When are health professionals ethically obligated to engage in public advocacy?

Wynia, M. K., Peek, M. E., & Heisler, M. (2025).

The Lancet.

https://doi.org/10.1016/s0140-6736(25)01378-9

Here is how it opens:

In 2025 the US Federal Government has attacked scientific research and evidence, medical expertise, public health, health equity, and human rights. At this challenging time, many health professionals are uncertain about what is in their power to change, and whether or how they may be ethically obligated to engage in public advocacy.

While clinical advocacy on behalf of individual patients is a long-standing core value across health professions, clinicians also have public advocacy obligations. For health professionals, one definition of public advocacy is taking actions to promote “social, economic, educational, and political changes that ameliorate suffering and contribute to human well-being” that are identified through “professional work and expertise”. Public advocacy obligations are in the Physician Charter, endorsed by 109 organisations internationally, and the American Medical Association’s Declaration of Professional Responsibility, endorsed by almost 100 US medical associations. Nearly two-thirds of US medical schools’ curricula include teaching on public advocacy skills.

Here are some thoughts:

Psychologists have an ethical duty to advocate against policies harming mental health and human rights, grounded in principles of justice and beneficence. When witnessing harm directly, possessing relevant expertise, or being positioned to create change—such as documenting trauma in marginalized groups or analyzing mental health impacts of funding cuts—advocacy becomes imperative. While fears of backlash exist, collective action through professional organizations can reduce risks. Psychologists must leverage their unique skills in behavioral science and public trust to combat misinformation and promote evidence-based policies. Advocacy isn't optional—it's core to psychology's mission of reducing suffering and upholding equity, especially amid growing threats to vulnerable populations. 

Psychology Trainees’ & Professionals’ Perceived Importance of & Engagement in Advocacy for Marginalized Groups

Forestieri, K. J., et al. (2024).

Professional Psychology, Research and Practice.

https://doi.org/10.1037/pro0000543

Abstract

The recent sociopolitical climate necessitates psychology professionals advocating for their clients under a social justice framework. However, research on the prevalence of advocacy by psychology trainees and professionals for marginalized groups (e.g., people of color, immigrants, refugees, women, lesbian, gay, bisexual, transgender, questioning, intersex, asexual+ individuals, and unhoused individuals) and causes (e.g., police-community relations, and criminal justice reform) is sparse. Data for the present study were gathered as part of a larger research project conducted in 2018. A total of 165 participants began the survey, with only 104 completing all questions. The study aimed to understand psychology trainees’ and professionals’ attitude toward advocacy for others, frequency and type of advocacy behaviors that they engage in, and potential barriers to advocacy work. Results showed a large discrepancy between participants’ highly self-reported beliefs in the importance of advocacy and low actual engagement in advocacy behaviors. Contrary to the original hypotheses, barriers to advocacy were not the most salient predictors of lack of engagement in advocacy; instead, it appears that a less positive attitude toward advocacy and conservative political affiliation may play more of an integral role. Implications for remedying this discrepancy among psychology trainees and professionals are discussed (e.g., training), as well as strengths and limitations of the present study.

Public Significance Statement

Psychology trainees and professionals endorse advocacy for marginalized groups as important, but infrequently engage in such behaviors. A less positive attitude toward advocacy and conservative political affiliation may play more of an integral role in predicting advocacy behavior.

Here are some thoughts:

The recent sociopolitical climate has highlighted the need for psychology professionals to advocate for their clients within a social justice framework. However, research on the prevalence of advocacy by psychology trainees and professionals for marginalized groups and causes is limited. This study, conducted in 2018, aimed to understand psychology trainees' and professionals' attitudes toward advocacy, their engagement in advocacy behaviors, and potential barriers to advocacy work.

The study revealed a significant discrepancy between participants' self-reported beliefs in the importance of advocacy and their actual engagement in advocacy behaviors. Contrary to initial hypotheses, barriers to advocacy were not the most salient predictors of lack of engagement. Instead, a less positive attitude toward advocacy and conservative political affiliation appeared to play a more significant role.

Across all groups and causes, working directly on changing legislative policies was the least endorsed actionable step, while attending protests and donating money were among the most endorsed behaviors. Educating oneself and others were the most frequently reported educational steps. The study found that barriers such as lack of awareness of issues and disinterest in advocacy resulted in less participation in advocacy behaviors.

Interestingly, political affiliation emerged as a significant predictor of engagement in advocacy for certain groups, with more conservative-identifying participants less likely to advocate for people of color, women's issues, and LGBTQIA+ individuals. The study suggests that low levels of engagement in advocacy may be due to training deficits, lack of time, a micro-level focus on clients rather than systems, and insufficient knowledge about advocacy opportunities and methods.

