Mental Health and Advocacy: Why the Future of Care Depends on the People Who Provide It
- Cody Thomas Rounds
- Nov 19
- 11 min read
PsychAtWork-Pro Magazine
Every story about mental health care begins with a provider—someone in a room with a person who needs help. Yet nearly every national conversation about mental health happens without the workforce in mind. Awareness campaigns dominate the headlines. These campaigns often focus on raising awareness, mental health education, and reducing stigma as key strategies to promote mental health awareness and improve overall well being. Politicians talk about crises in vague, sweeping language. Organizations issue statements about “breaking the stigma,” as if stigma is the only barrier standing between people and care.
The reality is far less poetic, and far more structural.
Mental health care doesn’t fail because people feel ashamed to talk about anxiety or depression. It fails because the people trained to treat those conditions are overextended, under-supported, legislatively invisible, and navigating systems that were never designed to sustain the work we ask them to do. Providers are the backbone of the mental health system, yet they are almost entirely absent from how the nation talks about mental health reform. There is also a significant gap between those diagnosed with mental illness and those actually receiving treatment, which can negatively affect individuals' overall well being.
This isn’t an oversight. It’s a habit—a comfortable way of discussing mental health that keeps the focus safely on messaging and away from the uncomfortable truth that systems, not stigma, create the largest barriers to care.
For clinicians, this omission is more than frustrating. It’s professionally dangerous.
Because when the workforce is ignored, it slowly erodes. When the people who deliver care are treated as interchangeable, replaceable, or secondary to the narrative, the system begins to crack from within. And once the workforce weakens, no amount of awareness will bring it back. The lack of support for providers can negatively affect the ability of people to receive treatment and maintain their overall well being.
A mental health system is only as strong as the people who can show up to meet its needs. If we want to talk honestly about mental health and advocacy, we must start with the workforce.
The Conversation We Are Not Having
Clinicians know what the national conversation sounds like. We hear it every time a politician invokes mental health as a talking point—often as a deflection from violence, social instability, or public pressure. We hear it when philanthropy funds glossy public campaigns while cutting grants for community programs. We hear it when insurers eagerly discuss parity, yet quietly reduce reimbursement rates and increase administrative burden.
The overwhelming majority of mental health “advocacy” messages focus on either:
stigma (“We need to talk about mental health more”), or
awareness (“Mental health is health”).
These are safe, sanitized forms of advocacy. They allow everyone to feel supportive without requiring any examination of the systems that shape actual access to care. They also ignore the core issue: people can’t access services that don’t exist, and services don’t exist without a strong, stable, well-supported workforce.
Clinicians know this intuitively. We see it in our schedules, our waitlists, our referrals, our sliding scales, our fatigue. We understand that the greatest limitations on access have nothing to do with how openly society talks about mental illness.
The limitations are:
not enough providers,
not enough training pathways,
not enough reimbursement,
not enough legislative protection,
not enough policy recognition, and
too many structural barriers that keep qualified people from entering or staying in the field.
Advocacy initiatives and advocacy efforts are essential to improve access to mental health services by addressing these limitations and promoting systemic change.
But these realities rarely surface in the public narrative because they implicate the systems responsible for maintaining a healthy workforce. Legislative advocacy and strong mental health policy are crucial for supporting the workforce and improving access to care, yet they are often overlooked in favor of less challenging conversations. Talking about stigma is socially satisfying. Talking about licensure, reimbursement, rulemaking, telehealth, and provider safety is politically inconvenient.
And so the people whose work actually keeps the mental health system functioning—the clinicians—remain largely invisible in the national conversation. Supporting advocacy efforts that focus on workforce sustainability is necessary to bring these issues to the forefront.
The Workforce as the Missing Middle
If you listen carefully, nearly every mainstream message about mental health jumps from the individual to the system, skipping over the workforce entirely. Public conversations ask why more people aren’t getting help, but almost never ask what might prevent a clinician from being able to provide it. Advocacy organizations focus on symptoms rather than infrastructure. Policymakers focus on end results without recognizing the labor that produces them. Advocacy services and community based organizations also play a crucial role in supporting individuals with mental health needs, helping them navigate complex systems and access appropriate care.
Yet providers sit in the middle of every outcome. Access cannot improve without them. Early intervention cannot happen without them. Suicide prevention cannot expand without them. Mental health services cannot function without a workforce equipped to deliver them. Community based organizations, alongside advocacy services, are essential in providing mental health support and resources to support individuals in their recovery journey.
