Goobernut makes a good point that MSW programs can vary tremendously in terms of the clinical learning completed, but inevitably the first year will conform to very generalist (non-clinical) standards. Also, most of the better programs I've come across, especially the online ones -- like USC -- are incredibly expensive, some nearly in the six figures. I don't think any degree below a doctorate is worth that kind of debt unless you are wealthy enough to forgo the need for loans. For many, in-state public universities are the only economically responsible options.
I'm not sure what you're referring to when you say un-regulated. The LPC licensure standards for accrediting graduate MHC programs are maintained by CACREP just as LMFTs are by COAMFTE and LSWs by the NASW. Echoing the above, LPCs are certainly limited in California and a few other places where they have ample opportunity outside of Medicare (e.g. SNFs) in most states otherwise. Here in Pennsylvania, LMFTs seem to be the most limited from all three, but not significantly.
So this is what I'm talking about when I refer to state standards. In my state, CACREP accreditation is not required for individuals to sit for the LPC or LBP exam (google that license for an interesting rabbit hole). There are educational minimums, but you can graduate from an HR program and still sit for the LPC exam. I am not completely sure if colleges in our state have to be COAMFTE accredited for an individual to sit for the LMFT exam in our state. I used to know when I was researching licenses, but I've since forgotten haha. However, nationally a program has to be CSWE (not NASW) accredited before they can sit for any exam in any state.
Again, I want to be clear, that I'm not saying that the MSW is better than any other masters program. I am saying "buyer beware" at the master's level. It does frustrate me when individuals who have not taken a single MSW class assume they have a working knowledge of what my education entails. When you say, "the first year is very generalist" do you have a concept of what that means in relationship to
every single MSW program ever, or are you just making assumptions? In addition, are you considering variability in relationship to hours required to complete the different masters programs? Mental health programs vary widely by state AND programs within a state. My masters program was 60 hours -- all MSW programs for non-advanced standing students are required to be 60 hours by a national standard. So lets just say, for the sake of argument, that my first year was "very generalist." On average, compared with other public college mental health programs in my state, the mental health programs require about 45 hours, as the CACREP minimums are not adhered to strictly because
it's not required to sit for the exam. So I'm getting an additional 15 hours of graduate instruction that the mental health counseling programs (in my state) are not receiving, which might, in part compensate for that "very generalist" first year. You know making the assumption that I didn't have A SINGLE clinical class that first year. Again, it's not my goal to say, because I'm an MSW that's what everyone should do, I'm saying it was absolutely 100% the right decision to make for me in my situation.
Now are there mental health counseling programs in other states that could have given me a better foundation on therapy skills? I bet so! There is always a better program somewhere. Are there generalist MSW programs in other states that leave people ill-equipped to conduct therapy? Most likely. Are there problems with MSW programs? Yes! Despite the "standardization" MSW programs can and will have vastly different programs. I'm going to assume that most likely goes for CACREP and COMAFTE programs too. All that being said, for someone to say across the board, "all mental health programs prepare you better for therapy than MSW programs" is extremely ignorant and demonstrates the individuals lack of knowledge of the entire mental health industry and master's level programs. I will even say that in reverse, if anyone tells you that MSW programs are always superior, that person should also not be trusted.
In addition, if you can't bill Medicare, you basically cut yourself out of working in certain areas of mental health. One of which was the areas I was highly interested in. I wanted to work with individuals with chronic illnesses, who are often on disability. If my licensure didn't allow me to bill Medicare as a payer source, I'd be ignoring a large part of the population I wanted to work with, and do currently work with right now. It's not just the elderly who use Medicare.