The researchers propose that addressing advocacy training in psychology programs could help bolster engagement. This includes exploring political affiliation in training programs to understand the discrepancy in advocacy engagement between self-identifying liberals and conservatives, and framing advocacy from an empathetic, social justice lens. The study acknowledges limitations, including the timing of data collection in 2018, prior to recent significant sociopolitical events.

Navigating the Challenges of Conservators or Adult Guardians in Psychiatric Practice

Dike, C. C. (2024).

Psychiatric News, 59(07).

https://doi.org/10.1176/appi.pn.2024.07.7.48

An inpatient psychiatrist and her team are caught in a quandary. A hospitalized patient with chronic respiratory compromise is demanding to receive a COVID vaccination, but his conservator of person, also known as adult guardian in some states, is refusing to consent to the vaccination. Staff members suspect that the conservator’s refusal to approve the vaccination was driven by the conservator’s religious and spiritual beliefs. They also believe the patient’s best interest will be better served by getting the vaccination, given the patient’s underlying serious medical condition.

A different scenario is playing out in a sister hospital. A medically compromised patient admitted for psychiatric treatment is refusing the recommended COVID vaccination, but her conservator is insisting the psychiatrist should proceed with the injection, including holding or strapping down the patient to administer it. The psychiatrist is reluctant to do so over the patient’s objection but is worried about disregarding the request of the patient’s conservator.

Examples such as these—in which conserved patients’ requests are disapproved by their conservator—are common in psychiatric practice. Areas of conflicts include refusal to provide funds for cigarettes, certain food items, phones or computers, and alcoholic beverages and decisions regarding where to live. Often, the treating psychiatrist is caught in the middle.

The entire article is here.

Here are some thoughts:

This article wrestles with the ethical tightrope mental health professionals walk when treating patients with conservators. Balancing patient autonomy and their best interests is complex. While conservators are meant to protect those unable to care for themselves, the system can infringe on patient choice. The article emphasizes respecting patients' wishes whenever possible, and that mental health professionals must be vigilant for potential conservator abuse.  Ultimately, mental health professionals must act as patient advocates, focusing on their well-being (and in court if necessary). Even when court decisions go against the patient's wishes, the mental health professional's ethical duty remains - to support the patient through the situation (aka patient autonomy).

Becoming a culturally responsive and socially just clinical supervisor

Spowart, J. K. P., & Robertson, S. E. (2024).

Canadian Psychology / Psychologie canadienne.

Advance online publication. 

https://doi.org/10.1037/cap0000388

Abstract

Clinical supervisors must learn to attend to and address a breadth of cultural, diversity and social justice factors and dynamics when providing supervision. Developing these abilities does not occur automatically; rather, training in clinical supervision has a significant impact on supervisors’ development. Unfortunately, there is relatively limited research on how supervisors develop these same ways of being and working. Therefore, the purpose of this study was to explore how counselling psychology doctoral students understand their experiences of becoming culturally responsive and socially just clinical supervisors. Findings from this study detail the developmental experiences of novice supervisors and highlight training needs, educational interventions, progression of competencies and experiences with counselling supervisees and supervisors-of-supervision. Implications for theories of supervisor development and approaches in graduate training programmes are discussed along side of calls to more robustly integrate culturally responsive and socially just training and approaches throughout the field of clinical supervision.

Impact Statement

Clinical supervisors are responsible for attending to and addressing issues of culture, diversity and advocacy so that they may better prepare new mental health practitioners to support populations from diverse backgrounds. Little is known about the training experiences and needs of clinical supervisors as they learn to carry out this important work. The present study addresses this gap in the literature by highlighting the experiences of supervisors-in-training and provides tangible education and training recommendations to help ensure more culturally responsive and socially just clinical supervision practices.

Here are two excerpts:

From the Introduction:

Clinical supervision is a distinct area of practice in psychology (Arthur & Collins, 2015). Historically, it was assumed that becoming a clinical supervisor was "a natural outgrowth of the acquisition of [counselling] experience" (Thériault & Gazzola, 2019, p. 155). Currently, it is recognised that becoming a clinical supervisor is a unique, complex and multifaceted developmental process in which distinct skills, knowledge, awareness and attitudes must be cultivated (Falender & Shafranske, 2017; Thériault & Gazzola, 2019). Adding to this, providing supervision alone does not guarantee supervisor development or the acquisition of clinical supervision competencies (Falender & Shafranske, 2004; C. E. Watkins, 2012). Rather, training in clinical supervision has been shown to have a significant impact on development as a supervisor (Christofferson et al., 2023; Gazzola & De Stefano, 2016; Milne et al., 2011). Individuals may obtain such training either during graduate school or through postgraduate professional development.

