, this bill passed the state legislature and in 1983 over eighteen-hundred counselors become LMHCs. Today in Florida, over tenthousand LMHCs are practicing along with over elevenhundred MHC residents pursuing full licensure.

Only sixteen states currently feature the term “mental health” in the title of their professional counselors. To add to the identity confusion, thirty-four states use the term “licensed professional counselors” as the legal descriptor which weakens the Mental Health Counselor designation. The American Counseling Association (ACA, 2011) documents the existence of 140,000 Licensed Professional Counselors, 54,785 Licensed Marriage & Family Therapists, and 202,924 Licensed Social Workers in the United States.

Pillar 6: Research into the Effectiveness of Clinical Mental Health Counselors: The Journal of Mental Health Counseling was established in 1976 featuring Bill Weikel as the first editor. The first edition of the Journal appeared in 1979 after AMHCA was formally recognized as an official division of APGA and has been published regularly since that time.

An Unresolved Training & Identity Dilemma

The founders of AMHCA entered the field of clinical behavioral medicine without any educational underpinning for this new professional identity. The founders did not realize that by using the term "clinical mental health counselors" that the professional training would need to emerge from the colleges of education and take its place in the field of behavioral medicine. Current training programs based in education departments were not in a political position to support the concept that their graduates engaged in “clinical mental health work”.

This obstacle has, over the last 40 years, hindered the professionalization of the field of mental health counseling. Finally, however, in 2009 CACREP approved accreditation for clinical mental health counselors with a 60-hour graduate program requirement. To date, more than 300 counselor education programs are now accredited under the CMHC standards. Counselor educators had resisted using the term “clinical mental health counselors,” and indeed, during licensure efforts, even presidents of AMHCA who were also leaders in APGA, the American Association for Counseling and Development (AACD), and the American Counseling Association (ACA) supported the term “licensed professional counselors.” This explains why the field of mental health counseling has a bifurcated naming. For its 50 state licenses, 17 states use “licensed mental health counselor” and the rest use “licensed professional counselor.”

Unfortunately, no theoretical model of counseling has developed with roots in Mental Health Counseling over the last thirty years. In addition, no significant body of research exists to assess and document the effectiveness of Clinical Mental Health Counselors. This fact has weakened the impact of the Clinical Mental Health Counselors among the other mental health professions and is an issue which needs attention by the professional organizations advocating for Clinical Mental Health Counselors.

Since the early 2000’s, AMHCA has focused on working cooperatively with ACA and AAMFT to include CMHCs and MFTs in Medicare Reimbursement. Major legislative initiatives have resulted in Federal recognition of CMHCs for hiring with the Veteran's Administration and the Department of Defense as well as TRICARE reimbursement.

CMHCs now make up over one fifth of the available psychotherapists who are licensed in the United States (approximately 140,000 of the total number of 502,000 psychotherapists).

AMHCA continued to update the AMHCA Code of Ethics with the latest revision in 2021. The code of ethics was developed specifically to address issues specifically pertaining to the practice of clinical mental health counseling in an era of increasingly complex ethical concerns.

FMHCA and AMHCA a 45 Year Working Relationship

In 2013-2014 the then President of FMHCA Steven Giunta became president of AMHCA becoming the fifth Florida resident and FMHCA member to become President of AMHCA. He followed the traditions of Nancy Spisso 1977- 1978, Jim Messina 1978-1979, Nancy McCormick 1987-1988, and Roberta Driscoll Marowitz 1993-1994.

I(Jim Messina) have been involved with the work of FMHCA since 1979 when I was a lobbyist for Mental Health Counselor Licensure and the drafter of language for the new PL 490 Licensure for Mental Health Counselors from 1978-81. I then took a break from professional organization work and went to work to make a living for my family. I came back to a revitalized 2012 FMHCA Annual Conference to present two programs. I went on to become Chairman of FMHCA’s Higher Education Committee 2012-2015. After which I became a member of the FMHCA Board of Directors 2015-2019 and was FMHCA’s Treasurer 2015-2017 and in 2018-2019. In working with FMHCA I supported the outstanding work of its Administrative Executives: Darlene Silvernail followed by both Diana Huambachano and Laura Giraldo. My wife Connie and I have attended the FMHCA Annual Conference yearly since 2012 and I have made presentations at each of them. I firmly believe that FMHCA is still the vital base for the overall Mental Health Counseling Profession, and they have demonstrated this during the COVID-19 times by initiating a series of online webinars which have been more than well received. I have been and will always be an ever-present advocate in AMHCA for its Florida Chapter FMHCA and I am exceedingly proud of the work and accomplishments of FMHCA.

2013 When FMHCA received outstanding state chapter award. Accepted by Darlene SIlvernail.

References

Altekruse, M. K. & Sexton, T.L. (1995), Mental Health Counseling in the 90's: A Research Report for Training and Practice. Tampa, FL: National Commission for Mental Health Counseling - An Orlando Model Monograph Series Monograph. AMHCA Certification Committee. (1979). The Board of Certified Counselors procedures. American Mental Health Counselors Association Journal, 1, 23-28.

AMHCA/NACCMHC Blue Ribbon Task Force. (1980). Standards and procedures for competency based mental health counselor training programs.Unpublished Text. Washington, DC: AMHCA

Council for the Accreditation of Counseling and Related Education Programs (CACREP). (2009), CACREP 2009 Standards, Washington, DC. CACREP

Covin, T. M. (1994). Credentialing - an Orlando model project report. Unpublished Text, Washington, D. C. AMHCA.

McCormick, N. J. & Messina, J. J. (Eds.). (1987). Professionalization - the next agenda for the mental health counseling profession: The proceedings of the 1987 AMHCA think tank. Washington, DC: AMHCA

Messina, J. J., Breasure, J., Jacobson, S., Leymaster, R., Lindenberg, S. & Scelsa, J. (1978). Blueprint for the advancement of the counseling profession. Unpublished text. Washington, DC: AMHCA

Messina, J. J. (1979). Why establish a certification system for professional counselors? A rationale. American Mental Health Counselors Association Journal, 1, 9-22.

Messina, J. J. (1985). The National Academy of Certified Clinical Mental Health Counselors: Creating a new professional identity.

Journal of Counseling and Development, 63, 607-608.

Seiler, G. & Messina, J. J. (1979). Toward professional identity: The dimensions of mental health counseling in perspective. American Mental Health Counselors Association Journal, 1, 3-8.

Seiler, G. Brooks, D. K. & Beck, E. S. (1990). Training standards of the American Mental Health Counselors Association: History, rationale and implication. In G. Seiler (Ed.) The mental health counselor’s sourcebook (pp. 61-77), New York: Human Sciences Press, Inc.

Weikel, W. J. (1985). American Mental Health Counselors Association. Personnel and Guidance Journal, 63, 457-60.