Mental Health Advocacy: Psychology Beyond Therapy

Mental Health Advocacy: Psychology Beyond Therapy March 28, 2019

Guest post by Dr. Georgeann Brown

Their stories are with me. Maybe they needed substance abuse treatment, but there were no inpatient programs with openings or that were affordable without insurance. Maybe they needed an intensive treatment program for an eating disorder or PTSD, but there were no programs in the state. Maybe they were facing systemic discrimination because of their race or sexual identity, and this was causing their distress. Maybe their insurance policy did not cover essential services for autism because it was considered too expensive; or maybe they had a severe mental illness that was untreated and unrecognized, so they ended up in the criminal justice system. Maybe there was a waiting list of three months for treatment, but they were severely depressed and needed immediate help. So many stories, so many failures in the system to give people what they needed. I went into the “helping profession” to help, but felt helpless … how could I use these stories for good? How could I do more?

I love being a psychologist and providing therapy. Mental health treatment has been increasingly destigmatized, and it works. Efficacy rates of various treatments are often above and beyond psychotropic medication for many presenting issues. I have worked in a number of settings, including a college counseling center, a Community Mental Health Center, a VA hospital, a substance abuse treatment center, as a group therapist, a free training clinic, and soon will work in a private practice. Having a front row seat in the therapy room is powerful. I have been lucky to witness epiphany moments, great change, and lifesaving/transformative events. But, ask any therapist about the limitations of therapy, and you may get an earful. For me, it is often the inability to change something in a client’s life that is the cause of the distress, something that felt wrong to “accept.” Something they often have little control over, like lack of affordable housing, no social support, living in a home/community where they experienced repeated traumas, being surrounded by family members and peers that abuse substances, the lack of opportunities, dealing with discrimination, not having health insurance, not having access to the “right” treatments for their issues, and much more.

And don’t get me started on the waiting lists. Most people seeking services needed it yesterday, but have to wait for weeks to months to receive them because mental health providers are inundated. This is also occurring at a time where reimbursement rates from insurance policies/Medicaid/Medicare are decreasing for mental health providers (and sometimes they fail to be reimbursed at all), and providers often have to fight and appeal for reimbursement. Many providers are struggling to make a viable living in a time where their services are desperately needed.

While many people visualize psychologists as direct providers with a couch in their offices, psychologists are involved in many areas, including teaching, program development and evaluation, training other professionals, consultation, integrated health care, health psychology, forensics, public policy, many types of research, and advocacy. As experts in mental health research, it is critical that psychologists have a seat at the table when decisions about mental health are being made on a public policy level. Access to quality care and funding for mental health treatment are huge barriers for many individuals. Psychologists have a duty to give voice to the hundreds of stories and faces we see every day, some of whom are able to give voice to their own stories, and some who feel too defeated to do so.

My passion for advocacy has been evolving for some time. I received my dual doctoral degree in clinical-community psychology at the University of South Carolina, consulted with the Department of Alcohol and Other Drug Services (DAODAS) on environmental approaches/public polices to decrease substance abuse, as well as program design/evaluation. I helped start a college counseling center at my alma mater, Transylvania University, and successfully advocated for increased mental services for students when our waiting list kept building.

It was shortly after the Sandy Hook tragedy that I knew I needed to step up to another level. I was horrified that individuals with mental illness were being blamed for the crux of gun violence, but it was also a time when people and politicians began acknowledging the lack of mental health care access in our country, which was at a crisis level. Many of the people making the decisions had little knowledge of mental health research or what was actually going on. They often did not understand the difference between a psychologist and “a mind reader.” I recognized that as a psychologist, I had to step up and be a louder voice in the conversation. Decisions were going to be made whether or not I was at the table.

Serendipitously, I found the opportunity and inspiration to delve deeper into mental health advocacy through the Kentucky Psychological Association (KPA). I was inspired by KPA member and psychologist Dr. Sheila Schuster. Previously a child psychologist, she is now recognized as one of the most passionate and successful mental health advocates and lobbyists in the state. Dr. Lisa Willner, KPA executive director, also recognized the need for growing KPA’s advocacy efforts years ago. Understanding how important it is for psychologists to be at the table, she recently was elected as a state representative. In 2013, I was asked to be KPA’s Advocacy Chair (a volunteer role) and I immediately accepted, even though I had no idea what it entailed. The learning curve was steep, and I’m still learning, but I’m proud of the efforts put forth by many members in our organization.

