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Authored by: Jonathan Teller, MA
Despite decades of evidence that cognitive-behavioral therapy works, most people who need it never receive it.
The most recent National Survey on Drug Use and Health found that just over half of adults with any mental illness received any treatment in the past year, leaving tens of millions of Americans without care (Substance Abuse and Mental Health Services Administration [SAMHSA], 2024). Even for well-characterized conditions like obsessive-compulsive disorder, a recent systematic review found that the average duration of untreated illness ranges from 7 to nearly 21 years across studies (Perris et al., 2023).
Barriers to care are well-documented and include:
- self-stigma,
- limited mental health literacy,
- and weak social supports.
Less attention has been paid to what trainees can do about it. Graduate trainees are well-positioned to engage in advocacy, and training programs should treat it as a core competency alongside clinical skills.
Why Trainees?
Graduate trainees sit at the intersection of current research and frontline practice. We read the literature in seminars and watch its limits play out in our placements—we cross the research–practice gap every day, which makes it easier to see where systems fail the people they were built to serve. We also have decades of career ahead of us, so investing in advocacy skills now compounds over time. Although psychology has increasingly recognized advocacy as a professional responsibility, its integration into training has been uneven, and participation in advocacy remains low among trainees and practitioners alike (Keum et al., 2022). Promisingly, structured training appears to work: when trainees complete supervised community advocacy projects, they emerge with broader definitions of advocacy and measurable gains in confidence (Edwards et al., 2017).
The Training Landscape
The role of advocacy in mental health training has evolved considerably over the past decade. Medicine has perhaps moved furthest, with the CanMEDS framework naming "Health Advocate" as a core physician competency and a growing literature documenting advocacy interventions in postgraduate medical education (Scott et al., 2020). Psychology has made progress too: advocacy competencies have been articulated in counseling psychology (Ratts et al., 2015), and APA accreditation standards have increasingly emphasized systems-level thinking. Still, integration varies widely across programs, and many trainees finish their doctoral training fluent in delivering evidence-based interventions but with limited preparation to navigate the funding structures, policies, and systems that determine who actually gets access to them.
Three Levels of Advocacy
For trainees ready to start without waiting for a curriculum to catch up, advocacy happens at three levels.
- Policy
At the policy level, trainees can engage in the legislative processes that shape mental health funding, service delivery, and research priorities. Programs like the AAAS Catalyzing Advocacy in Science and Engineering Workshop teach the federal appropriations process and how to translate research into policy-relevant language. When you can explain to a congressional staffer that the average duration of untreated illness for conditions like OCD can stretch from 7 to nearly 21 years (Perris et al., 2023), the treatment gap stops being an abstraction and becomes a problem with identifiable solutions.
- Community
Schools, faith communities, and nonprofits regularly need psychoeducation that improves mental health literacy and reduces stigma. Conferences such as ABCT, ADAA, and the IOCDF annual conference allow trainees to share research with both clinicians and the families they are meant to help. Engagement does not need to be elaborate—a workshop on recognizing anxiety in adolescents, a resource guide for parents navigating the system, or a presentation at a community health fair all count.
- Individual
Every clinical encounter is an opportunity for advocacy. The language we use, how we frame distress, and how we respond when a client is unsure about treatment all shape whether they come back. If we cannot reduce barriers in the room, the systemic work will not matter.
What Programs Can Do
If advocacy is to become standard rather than optional, programs need to embed it deliberately. Scott et al. (2020) found that the most effective interventions in medical education were longitudinal—integrated across training rather than offered as one-off workshops. The same likely holds for psychology. Embedding advocacy in existing courses, building in supervised experiential components, and modeling the work at the faculty level would provide trainees with the scaffolding that current curricula often omit.
A Note to Trainees
You do not need permission. Attend a legislative briefing. Volunteer with a patient advocacy organization. Present at a venue where affected families will be in the room. Ask your supervisor what systemic factors shaped your client’s path to care. Advocacy is not separate from clinical work—it is its logical extension. The same impulse that draws people into this field should pull our attention toward the structures that decide who suffers and who gets help.
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