Clinicians are the missing middle in the mental health ecosystem—central to everything, considered in almost nothing.
Advocacy groups often highlight “access” as if it is a product one can distribute, like test kits or pamphlets. But access is labor. Access is human availability. Access is a trained professional who has the time, the resources, the legal protection, and the compensation to sit across from someone who needs help. Group advocacy, peer advocacy, and self advocacy all play important roles in supporting individuals, improving access to treatments, and ensuring that people can voice their needs and receive appropriate care.
If there are no clinicians, or if clinicians are too overwhelmed to take on more clients, access cannot magically be conjured by awareness campaigns.
And if there are clinicians, but they are working under unsafe, restrictive, or punitive conditions, we cannot pretend that awareness will fix what is fundamentally a workforce crisis. Mental health professionals and primary care providers are both vital in delivering mental health support, coordinating care, and ensuring that individuals receive timely and effective treatments.
What Mental Health Advocacy Should Mean in Mental Health
Advocacy should begin with the recognition that the most influential forces in mental health care are not cultural attitudes or public willingness to “open up,” but the structures that determine what a clinician’s workday looks like. If the workday becomes unmanageable, the system becomes inaccessible. If the conditions of practice deteriorate, the system does too. And yet, the dominant narrative keeps the focus on talking about mental health rather than examining the conditions under which mental health care exists.
Real mental health advocacy requires us to confront the economic, regulatory, and administrative landscapes in which clinicians operate. It demands attention to the rules, policies, and institutions that shape what kind of care is possible. This includes recognizing the importance of legal advocacy, statutory advocacy, and understanding legal rights, mental capacity, and the role of local authority and social care in supporting both mental health professionals and service users. It requires us to look at how decisions made in distant rooms—legislative committees, insurance board meetings, regulatory agencies—reach all the way down into the treatment room, constraining what a clinician can do, how long they can do it, and under what conditions they can keep doing it.
The public conversation, however, skips over this reality because it’s easier to endorse compassion than confront structure. Compassion is tidy. Structure is messy. But structure is where the system succeeds or fails. Advocacy that stays at the level of sentiment will always fail to understand why care remains so difficult to access even in a culture that now openly discusses mental illness. The conversation simply hovers above the ground, never touching the systems that define the limits of what clinicians can provide.
Clinicians live inside these limits every day. They know what the system feels like from within: the weight of documentation that climbs higher each year, the reimbursement that shrinks in value, the ever-expanding administrative requirements that swallow their time, the shifting rules for telehealth, the licensure maze that slows the entry of new professionals, the inconsistency across states, the opacity of insurance decision-making, the hollow promise of parity laws no one enforces, the audits that presume guilt, the liability landscapes that grow more complicated with each legislative session. Their work is shaped by systems that rarely acknowledge their existence. Health insurance policies and coverage can significantly affect access to mental health care, and policy change is needed to improve access for those affected by mental health conditions.
This is the quiet paradox of mental health care in America: the people whose labor sustains the entire mental health system are almost entirely absent from the discussion of mental health reform. Providers are expected to absorb the chaos around them—economic changes, policy instability, administrative inconsistency, public demand, societal distress—while functioning as though their capacity has no limits. In this model, the clinician is not a human being working within a system; the clinician is the system. Everything else merely orbits around their ability to keep practicing.
When advocacy ignores the workforce, it subtly implies that clinicians are peripheral to the real work of improving mental health. But clinicians are not peripheral. They are the infrastructure. They are the point of contact where theory becomes practice, where policy meets reality, where “access” is either actual or unavailable. They carry the mental health needs of the population in real time, and their presence—or absence—determines whether any public promise can be fulfilled.
Yet, because they work quietly, because their labor is private and often unseen, because crises are handled behind closed doors and not in press conferences, they are assumed to be endlessly available. The system behaves as if clinicians can expand or contract their capacity at will, as if the limits of human endurance do not apply to them. The public imagines that access is simply a matter of finding the right phone number. Clinicians understand that access is a matter of policy, economics, labor, and structural design.
If we are serious about mental health advocacy, we must acknowledge that the workforce cannot be separated from the system’s health. A mental health system without a stable workforce is a system in name only. The conversation must stop treating clinicians as an afterthought and start recognizing their centrality to every outcome we measure: early intervention, crisis response, suicide prevention, community stabilization, long-term recovery, and the daily work of keeping people functioning in their own lives. National organizations such as the National Alliance on Mental Illness, American Foundation for Suicide Prevention, Mental Health America, and Active Minds play a crucial role in promoting mental health advocacy, education, and support for clinicians, service users, and communities.
