Psychology’s advocates are fighting for accessible care

[This article is part of the 2025 Trends Report]

After a year of fighting to stave off major funding cuts to mental health programs, psychology’s top advocates are aiming to gain ground with a new Congress in 2025.

Fighting for psychology in the face of a largely inactive Congress has been an uphill battle, especially given the uncertainty of an election year. But the APA Advocacy Office, which works to advance psychology both as a discipline and a practice, with help from APA membership and other interested parties, persevered. Staff gained key sponsors for important bills and are poised to reintroduce many with new sponsors after the 119th Congress is sworn in.

Looking ahead, advocates are aiming to secure sustainable, long-term investment in psychology through such means as pushing legislatures to keep funding for youth mental health at the levels spurred by the Covid-19 crisis and the Uvalde school shooting or advocating with insurance payers to enable affordable psychological treatments.

“We can’t only legislate in response to an emergency,” said Kenneth Polishchuk, the senior director for congressional and federal regulations and the education policy lead in the Advocacy Office. “We are telling Congress they need to continue to invest rather than cut.”

Other advocacy efforts are public facing: APA is providing scientific expertise to the Office of the Surgeon General, which regularly develops and publishes health advisories on matters related to mental health. APA also works with journalists to bring widespread attention to the barriers to psychological treatment.

In 2024, cuts were on the table while emergency Covid-19 funding for mental health, education, and research was expiring, Polishchuk said. By engaging grassroots advocates, APA Services, a 501 (c)(6) organization focused on advocating for the profession of psychology, and their partners were able to encourage Congress to reject the cuts. “I don’t typically like to say that flat funding is a win, but considering what we were facing, it really was,” Polishchuk said.

Throughout the year, advocacy efforts focused strongly on youth mental health, often working in concert with partner organizations advancing similar goals. In February, for example, more than 40 members of APA’s Council of Representatives and Board of Directors met with Congress members and staffers to push support for the Youth Mental Health Research Act (H.R. 5976/S. 3060) and funding for the Department of Labor to investigate child labor violations. Also in February, APA Services joined with the Friends of the Institute of Education Sciences to urge Congress to support that institute’s research and evaluation work in order to better support U.S. students. Both of these advocacy efforts were focused around advancing the goals of recent Council resolutions: the Council Resolution on Child and Adolescent Mental and Behavioral Health and the Council Resolution on Developmental Risks and Opportunities in Adolescent Employment. In a regulatory win for youth mental health, the Biden administration expanded the protections of the federal civil rights law Title IX to LGBTQ+ students, an effort strongly supported by APA.

“We deeply appreciate the pivotal role of psychological science in guiding policy changes and addressing the myriad challenges our society faces,” said Katherine McGuire, APA’s chief advocacy officer. “Our success relies on our partnership with researchers, educators, practitioners, and students and our collective efforts to advance research and apply it to real-world issues contributing to a better future for all.” Looking forward, Polishchuk said, there is a lot of momentum for building on school-based mental health services established over the past 5 years. “Part of the goal is to continue to provide this kind of funding so schools can continue to hire more professionals and also invest in career pathways for these folks,” he said. “We need to continue down this path and not go backward because the need is so, so substantial.”

Because a key part of ensuring access to mental health support is ensuring a strong and diverse mental health workforce, the APA Advocacy Office is also involved in efforts to strengthen training and reimbursement. APA Services helped draft the ACCESS in Mental Health Act (H.R. 7924), introduced in March 2024. The bill would provide grants to minority-serving institutions to create or expand graduate programs in mental health fields and would provide grants to students attending these graduate programs. Though the bill did not pass in 2024, getting it introduced laid the groundwork for this year’s efforts: APA Services will be working with a new lead sponsor in 2025 to push the legislation forward.

APA Services has also been working to increase mental health options for Medicare beneficiaries by supporting reimbursements to doctoral interns and postdoctoral residents practicing under supervision. The Accelerating the Development of Advanced Psychology Trainees (ADAPT) Act (S. 2511/H.R. 9138) and Increasing Mental Health Options Act (S. 669/H.R. 8458) have been introduced in both the Senate and House with bipartisan support in committees with jurisdiction over Medicare, a “critical step forward,” said Scott Barstow, APA’s director of congressional affairs. The office is also lobbying in support of evidence-based integration of behavioral health services into integrated care models that deliver mental health services in primary-care settings. Policymakers are increasingly focusing on integrated care as well as shifting to value-based payment systems and establishing new models of paying for primary care. APA Services is working to ensure patients served by new payment models get the behavioral or mental health services they need. At the same time, psychology is joining the broader health care provider community in uniting behind efforts to address the continuing failure of Medicare provider payments to keep pace with inflation.

“I think there is a really good chance that discussions across all these fronts lead to progress next year,” Barstow said.

