MFTs lose diagnosis fight at Texas Supreme Court

TexasUpdate, February 24, 2017 – The Texas Supreme Court agreed to rehear the case, and ruled that MFTs *are* allowed to independently diagnose. More on the ruling can be found here.

Original post, published June 6, 2016 – Ten days ago, the Texas Supreme Court refused a petition for rehearing from marriage and family therapists (MFTs) seeking to preserve their ability to independently diagnose mental illness. The refusal brings at least a temporary close to a years-long fight between MFTs and the Texas Medical Association, with TMA winning. It could impact other master’s-level professionals not just in Texas but around the country.

As background, back in 2008 the Texas State Board of Examiners of Marriage and Family Therapists — the state’s MFT licensing board — sought to clarify in their rules that MFTs can independently diagnose mental illness. Texas had been one of many states that allowed MFTs to diagnose in practice, but didn’t actually use the word “diagnose” in the MFT scope of practice. When the Texas board sought to add the term to the MFT scope, the Texas Medical Association sued. TMA argued that such a change would need to be made by the state legislature, and that without the legislature specifically including diagnosis in the MFT scope, MFTs actually did not have the authority to diagnose on their own. A trial court sided with TMA, as did a Court of Appeals, and the Texas Supreme Court’s refusal to hear the case means that the ruling from the Court of Appeals stands.

As the court battle had dragged on, there were attempts to solve the problem legislatively. House Bill 3995 would have specifically added diagnosis to the MFT scope of practice in Texas. The bill made it out of committee but never to a floor vote.

What is most troubling here is that, if taken at face value, the Texas courts’ agreement with TMA that diagnosing is the exclusive domain of physicians would mean that tens of thousands of mental health practitioners who currently diagnose independently could lose the ability to do so. This is most concerning for those who do not have the word “diagnose” specifically written into their scope of practice in their state of licensure.

It is not yet clear whether other state medical associations will file similar lawsuits against mental health licensing boards over the diagnosis of mental illness. At a minimum, the case is likely to have a chilling effect on other states seeking to update their scope of practice language to reflect what mental health professionals are actually doing in practice.