Can mental health counselors diagnose conditions?

Mental health counselors can diagnose conditions, but the type of conditions they're allowed to diagnose depends on the licenses they hold and where they live. That's because of a concept called diagnostic authority, which describes who's able to diagnose what conditions. And since the mental health field is primarily regulated at the state level, there's a great deal of difference between states in who's allowed to diagnose what.

If you're embarking on the pathway to becoming a mental health counselor, it's important to understand that your day-to-day work will be influenced to a large degree by where you live. Learning how diagnostic authority works ahead of time will enable you to map out your educational and career goals in advance.

Read on to learn more about diagnostic authority and the scope of power for a licensed mental health counselor.

Quick answer: "It depends on the state"

The simple answer to "Can a licensed professional counselor diagnose mental health conditions?" is that most states in the U.S. allow licensed professional counselors (LPC) and licensed mental health counselors (LMHC) to make these determinations within a limited scope. These limitations matter. For example, an LPC couldn't diagnose a neurological disorder; they would need a medical degree for that.

It's also important to remember that the state you live in, the number of clinical hours you've clocked, and your degree of licensure can all make an impact. Still, the fact that LPCs and LMHCs are able to diagnose any mental health conditions at all is a testament to recent changes within the medical field. Historically, this privilege was limited to psychiatrists and psychologists.

State-by-state variability

It's important to remember that certain states have stricter rules than others when it comes to diagnostic authority. For example, in California, you need:

• A 60-credit semester or 90-quarter-units masters degree
• 3,000 hours of clinical experience
• 150 hours of clinical experience at a hospital or community mental health center
• To pass the California Law and Ethics Examination and the National Clinical Mental Health Counseling Examination (NCMHCE)
• To meet a 36-hour continuing education requirement per two year cycle (18 hours for the first cycle).¹

Other states, like Nebraska, operate in a tiered structure,² where only those who've attained the highest levels of licensure are allowed to make diagnoses.

On the other hand, in June of 2024, New York added a formal diagnostic privilege, which let LMHCs who meet higher training and experience thresholds make diagnoses.³ This change is symptomatic of broader changes in the way states have begun to offer greater diagnosing privileges to mental health counselors.

What gives a counselor diagnostic authority?

To get diagnostic authority, you'll typically need to finish a 60-credit master's degree from a Council for Accreditation of Counseling and Related Educational Programs (CACREP) accredited program.⁴ This will include specific coursework in psychopathology, assessment, and diagnostic procedures.

Then, after getting your masters, you'll generally have to pass a national exam, such as the National Clinical Mental Health Counseling Examination (NCMHCE)⁵ or the National Counselor Examination (NCE).⁶

As a post-grad, you'll have to get about 2,000 to 3,000 hours of supervised clinical work experience under your belt before you can make a formal diagnosis on your own.⁷ The exact number of hours you'll need to complete will depend on where you live. During your supervised clinical work, you'll have the opportunity to work on your assessment, diagnosis, and treatment planning skills.

The final step to gaining diagnostic authority is getting licensed with your state's licensing board. Keep in mind, once you're licensed, you'll have to meet continuing education requirements.

Diagnostic tools & process

As a licensed mental health counselor, you'll be able to use several standardized diagnostic tools including:

• The Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders ( DSM-5-TR)
• International Classification of Diseases (ICD-10) codes for billing and documentation 
• Comprehensive mental status examinations
• Biopsychosocial tests⁸

In addition, you'll have the opportunity to do clinical interviews where you can learn more about your patient's medical history and other pertinent details.

During the diagnostic process, you'll commonly collaborate with physicians to ensure underlying medical conditions aren't responsible for your patient's symptoms and to prescribe medication if necessary since that falls outside your scope. This diagnostic process utilizes evidence-based testing techniques, cultural considerations unique to your patient, and ongoing evaluation of diagnostic accuracy.

Remember, it's important for counselors to document their diagnostic reasoning and treatment planning decisions.

Limits & when referral is required

It's important for mental health counselors to recognize the limits of their diagnostic authority. If a client's needs exceeds the scope of your capabilities, you may need to refer them for a specialized evaluation from an appropriate medical professional. These may include:

• A medical condition that coexists with psychiatric symptoms
• Neurocognitive disorders requiring neuropsychological testing
• Court-mandated psychiatric evaluations, which typically require a psychiatrist or psychologist with specialized training

Tips for clients & employers

Employers and individuals looking for a licensed mental health counselor should take the following steps before engaging a therapist:

• Verify that the mental health counselor has an active license by checking your state's professional licensing board website.
• Ask the therapist directly about diagnostic training and supervision experiences.
• Confirm that the therapist is able to work directly with your insurance company⁹

Advance your clinical mental health counseling career

Are you ready to take the next step in your clinical mental health counseling career? Oklahoma City University's online Clinical Mental Health Counseling program gives you the skills you need to meet your state's licensing requirements along with valuable diagnostic and ethical-decision making skills.

Get in touch with an admissions advisor today to learn more about how a degree in Clinical Mental health Counseling can transform your career and life.