From the Discussion:

To begin, the importance of MCSJ (Multicultural Social Justice) factors and dynamics served as a context for the doctoral student SITs' (Supervisors In Training) experiences. As if it were a lens through which they understood their practice and development, their focus on MCSJ factors and dynamics was not something that could be divorced from their experiences. As they were transitioning into and taking on their new role, the SITS experienced some initial difficulties. At first, they felt they needed a road map. They did not have a clear understanding of how they could provide CRSJ supervision and wished they had received more initial guidance. Some of these initial difficulties abated as the doctoral student SITS were impacted by a number of supports to their development.

Are Illiberal Acts Unethical? APA’s Ethics Code and the Protection of Free Speech

O'Donohue, W., & Fisher, J. E. (2022). 

American Psychologist, 77(8), 875–886.

https://doi.org/10.1037/amp0000995

Abstract

The American Psychological Association’s (APA’s) Ethical Principles of Psychologists and Code of Conduct (American Psychological Association, 2017b; hereinafter referred to as the Ethics Code) does not contain an enforceable standard regarding psychologists’ role in either honoring or protecting the free speech of others, or ensuring that their own free speech is protected, including an important corollary of free speech, the protection of academic freedom. Illiberal acts illegitimately restrict civil liberties. We argue that the ethics of illiberal acts have not been adequately scrutinized in the Ethics Code. Psychologists require free speech to properly enact their roles as scientists as well as professionals who wish to advocate for their clients and students to enhance social justice. This article delineates criteria for what ought to be included in the Ethics Code, argues that ethical issues regarding the protection of free speech rights meet these criteria, and proposes language to be added to the Ethics Code.

Impact Statement

Freedom of speech is a fundamental civil right and currently has come under threat. Psychologists can only perform their duties as scientists, educators, or practitioners if they are not censored or fear censorship. The American Psychological Association’s (APA’s) Ethics Code contains no enforceable ethical standard to protect freedom of speech for psychologists. This article examines the ethics of free speech and argues for amending the APA Ethics Code to more clearly delineate psychologists’ rights and duties regarding free speech. This article argues that such protection is an ethical matter and for specific language to be included in the Ethics Code.

Conclusions

Free speech is central not only within the political sphere but also for the proper functioning of scholars and educators. Unfortunately, the ethics of free speech are not properly explicated in the current version of the American Psychological Association’s Ethics Code and this is particularly concerning given data that indicate a waning appreciation and protection of free speech in a variety of contexts. This article argues for fulsome protection of free speech rights by the inclusion of a clear and well-articulated statement in the Ethics Code of the psychologist’s duties related to free speech. Psychologists are committed to social justice and there can be no social justice without free speech.

A pdf is paywalled here.

Bringing back professionalism in the practice of law is key

Samuel C. Stretton
The Legal Intelligencer
Originally published October 4, 2018

Here is an excerpt:

All lawyers ought to review the Pennsylvania Rules of Civility. Although these rules do not have disciplinary consequences, they set forth the aspirations all lawyers should achieve in the legal profession. Perhaps lawyers have to understand what it means to be a professional. To have the privilege of being admitted to practice law in a state is a wonderful opportunity. The lawyer being admitted becomes part of the legal profession which has a long and historic presence. The legal profession can take great credit for the evolving law and for the democratic institutions which populate this country. Lawyers through vigorous advocacy and through much involvement in the community and in the political offices have help to create a society by law where fairness and justice are the ideals. Once admitted to practice, each and every lawyer becomes part of this wonderful profession and has a duty to uphold the ideals not only in terms of representing clients as vigorously and as honestly as they can, but also in terms of insuring involvement in the community and in society. Each generation of lawyers help to reinterpret the constitution and make it a living document to adjust to the modern problems of every generation. It is a wonderful and great honor to be part of this profession and perhaps one of the greatest privileges any lawyer can have. This privilege allows a lawyer to participate fully in the third branch of public. This privilege allows a lawyer to become part of the public life of their community and of the country in terms of representation and in terms of legal and judicial changes.

The information is here.

Data Citizens: Why We All Care About Data Ethics

Caitlin McDonald
InfoQ.com
Originally posted July 4, 2018

Key Takeaways

• Data citizens are impacted by the models, methods, and algorithms created by data scientists, but they have limited agency to affect the tools which are acting on them.

• Data science ethics can draw on the conceptual frameworks in existing fields for guidance on how to approach ethical questions--specifically, in this case, civics.

• Data scientists are also data citizens. They are acted upon by the tools of data science as well as building them. It is often where these roles collide that people have the best understanding of the importance of developing ethical systems.

• One model for ensuring the rights of data citizens could be seeking the same level of transparency for ethical practices in data science that there are for lawyers and legislators.