In addition, advocacy efforts are increasingly focused on raising the public’s understanding of why their insurance may offer poor coverage for mental health care. APA has been assisting the investigative journalism organization ProPublica to expose insurance barriers that keep psychologists and other mental health professionals from practicing in-network. More than 500 mental health professionals shared their experiences with ProPublica for the final article, which was copublished with NPR in August (Waldman, et al. ProPublica, August 25, 2024opens in new window).

“It’s one thing to go talk with payers to say, ‘You need to reimburse people better,’” said Stephen Gillaspy, PhD, director of health and health care at the APA Center for Psychology and Health. “It’s something else if someone in the state legislature reads an article and goes to the health care commissioner.”

APA is also lending expertise to independent organizations drawing attention to insurance coverage gaps. APA helped fund the nonprofit RTI International to look at in-network and out-of-network coverage of mental and behavioral health. That report, released in April, found that patients went out of their health care network 10.6 times more often to see a licensed psychologist than to see a medical or surgical clinician (Mark, T. L., & Parish, W. J., Behavioral health parity—Pervasive disparities in access to in-network care continue, RTI International, 2024opens in new window). APA also contributed psychology expertise to a National Academies of Sciences, Engineering, and Medicine report on expanding access to behavioral health care through Medicare and Medicaid (Expanding Behavioral Health Care Workforce Participation in Medicare, Medicaid, and Marketplace Plans, The National Academies Press, 2024opens in new window). The hope is that these reports give local state psychological organizations a tool for advocacy, Gillaspy said.

“Partnering with psychologists in the states is a force multiplier for our advocacy efforts,” McGuire agreed.

The effort to secure better access to mental health care will continue in 2025. One major goal is to push for an increase in the Medicare Conversion Factor for mental health services. Conversion factors are monetary values on medical services that act as a multiplier for the value for specific services. If, for example, the value for service for 60 minutes of psychotherapy is set at 3.5, the payment would be 3.5 times that year’s conversion factor.

As of 2023, the conversion factor sat at $33.89, barely above the 1992 factor of $31.00. APA Services supports the Strengthening Medicare for Patients and Providers Act (H.R. 2474), which would build in an inflationary index to the conversion factor. That bill was introduced by Representative Raul Ruiz, MD, (D-California) in April and is also supported by other professional organizations such as the American Medical Association.

Throughout 2025, APA Services will also continue working to maintain the telehealth access expansions first established during the Covid-19 pandemic by supporting the Telemental Health Care Access Act of 2024 (S. 3651).

Finally, APA has provided scientific feedback on U.S. Surgeon General’s Advisories, which are public statements on matters of public health written and published by the Office of the Surgeon General.

“The Surgeon General is an incredibly important partner,” said Corbin Evans, APA’s deputy chief of advocacy for science and technology. “They have the ability to impact recommendations for federal policy, but also to impact people outside of the government, whether it be parents or teachers, looking for tips from their office on how to react to the most pressing mental and physical health concerns.”

APA provided subject matter expertise for a U.S. Surgeon General’s advisory on social media and youth mental health (Social Media and Youth Mental Health, 2023opens in new window). The advisory highlights mental health concerns related to social media use, acknowledges gaps in the research, and recommends tips for children, adolescents, and caregivers to reduce the risk of negative outcomes. The advisory also calls for technology companies to prioritize safety and health in user design and to share data related to the health impact of their projects. In addition, it calls for policymakers to fund research on social media, strengthen privacy and safety standards for children, and support media literacy education.

APA also provided scientific feedback on a recent U.S. Surgeon General’s advisory on firearm violence (Firearm Violence: A Public Health Crisis in America, 2024opens in new window). “There is a lot of psychological science at the forefront of trying to explain why gun violence occurs and how to address negative repercussions,” Evans said.

Workplace mental health and parental mental health are two other areas of overlap between the goals of the field of psychology and Surgeon General Vivek Murthy, MD. APA provided psychological science expertise to the surgeon general’s framework on workplace well-being (Workplace Mental Health and Well-Being, 2022opens in new window). And a recent U.S. Surgeon General’s advisory on parental mental health and well-being used data from APA’s Stress in America survey to highlight the challenges faced by parents (Parents Under Pressure: The U.S. Surgeon General’s Advisory on the Mental Health and Well-Being of Parents, 2024opens in new window).

“APA’s work has long kept the country informed through scientific expertise across a range of critical topics,” said Murthy. “I am confident APA will remain a valuable resource for psychological expertise for years to come.”

“Our success relies on our partnership with researchers, educators, and practitioners and our collective efforts to advance research and apply it to real-world issues contributing to a better future for all,” McGuire said.

Looking ahead, the “bread and butter” of promoting the sustainability of the psychology workforce will remain a major goal, Polishchuk said. APA will also be active in legislative and regulatory conversations around technology, particularly artificial intelligence (AI). Bringing psychologists to the table early in the conversation around AI could help prevent some of the negative impacts seen with the excesses of social media.

“We would like to avoid negative implications for AI 10, 12, 15 years down the road,” Evans said, “if we’re able to do the work now on the front end on the design, transparency, research, access, and funding pieces that were absent from the social media conversation.”