In the past six years, I have been involved in organizing advocacy activities/events on the state and federal level for Kentucky psychologists, including our annual Psychology Day at the state Capitol and organizing Capitol Hill visits for KPA’s leadership. I assist in sending action alerts to the KPA membership; serve on the legislative committee where we track all legislation related to our priorities and actively support/oppose some pieces of legislation; serve on a Political Action Committee; help develop relationships with legislators; and serve as the Federal Advocacy Coordinator for KPA to our national organization, The American Psychological Association.

What I have learned about advocacy is the importance of understanding the political process, building relationships with legislators, teaming up with other organizations who share the same goals, and knowing when to show up. Many politicians are not experts on mental health, so it is also a process of informing them of the issues and what mental health providers do (and they love to make jokes about politicians needing treatment). There are hundreds of bills, and they may not be aware of all of them. There are also quite a few surprises. Sometimes a politician I may disagree with politically 95 percent of the time ends up being a strong ally for mental health or a particular bill we need sponsored.

It also requires a lot of patience. I have been gravely disappointed when progress has been slow or seems to have regressed. Other times, we are advocating for a bill when something we wanted in the bill gets taken out; vice versa, additional language sometimes gets added to bills that we do not want. However, Dr. Schuster advises to celebrate “every advocacy victory, no matter how small” because the journey is a marathon, not a sprint. We plant seeds, and sometimes it takes years to accomplish what we set out to do. And sometimes, there’s a victory.

Mental health advocacy takes many voices, and not just psychologists’ voices. Some of the most effective advocates are self-advocating or representing a family member. With the advocacy of multiple groups/individuals including KPA (it takes many voices), I have been pleased to bear witness to legislation giving parity to mental health/substance abuse treatment through insurance plans, legislation to establish evidence-based treatment recommendation for substance abuse, maintaining mental health funding for Community Mental Health Centers and other agencies, increasing funding for substance abuse treatment, increasing access to care by coverage of telehealth, establishing Tim’s Law to break the cycle of repeat hospitalizations for the severely mentally ill population, the adoption of the trauma-informed approach in Kentucky schools, improvements to the Medicaid appeals process, clarifying “duty to warn” practices for psychologists in Kentucky … just to name a few.

Mental Health advocacy is never done, and it’s not a box to be checked off. It is essential that we improve access to quality, affordable mental healthcare for everyone, and protect the Medicaid expansion in Kentucky. Despite improvements in parity, mental health and substance abuse treatments are in danger of not being considered as “essential healthcare benefits” in some insurance plans. I would like to see reimbursement rates for providers that allow for a sustainable living. I would like to see our schools and communities prioritize policies that promote good mental health and use evidence-based approaches. I advocate for policies that promote social justice for all individuals. There is a lot of work to do, and we need many voices. Please consider adding yours.

Here are some great websites from some of my colleagues/Kentucky networks for more information about mental health advocacy:

https://advocacyactionnetwork.wildapricot.org

http://davidsusman.com

https://www.kpa.org/why-advovacy-is-important

http://namiky.org

Georgeann Stamper Brown, Ph.D., is currently the volunteer Federal Advocacy Coordinator for the Kentucky Psychological Association (KPA). She is also involved on KPA’s Legislative Committee, the KPA-PAC committee; and has helped plan the past six annual KPA Psychology Days in Frankfort and past four annual KPA Capitol Hill visits, and frequent advocacy presenter for KPA. She worked at Transylvania University’s Counseling Center from 2007 to 2016, where she started the on-campus counseling center. Soon, she will join a new private practice in Lexington, Ky., to continue clinical work in addition to advocacy pursuits.  She completed her undergraduate degree with a major in psychology at Transylvania University and completed her master’s and doctorate in clinical-community psychology at the University of South Carolina in 2003 and 2006, respectively. She resides in Lexington with her spouse, two children and their dog.   

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