• As with other ethical movements before, like seeking greater environmental protection or fairer working conditions, implementing new rights and responsibilities at scale will take a great deal of lobbying and advocacy.

The information is here.

Rather than being free of values, good science is transparent about them

Kevin Elliott
The Conversation
Originally published November 8, 2017

Scientists these days face a conundrum. As Americans are buffeted by accounts of fake news, alternative facts and deceptive social media campaigns, how can researchers and their scientific expertise contribute meaningfully to the conversation?

There is a common perception that science is a matter of hard facts and that it can and should remain insulated from the social and political interests that permeate the rest of society. Nevertheless, many historians, philosophers and sociologists who study the practice of science have come to the conclusion that trying to kick values out of science risks throwing the baby out with the bathwater.

Ethical and social values – like the desire to promote economic development, public health or environmental protection – often play integral roles in scientific research. By acknowledging this, scientists might seem to give away their authority as a defense against the flood of misleading, inaccurate information that surrounds us. But I argue in my book “A Tapestry of Values: An Introduction to Values in Science” that if scientists take appropriate steps to manage and communicate about their values, they can promote a more realistic view of science as both value-laden and reliable.

The article is here.

Cook County Sheriff Dart: Jailing poor, mentally ill is unjust

Madhu Krishnamurthy
Daily Herald
Originally posted April 6, 2016

The numbers of mentally ill people housed in the nation's prisons and jails are staggering, Cook County Sheriff Tom Dart says, and many of them shouldn't be there.

Dart, speaking Wednesday at Elgin Community College, has led a campaign to reduce what he calls the unjust incarceration of the poor and mentally ill. He's been recognized by health advocacy organizations for trying to change the criminal justice system, which perpetuates a revolving door at jails. His presentation was part of the college's Humanities Center Speakers series.

The article is here.

What the FDA’s approval of “pink Viagra” tells us about the problems with drug regulation

by Julia Belluz
The Vox
Originally published on September 18, 2015

Here is an excerpt:

The episode raised hard questions about the changes wrought by the patient movement and other reforms that have followed. There were excellent reasons for the FDA to bring HIV-positive patients into its deliberations in the 1980s — they provided a crucial perspective that the agency's in-house scientists and officials lacked. But these days, some critics argue that those listening sessions have been hijacked by drug companies. As I found in my reporting, the patients who had lobbied the FDA to approve pink Viagra were often sponsored by the drug's manufacturer.

"The role of pharma in patient groups in the contemporary era is entirely fraught," says Yale Law School's Gregg Gonsalves, who was once one of those HIV activists in the 1980s. "[Drug companies] learned from the early days of the AIDS epidemic that the patient community could be useful allies, and they've poured money into patient groups here in the US and around the world."

So is the FDA approving drugs too easily? Has the push for speed and efficiency now undermined the agency's ability to protect public health? To find out, I took a closer look at the approval of "pink Viagra," which offers a vivid illustration of just how much the FDA has transformed over time — and why those changes worry many experts.

The entire article is here.

Getting mental health services can be hard, despite law requiring parity

By Lisa Gillespie
The Washington Post
Originally published January 5, 2015

Even though more Americans than before have access to health insurance because of the Affordable Care Act, getting mental health services can still be challenging.

A report released in November concludes that despite a 2008 mental health parity law, some state exchange health plans may have a way to go to even the playing field between mental and physical benefits. The report, released by the advocacy group Mental Health America, was paid for by Takeda Pharmaceuticals U.S.A. and Lundbeck U.S.A., a pharmaceutical company that specializes in neurology and psychiatric treatments.

The report listed the states with the lowest prevalence of mental illness and the highest rates of access to care as Massachusetts, Vermont, Maine, North Dakota and Delaware. Those with the highest prevalence of mental illness and most limited access are Arizona, Mississippi, Nevada, Washington and Louisiana.

The entire article is here.

The Ethics of an Ordinary Doctor

William T. Branch Jr.
Article first published online: 9 JAN 2014

DOI: 10.1002/hast.250

Here is an excerpt:

Bioethicists have proposed that an emphasis on autonomy and justice constitutes the important turn in contemporary medical ethics. As an ordinary doctor involved in the care of sick patients, I experienced a different turn: the shift from scientific hubris toward more compassionate care.

The future will likely bring an emphasis on limiting the costs of health care, related in ethics to distributive justice. But what do we learn about justice from being at the patient's bedside? We will not learn to abandon being our individual patients’ advocates. As in the case above, we witness their suffering. We participate. Our responsibility is to care for them.

The entire article is here.

An Imperative for Change: Access to Psychological Services for Canada

Canadian Psychological Association
Press Release
May 2013

To mark the one year anniversary of Canada’s first mental health strategy next week, the Canadian Psychological Association (CPA) is releasing an independent report by a group of health economists. The report ‘An Imperative for Change’ states that the delivery of mental health services can be characterized as a silent crisis and provides a business case, and proposes models, for improved access to psychological services.

