Mental Health Month Expert Interview & Advocacy Guide
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“If we’re going to address mental health across all demographic groups and all age groups, then we really need to address some of the outdated policies and regulations we see at the federal and state levels.”
Joel Miller, former Executive Director and Chief Executive Officer of the American Mental Health Counselors Association (AMHCA)
It is a well-established fact that the pandemic has devastated America’s mental health. Before the Covid-19 pandemic, one in five adults in the US had experienced mental illness last year. Since then, the rate has increased to an estimated one in three. Racial and socioeconomic inequality in policy and practice exacerbate the issue further: today, only one in three Black adults with mental health issues receives care.
May is Mental Health Month—and it’s more important than ever. The theme for 2022 is “Together for Mental Health,” and people are encouraged to raise awareness about the importance of mental health, to fight against the stigmas surrounding it, and to lobby for policies that help support it. It’s also an opportunity to recognize the crucial work done by licensed mental health counselors (LMHCs), who stand on the front lines of the mental health crisis.
Mental health is everyone’s concern, and no one should have to face it alone. With greater public awareness, increased interprofessional collaboration, and more equitable healthcare policies, the nation can begin to recover from this pandemic not only physically, but also mentally.
To get a look at the landscape of mental health in America today and how clinical mental health counselors are fighting to improve it, read on.
Meet the Expert: Joel E. Miller, MS Ed
Joel Miller is the former Executive Director and Chief Executive Officer of the American Mental Health Counselors Association (AMHCA), where he led over 7,200 clinical mental health counselors (CMHCs) on the mission to enhance the mental health counseling profession through advocacy, professional development, education and licensing. At that time, he was also the publisher of AMHCA’s Journal of Mental Health Counseling (JMHC) and its Advocate newsletter and served as a member of the AMHCA Foundation Board of Directors. He retired in the summer of 2021 and continues his advocacy work on a volunteer basis.
Miller has held previous positions at the National Association of State Mental Health Program Directors (NASMHPD) and the National Alliance on Mental Illness (NAMI). He has published over 50 articles and reports on behavioral health and healthcare delivery and financing, new delivery models to integrate mental health and physical health, healthcare reform strategies, Medicare and Medicaid policy, health workforce issues, and information technology implementation.
The Role of Clinical Mental Health Counselors
Licensed clinical mental health counselors (CMHCs) assess, diagnose, and treat psychological disorders such as anxiety, depression, and PTSD. They also provide crucial services in treating behavioral health issues such as substance use, addiction, and co-occurring disorders.
CMHCs have carved out a niche in the behavioral health arena through their training and expertise in preventative and wellness services and chronic disease management, focusing on comprehensive health and mental health measures that promote positive lifestyle changes and greater mental and physical health resilience for clients and their families.
“CMHCs are promoting holistic, integrated, evidence-based treatments for several mental health conditions like anxiety and depression,” says Joel Miller, Executive Director and CEO of the American Mental Health Counselors Association (AMHCA). “They are really at the forefront for promoting integrated behavioral healthcare—‘integrated’ meaning working with primary care physicians, specialty providers, and other practitioners to address both medical and psychological issues at the same time.”
The Impact of Covid-19 on Mental Health
Integrated mental health and behavioral health services are particularly important now, as the impacts of the Covid-19 pandemic have cut across several different axes: social isolation, general anxiety, and economic uncertainty.
“Based on our analysis, at any given time last year, between 90 million and 100 million adults suffered from an anxiety or depressive disorder due to the pandemic,” Miller says. “CMHCs are seeing a significant increase in the number of individuals and families that are dealing with pandemic-related depression, anxiety, grief, substance use, and other mental health disorders.”
The pandemic has also exacerbated major societal issues such as systemic racism and discrimination. Bundled together with social isolation and economic distress, a perfect storm has formed in the nation’s mental health, and the full effects haven’t even arrived yet.
“This is going to be a problem beyond what we’ve experienced,” Miller says. “We’re going to see the after-effects of this for many years, and we need to be prepared.”
While at the beginning of the pandemic, the primary mental health care concern was for first responders and medical care providers, the focus has now shifted to the long-term effects on children and the elderly. According to the AMHCA, “nearly 25 percent of Americans (spiking up to 50 percent during some time frames surveyed) over the age of 65, are reporting symptoms of anxiety disorders and depressive disorders as reported by the Census Bureau and CDC.” Similarly, the Kaiser Family Foundation reports that 25 percent of teens have reported worsening mental health issues since the start of the pandemic.
The holistic approach of CMHCs prepares them for situations like this one. CMHCs are trained in career counseling and multicultural counseling and educated in diversity, inclusion, and systemic racism. They’re also attuned to the impacts of ancillary crises, such as the opioid epidemic. As primary mental health providers, CMHCs are one of the nation’s most precious resources in the battle to improve overall mental health, but they’re not being utilized as well as they could be.