But this kind of advocacy is uncomfortable because it implicates the institutions that prefer not to be examined. It requires us to question why insurance companies are allowed to dictate the terms of clinical care with no accountability. It requires us to ask why licensing structures remain outdated and hostile to entry. It forces us to confront the fact that clinicians are, in practice, small businesses navigating an economic environment not built to support essential health services. It requires attention to how regulations, reimbursement patterns, and policy decisions slowly shrink the capacity of the system, long before the public sees the consequences. The prevalence of mental health conditions, mental disorders, and substance abuse continues to rise, affecting children, young adults, and entire communities, with significant consequences for those affected and their families.
This is not the kind of advocacy that earns applause. It is not easily turned into a hashtag or a public campaign. It does not lend itself to slogans. But it is the only form of advocacy that addresses the root cause of access problems. Every other form of advocacy, no matter how sincere, remains cosmetic by comparison.
The uncomfortable truth is that the mental health system is collapsing from the inside out, one clinician at a time. Not because people don’t care about mental health, but because the structures determining care have not changed to match the demands placed on the workforce. Clinicians leave not because they are uncommitted, but because commitment alone cannot override unsustainable conditions. And when clinicians leave, the system loses capacity—not theoretically, but literally.
This attrition is rarely framed correctly. We hear, instead, about “provider shortages,” as though the shortage were a natural disaster or a demographic inevitability. But shortages are not mysterious. They are predictable outcomes of structural neglect. They are signals that the system is demanding more labor than it is willing to sustain. They are warnings that the people who provide care cannot continue to do so under current conditions.
Clinicians are not burned out from listening to suffering. That is the part of the job they are trained for. They are burned out from the structures surrounding the work: the constant administrative vigilance, the shifting rules, the antagonistic insurance environment, the uncertainty baked into every part of the profession. They are burned out from being told they are essential while being treated as expendable.
If there is any hope for the mental health system to stabilize, advocacy must begin by asking the questions the public conversation avoids. What would it take for clinicians to remain in the field for twenty years rather than five? What structural supports would allow them to practice without sacrificing their own well-being? What policies would make the profession sustainable, not heroic? What economic conditions would allow their work to be valued not just rhetorically, but structurally? The value of lived experience, sharing mental health journeys, and the support of peer advocates, support groups, communities, and community-based organizations is essential in reducing stigma and supporting individuals affected by mental health issues.
These questions are rarely asked because they shift the conversation from personal responsibility to systemic responsibility. They highlight the disconnect between what the public expects and what the system provides. They illuminate the fact that mental health care cannot be expanded through messaging. It must be expanded through infrastructure. Education, mental health education, and various forms of advocacy—including group advocacy, peer advocacy, and self advocacy—are vital for raising awareness, promoting open conversations, and empowering both clinicians and those they serve.
Clinicians are not the barrier to care; they are the victims of a system that refuses to maintain them. The barrier is not stigma, or awareness, or willingness to seek help. The barrier is the quiet accumulation of structural decisions made without the workforce in mind—decisions that shape the daily life of every mental health professional in the country. Discrimination and the stigma surrounding mental health, if left unaddressed, further discourage help-seeking; reducing stigma and fostering less stigma are necessary to encourage early identification and enable informed decisions for those affected.
The truth is simple: A mental health system is only as strong as the people who can show up to staff it.
If the nation wants to strengthen mental health care, it must begin with the workforce. Not with public sympathy. Not with awareness campaigns. Not with moral appeals about the importance of talking openly. Those may shape attitudes, but attitudes do not build systems. Systems are built on labor, regulation, economics, and support. And systems collapse when the people doing the labor cannot continue. Effective mental health advocacy requires the active role of organizations, advocates, and communities to improve access to care for all affected individuals, especially those experiencing poor mental health.
Advocacy must stop circling around the edges of the problem. It must confront the center: the people in the room with those who need help, doing the work that all other conversations depend upon. If we fail to advocate for them, we fail to advocate for mental health.
Additional Resources for Clinicians
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Advocacy in Vermont
The Vermont Psychological Association works to ensure that the voices of psychologists remain part of the state’s public conversation—where policy meets practice, and science meets service. Through legislative advocacy, professional education, and grassroots engagement, VPA protects access to care, promotes ethical standards, and supports those who make psychological health possible. To learn more or get involved, visit.