“One of the great challenges when it comes to caring for the mental health of Canadians is the significant barriers to accessing mental health services. Despite the fact that one in five Canadians will experience a mental health problem in a given year, only one-third will receive the help they need. We have psychological treatments that work, and experts trained to deliver them. Yet the services of psychologists are not funded by provincial health insurance plans, which make them inaccessible to many with modest incomes or no insurance. Publically funded services, when available, are often in short supply and wait lists are long. The cost of mental illness in Canada is estimated at 51 billion dollars annually so we need to act now and be innovative in our approach,” said Dr. Jennifer Frain, President of the CPA.

“Last year we were very pleased that Canada’s national mental health strategy called for increased access to evidence-based psychotherapies by service providers qualified to deliver them. In response, we commissioned a report to look at how this can be achieved. The report proposes and costs out four models that could be implemented and adapted here,” said Dr. Karen Cohen, Chief Executive Officer of the CPA.

“Canada has fallen behind other countries such as the United Kingdom, Australia, the Netherlands, and Finland who have launched mental health initiatives which include covering the services of psychologists through public health systems. These initiatives are proving both cost and clinically effective. Analysis of research in the United Kingdom found that substantial returns on investments could be achieved in the early detection and treatment of common mental health conditions such as depression. These models respond to the recommendations of the mental health strategy. By implementing them, we can move from conversation to action,” added Dr. Cohen.

Models for Canada

Adapt the United Kingdom’s publicly funded model for Improved Access to Psychological Therapies (IAPT) in the provinces and territories. Under this program psychologists and low intensity therapists deliver care for people with the most common mental health problems:

• depression and anxiety.
• Integrate psychologists on primary care teams so that mental health problems are addressed at the right time, in the right place, by the right provider.
• Include psychologists on specialist care teams in secondary and tertiary care facilities for health and mental health conditions.
• Expand private insurance coverage and promote employer support for psychological services
• Canadian employers could expect to recover $6 to $7 billion annually with attention to prevention, early identification and treatment of mental health problems among their workforces.

Read “An Imperative for Change: Access to Psychological Services for Canada” here

The Ethics of Influencing the Political Process

Stephen A. Ragusea, PsyD, ABPP

Chair, Florida State Psychological Association Ethics Advisory Committee

Ethics Corner

Summer 2012

In the last edition of the Florida Psychologist, I wrote an article about how psychologists often hesitate to encourage their patients to influence the political process. Psychologists frequently fear to unfairly utilize powerful relationships, somehow pushing patients into action they would not normally take. 

However, psychologists also too often personally and professionally avoid being involved with the political process.  To some, this avoidance is incomprehensible and frustrating.  Based on my experience, psychologists usually stay out of the political process for the most common of reasons, they just feel too busy in their daily lives to take the time to participate in the fray.  And, some psychologists seem to feel as if they would be sullied somehow by wrestling in the mud of the political arena.  Of course, some folks are just plain lazy and engage is what some writers have called, “social loafing.”   My ethics chair colleague in Pennsylvania, Dr. John Gavazzi, once wrote, “Social loafing is the tendency for people to expend less effort on a given task when working in groups than when working alone.  It is easier to loaf when individual contributions are not evaluated and when the individual can rationalize that someone else will ‘pull the weight.’”

In any case, because of social loafing and a variety of other reasons, psychologists seem to avoid involvement in the political process more often that do some other professionals.   For example, based on data from a variety of sources nurses are much more involved in political and legislative matters than are we.  Nurses and physicians also contribute substantially more money to lobbying efforts than do psychologists.  These tendencies of ours endure despite the fact that we are acting against our own best interests.  We need to do much better or, very soon I fear, we risk professional oblivion.

From my perspective in the catbird’s seat, I also think there are more lofty reasons for psychologists to be actively involved in the democratic process.  I believe psychologists have an ethical responsibility to be involved with influencing the political and legal process of our society.  It is what we owe in service to our culture and our patients.

The APA Ethical Standards actually address this topic in the preamble.  Specifically, the preamble declares the following.  (Italics are added by this writer for emphasis.)

“Psychologists are committed to increasing scientific and professional knowledge of behavior and people’s understanding of themselves and others and to the use of such knowledge to improve the condition of individuals, organizations, and society…. They strive to help the public in developing informed judgments and choices concerning human behavior.  In doing so, they perform many roles, such as researcher, educator, diagnostician, therapist, supervisor, consultant, administrator, social interventionist….”