Advocacy Issues in Mental Health
There is a wide range of advocacy issues in mental health, but most of them come down to improving access. Access means better ensuring that people have health insurance. It means lowering the barrier to providing telehealth and tele-mental-health services. It means making it easy for people to get the help and services they need. And it also means pushing back on longstanding inequalities: even before the pandemic, minorities in America experienced a disproportionately low level of access to care, whether physical or mental healthcare.
“If we’re going to address mental health across all demographic groups and all age groups, then we really need to address some of the outdated policies and regulations we see at the federal and state level,” Miller says.
One such policy-level issue is Medicare reimbursement. Today, psychiatrists, psychologists, and social workers are reimbursed for Medicare patients’ services; CMHCs are not. Changing this one simple issue could unlock America’s 140,000 mental health counselors and allow them to treat people over the age of 65, widening access for a growing segment of the population.
“We should not be tossing up any barriers for people to seek the care they need,” Miller says. “We don’t have a workforce shortage, per se, whether we’re talking about healthcare or mental healthcare. But we do have an underutilized workforce due to outdated policies or other barriers that have been put in place to prevent providers from treating certain populations, whether that’s Medicare beneficiaries, Medicaid enrollees, or people jumping through a lot of hoops to access care in private health insurance because of limited practitioners in health plan networks.”
In 2021 the Mental Health Access Improvement Act of 2021 was introduced to Congress. While this bill has many components, one of the primary pieces is to expand mental health care coverage for Medicare recipients. It was referred to the Finance Committee in March of 2021. The AMHCA is hopeful that it will see its way out of the committee and into legislation soon. To aid with this, constituents are urged to contact their senators to encourage them to support this bill.
Changing the Mindset on Mental Health
Improving mental health will also require a shift in public perception. This is a constantly evolving field, but the national mindset regarding mental health is still largely trapped in the past.
“Many Americans are hesitant to seek care because of the fear that they’ll be stigmatized,” Miller says. “There’s still a view by many that the reason someone has a mental health issue or is depressed or anxious or suffering from PTSD, is because they lack some personal will or fortitude, rather than all the evidence we have at hand that these are clinical mental healthcare conditions based on assessment and diagnosis. We, as a society, have to get beyond the stigma that still prevents us from addressing mental health disorders.”
Advocacy groups, corporations, government agencies, and even individuals can all play a role in raising the flag of mental health. Awareness campaigns are part of it, but education—both of the general public and policymakers—is critical.
“There have been hundreds of studies on various treatments and therapies by individual providers in the behavioral health sphere that are doing great work,” Miller says. “We need to spotlight those practices so people will feel more comfortable and confident about seeking treatments. And we need to inform policymakers and government agencies that these are good investments to make. When people receive the care they need, it saves a lot of money in the overall healthcare system.”
As the US emerges from the Covid-19 pandemic, it must focus on the mental health issues left in its wake. CMHCs are armed and ready. Policymakers would do well to empower them.
“There’s a major opportunity now,” Miller says. “We can improve quality of care, and we can improve quality of life for individuals.”
Resources for Mental Health and Mental Health Counselors
Mental health is everyone’s concern, and the theories and therapies are constantly evolving. To connect with the broader community of mental health professionals and learn more about advocacy in mental health, check out some of the resources below.
- American Mental Health Counselors Association (AMHCA): The only organization working exclusively for mental health counselors, AMHCA uses its unified voice to help meet the healthcare needs of those that mental health counselors serve and advance the profession.
- National Alliance on Mental Health (NAMI): Started at a kitchen table in 1979, NAMI has grown to become one of the nation’s leading voices on mental health, bringing together an alliance of more than 600 local affiliates who work in communities to raise awareness and provide support and education around mental health.
- Substance Abuse and Mental Health Services Administration (SAMHSA): Housed within the US Department of Health and Human Services (HHS), SAMHSA is an agency that leads public health efforts to advance the behavioral health of the nation and to improve the lives of individuals living with mental and substance use disorders and their families.
- Journal of Mental Health Counseling (JMHC): A quarterly publication, JMHC provides CMHCs and researchers with in-depth research on clinical studies and counseling practice. Published since 1978, JMHC articles address all aspects of practice, theory, professionalism, research, and neuroscience related to clinical mental health counseling.
- Anxiety and Depression Association of America (ADAA): The ADAA is a nonprofit “organization dedicated to the prevention, treatment, and cure of anxiety, depression, and OCD.” They were founded in 1979 and have been connecting people with anxiety and depression to resources and providers since then. Their ultimate goal is to improve the lives of those suffering from depression and anxiety.