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    Advocating for Mental Health Care Access for All

    by Alicia Bruzek, NCC, tLMHC

    As a counselor, I often hear frustrations with the barriers to mental health care due to finances, time, travel, etc. Mental health care is not given the same treatment as physical health care and it often feels like a large, overwhelming task to begin to change that.

    I wanted to share some information about topics that can benefit our communities and provide more inclusive and accessible mental health services for all. I ask that you use your voice to let legislators know how these issues affect you and what you would like them to do to make a change. I hope this information about current issues and tips to get involved inspire you to utilize your voice and share your story!


    For the past 30 years, services with counselors have been excluded from being covered by Medicare. Clients who have Medicare coverage do not have equal access to mental health services, especially in rural areas, like much of Iowa.

    In some rural areas, counselors are more widely available than other providers covered by Medicare, such as social workers, psychiatrists, and psychologists. Counselors not being able to accept Medicare leaves individuals in those areas with no options or unaffordable options to meet their mental health needs. Many Medicare recipients are in a high-risk group for COVID-19, and it is more important than ever to meet mental health needs that may worsen with fear and isolation. With counselors unable to accept Medicare, these individuals may be at risk of going untreated.

    What can I do?

    Currently, there are laws being proposed in both the House and Senate that address Medicare reimbursement for counselors. In the Senate, this bill is the Mental Health Access

    Improvement Act of 2019 (S. 286).In the House, this bill is the Mental Health Access Improvement Act (H.R. 945).

    It is important to reach out and let your legislators know if you support the expansion of Medicare benefits to cover mental health services with counselors! You can find links to your representatives below:



    If you would like to contact your representatives, keep reading for some tips on what you might say!


    COVID-19 has changed mental health services, with many counselors moving to technology-based services, such as video or telephone calls, called telehealth,in order to limit person to person contact. Recent emergency legislation has allowed for telehealth to be covered by state programs (including Medicaid) beginning with Governor Reynold’s March 26th proclamation, allowing for expanded telehealth coverage and flexibility for counselors, and her most recent proclamation on May 26thextending coverage of telehealth services for Medicaid through June 25th.

    In addition, many private insurance companies have expanded telehealth coverage into the summer. These are all great steps to protect the health and safety of clients, while also meeting their mental health needs, which have been greatly affected by COVID-19. Telehealth doesn’t just benefit those affected by COVID-19, however. People in rural communities who have less access to mental health care could more effectively seek help via telehealth without having to worry about lack of time, transportation, or financial barriers. Telehealth is also beneficial for people in crisis who need to get in to see a counselor quickly, but may not have the time or ability to travel.

    What can I do?

    Although the recent changes in legislation have been a good first step, there is still work to be done! Extending the coverage for telehealth services after June 25th, and after concerns surrounding COVID-19 end, is the next step.

    You can help by contacting policy makers and letting them know that telehealth is beneficial for you and for those in your community. For Iowa, you can contact:

    Governor and Lt. Governor:

    Iowa Legislators in the Iowa House & Senate:


    Tips and Resources for Advocating for Mental Health

    Now that you know about some issues that are impacting counseling access currently, here are some tips to get involved with making changes in these areas:

    • Stay up to date on policy issues by getting on email lists of legislators, following them on social media, or searching for news articles about topics that are important to you.
    • To see bills currently in the house and senate, visit
    • Utilize contact forms on legislator’s websites to share your views or stories. Here are a few things you might want to keep in mind:
      •  Introduce yourself and where you live.
      • Tell them why you’re contacting them. If there is specific legislation that you would like them to support or oppose, make sure to include that in your letter or email!
      • Share your story and why this issue is important to you or how it affects you.
      • Try to focus on one topic or issue at a time to avoid confusion.
    • If you prefer to call, here are some tips to aid you in the process:
      • Identify yourself as a constituent and ask to speak to the legislative aide assigned to the issue you are calling about
      • Share your reasoning for your support or opposition to the bill
      • Ask for their position on the bill
    • Support NAMI’s (the National Alliance on Mental Illness) efforts by telling your story or signing petitions in their action center:

    Other articles and resources

    Below are some articles and resources to learn more information about how mental health during the time of COVID-19 is affecting us here in Iowa, as well as general resources about advocating for mental health!

    As Farmers Face Increasing COVID-19 Pressure, Some Fear For Their Mental Health r-mental-health#stream/0

    COVID-19 challenges a strained mental health system in Iowa, but help is out there eady-strained-mental-health-system-but-counselors-ready-help/2937111001/

    American Counseling Association Government Affairs and Public Policy Glossary ic-policy-glossary.pdf?sfvrsn=eb6c202c_4

    National Alliance on Mental Illness (NAMI) Policy Priorities


    American Counseling Association. (2020, May). 2020 Government Affairs and Public Policy Virtual Town Hall.

    American Counseling Association (2020). Advocacy Toolkit. fvrsn=f9815e2c_4


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