Therefore, beyond our own self-interest, based on our ethical standards, we are not only free to participate in the political process through political giving and social activism, but we actually have an affirmative ethical responsibility to do so.  Again, quoting John Gavazzi’s article, “Although no law, statute, or ethical code mandates ‘Thou shall participate in the political process,’ psychologists are responsible to promote our patients’ welfare.  Enhancing patient welfare can occur at the community and systems level, not just within the confines of our offices.  The goals of political advocacy are noble and worthy.”

Amen, brother John.  Is anybody out there listening?  Is anybody out there acting?

References

American Psychological Association. (2002). Ethical principles of psychologists and code of conduct. American Psychologist,Vol. 57, 1060-1073. 

Gavazzi, J. D. (2006). Legislative Efforts and Positive Ethics: Say what? The Pennsylvania Psychologist, February Quarterly, 2, 6.

If you have specific suggestions for topics to be covered in The Ethics Corner, please e-mail me with your suggestions.  My e-mail address is ragusea@aol.com. 

Identifying Perceived Personal Barriers to Public Policy Advocacy Within Psychology

The authors are Amy E. Heinowitz, Kelly R. Brown, Leah C. Langsam, Steven J. Arcidiacono, Paige L. Baker, Nadimeh H. Badaan, Nancy I. Zlatkin, & Ralph E. (Gene) Cash.
Professional Psychology: Research & Practice

There is an urgent and growing need for professional and social justice advocacy within the psychological community (Ratts & Hutchins, 2009; Kiselica & Robinson, 2001; Ratts, D'Andrea, & Arredondo, 2004; Toporek, Gerstein, Fouad, Roysircar, & Israel, 2006).  Psychology, as a field as well as a profession, aims to reduce negative treatment outcomes and to enhance personal wellbeing through research and practice (Council of Specialties in Professional Psychology, 2009; American Psychological Association, 2010b).  The viability of the profession and its capacity to provide fundamental and essential services are directly affected by legislation and regulations (Barnett, 2004).  As a result, advocacy is integral to the roles of all psychologists, with the future and success of their profession and careers depending on their incorporation of advocacy into their professional identity (Burney et al., 2009).

(cut)

The findings presented in this study carry valuable implications for efforts aimed at enhancing participation in advocacy. Lating et al. (2009) suggest that the continued separation of professional and educational agendas in the training of psychologists may contribute to the profession's deficient involvement in advocacy. Specifically, psychology is the only major health profession to maintain an academic training model despite the creation of professional training programs. The lack of advocacy training appears to contribute to the development and maintenance of barriers such as lack of awareness of and lack of perceived competence in discussing public policy issues.

Efforts to increase psychologists' participation in public policy advocacy must begin early on and be integrated throughout their curricula. Pertinent public policy issues fit well into courses on ethics, diversity, assessment, and even intervention. Similarly, discussion about and training in the advocacy role may be reinforced through clinical training and supervision. In addition to incorporated teaching lessons, specific coursework in public policy advocacy might aid students in developing skills used to advocate, while increasing comfort, enhancing familiarity, and expanding knowledge of current issues.

Thanks to Ken Pope for this information.

Parity for Patriots: The mental health needs or military personnel, veterans and their families

The National Alliance on Mental Illness released a report entitled Parity for Patriots: The Mental Health Needs of Military Personnel, Veterans and their Families.  Here is a section of the report that is particularly important.

"The U.S. Department of Defense must move more forcibly to end discrimination associated with invisible wounds of war. Reducing the stigma of mental illness will enhance opportunities to deliver prompt, effective treatment to military service members and families who live with PTSD, depression and other mental health conditions. Examples of immediate steps that can be taken to eliminate stigma and barriers to seeking help include:

• Military leader accountability for stigma and suicide: Military leaders throughout the chain of command should be required to focus on preventable psychological injuries and deaths, which should be part of their efficiency reporting process. Suicides are preventable just as are the heat and cold injuries of service members for which leaders are routinely relieved of command.
• Purple Heart for psychological wounds: Posttraumatic stress and other mental health injuries, that are the result of hostile action, including terrorism, should be eligible for award of the Purple Heart with the same level of appreciation and recognition as those awarded to warriors with visible wounds.

The Veterans Health Administration must increase service capacity by expanding provider networks to include community mental health agencies and private practitioners. The VHA should monitor the degree to which contract providers accept veterans and families as clients and should adjust networks to make care available when and where it is needed. Ongoing training in military-informed mental health treatment should be a basic requirement for contract providers. Improved distance delivery through technology should be implemented to remove the travel burden from veterans and improve the use of professional care giver time."

The entire report is here.

Please remember our military service personnel on this holiday.

Backers of health insurance rate regulation edge closer to ballot

Los Angeles Times
Originally published May 19, 2012

Supporters of a proposed ballot measure seeking tighter regulation of health insurance rates in California turned in 800,000 petition signatures, confident that they will qualify for the Nov. 6 election.

In the coming weeks, county election offices and the California secretary of state will determine whether the measure meets the requirement for 504,760 valid signatures of registered voters. The deadline to qualify is June 28.

The initiative is expected to spark an expensive campaign battle over rising health insurance rates, which have angered thousands of California consumers in recent years. This measure seeks to regulate rate increases for health policies sold to individuals and small businesses, which cover about 5 million people. It doesn't affect plans purchased by larger employers that cover about 15 million Californians.

The entire story is here.

Three Weeks to Stop Medicare Cuts

Ethics is more than a code.  Ethical behavior extends beyond treating our patients to advocating on behalf of our patients.

Even if you do not work with Medicare patients, many insurance companies base reimbursement schedules on Medicare rates.

TO:   All Psychologists 

RE:    Three Weeks to Stop Medicare Cuts

Legislative leaders have begun to discuss options to address critical, time-sensitive issues by the end of the year, including the expiration of unemployment benefits, the Alternative Minimum Tax patch, tax extenders and Medicare extenders.

Now is the time for psychologists to make their voices heard and remind Congress that their patients and practices will soon face a 5% cut to psychotherapy payments in addition to a 27.4% Sustainable Growth Rate (SGR) cut to all services scheduled for 2012 if they fail to act. 

Congress has blocked the SGR cut 12 times since 2001 and the APA Practice Organization has successfully secured the psychotherapy restoration 3 times since 2008, but practitioners face a tougher climate this time around in light of the unprecedented focus on deficit reduction and the broadening divide between legislative leaders.

Your profession needs you to take action NOW to ensure legislators are attentive to these critical priorities.

Take Action Now!

Click here to urge your Senators and your US Representative to halt Medicare cuts to psychological services.

Please TAKE ACTION by Tuesday December 6.

Feel free to leave a comment on this blog so that other psychologists know how easy and simple the process really is......as well as the importance of this advocacy effort!

Message:

 My patients and practice are only a few weeks away from major reimbursement cuts that will impact patient access and put my small business at risk.  As a psychologist and constituent, I urge you to extend the Medicare mental health add-on through 2012.

 Congress has repeatedly found extension of the 5% psychotherapy payment restoration necessary to address the unintended impact of CMS's last Five-Year Review on access to Medicare mental health services.  An extension is necessary until completion of the current Five-Year Review of psychotherapy codes, which has been delayed into 2012.

 As Congress works toward end-of-year action on several pressing priorities, please make my patients and the mental health extender a priority, as well as halting the 27.4% Sustainable Growth Rate (SGR) cut.  Thank you for your time and consideration.

 Additional Background:

CONGRESS SHOULD PROTECT MEDICARE MENTAL HEALTH PAYMENT

To ensure the viability of the Medicare outpatient mental health benefit, Congress should extend through 2012 the restoration of cuts to Part B mental health services made in 2007.

Mental Health Extender.  Congress restored payments temporarily but they now need to be extended.  Through the Medicare Improvements for Patients and Providers Act of 2008, Congress partially restored the cuts made by the Centers for Medicare & Medicaid Services (CMS) "Five-Year Review" through 2009. Subsequent laws then extended the restoration through December 2011. The valuation of psychotherapy codes in the 2011 Five-Year Review has been delayed into 2012.  Congress should pass new legislation to extend payments through 2012, until the Five-Year Review is completed.

Effect on Beneficiaries. Extending psychologist payments cut by the Five-Year Review is crucial to protecting access to Medicare mental health services.  Psychologists and social workers provide almost all of the Medicare psychotherapy and testing services, but many have indicated that they may have to reduce their caseloads or leave Medicare if they are faced with these reimbursement cuts. The cost of protecting mental health services is very low, increasing costs by only $30 million per year.

Cut By MEI Rebasing.  A CMS technical advisory panel will be asked to examine the effect of a 4% cut to Medicare part B reimbursement for psychologists in January 2011 due to "rebasing" of the Medicare Economic Index (MEI).  In the 2011 fee schedule, CMS used more recent survey data that showed practice expense and malpractice became a larger share of the payment formula while provider's time became smaller. This increased payments for some services, particularly of professionals who utilize expensive technology.  Due to budget neutrality requirements, CMS reduced other reimbursement work values, which hit services of psychologists and social workers the hardest because they are typically provided at lower cost and lower overhead.

These cuts are not related to the Sustainable Growth Rate.  Psychologists were saved from a second and even more devastating reduction when Congressional action halted the projected 25% SGR cut through December 31, 2011.  Ultimately Congress must replace the flawed SGR formula with one that responsibly and permanently addresses provider payments.

Psychologists will leave Medicare.  In a 2008 survey, 11% of psychologists reported that they have dropped out of Medicare participation and a primary reason cited was low reimbursement rates.

W.Va. board withdraws autism rule after lawsuit

By Lawrence Messina
Associated Press
Published September 27, 2011

The West Virginia board that regulates psychologists voted Tuesday to withdraw an emergency rule that claimed jurisdiction over specialists who treat children with autism, after the new policy spurred a lawsuit and an outcry among parents of these children and their supporters.

The rule issued in July by the state Board of Examiners of Psychologists has been misinterpreted and misunderstood, board Executive Director Jeffrey Harlow said in a statement emailed to the media late Tuesday.

"The parents are calling the board and expressing fear and anger," the statement said, adding that "The last thing the Board would want to do is obstruct the provision of vitally needed services to these vulnerable children."

The rule had barred applied behavioral analysis, a therapy considered crucial for many children diagnosed with an autism spectrum disorder, unless a licensed psychologist supervised the ABA analyst. When it applied for the rule, the board called the providing of this therapy outside its jurisdiction "an immediate threat to public safety."

"There is a relatively small, but most likely soon to increase, group of individuals engaging in the practice of psychology who are not licensed and who do not meet the minimum education and training requirements for licensure," the board wrote when it sought the rule. "They are not prepared to practice independently, lack oversight and constitute a serious and immediate concern to public safety."

A certified ABA analyst, Jill Scarbro-McLaury, sued the board last week, asking a judge to scuttle the rule. Her Kanawha Circuit lawsuit alleged that ABA therapy is separate and distinct from psychology, and has been practiced in West Virginia for years without the board's interference.

"We are encouraged that the board recognized that the rule should be pulled since it was in violation of the law, and we hope no more road blocks are placed in front of our families who just want to help their children," Scarbro-McLaury said in an email.

The board pursued the rule over a new law that will eventually require both public and private insurers to cover ABA therapy. Parents of children with these neurological ailments and their supporters had lobbied the Legislature for several years for the measure. Acting Gov. Earl Ray Tomblin signed the regular session bill into law in April.

The entire story can be read here.

Suicide Draws Attention to Bullying of a Gay Teen

By Anahad O'Connor
The New York Times



Five months ago, Jamey Rodemeyer, a Buffalo junior high school student, got on his webcam and created a video urging other gay teenagers to remain hopeful in the face of bullying.

The 14-year-old spoke of coming out as bisexual and enduring taunts and slurs at school. And he described, in at times desperate tones, rejection and ridicule from other teenagers.

Jamey made the video as part of the It Gets Better project, a campaign that was started last fall to give hope to bullied gay teenagers. “All you have to do is hold your head up and you’ll go far,” he said. “Just love yourself and you’re set. … It gets better.”

But for Jamey, the struggle apparently was just too much. This week his parents announced that their son was found dead, an apparent suicide. He didn’t leave a note, but his parents said he had endured “constant taunting, from the same people over and over.” They added that his school had intervened to help, and that Jamey appeared to be benefiting from counseling.

News that a bullied teenager had succumbed to the very pressures he urged others to resist came as a shock to supporters of the It Gets Better project. And it provided a sobering reminder that bullied teenagers who appear to be adjusting may still be in trouble.

Dan Savage, the advice columnist and co-founder of It Gets Better, noted on his blog on Tuesday that Jamey’s death showed that “sometimes, the damage done by hate and by haters is simply too great.”

It sounds like Jamey had help — he was seeing a therapist and a social worker and his family was supportive — but it wasn’t enough. Whatever help Jamey was getting clearly wasn’t enough to counteract the hatred and abuse that he had endured since the fifth grade, according to reports, or Jamey’s fears of having to face down a whole new set of bullies when he started high school next year.

As suicides among lesbian, gay, bisexual and transgender teenagers have gotten more attention in the past year, researchers have sought to identify the factors that play the largest role. One study published in the journal Pediatrics in May, which looked at nearly 32,000 teenagers in 34 counties across Oregon, found that gay and bisexual teenagers were significantly more likely to attempt suicide than their heterosexual peers. The risk of an attempt was 20 percent greater among gay teenagers who lacked supportive social surroundings, like schools with gay-straight alliance groups or school policies that specifically protected gay, lesbian and bisexual students.

An editorial accompanying the study said the findings pointed to the need for schools to adopt policies that create “more supportive and inclusive surroundings.”

“By encouraging more positive environments,” the report stated, “such policies could help reduce the risk of suicide attempts not only among LGB students, but also among heterosexual students.”

Watch Jamey’s It Gets Better video above.

The entire story was found here.

This story captured the attention of Lady Gaga, gay rights activist and a supporter of anti-bullying programs.  Lady Gaga dedicates a song to Jamey.