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Professionalization of the Field of Clinical Mental Health Counseling


Chapter 4: Advocacy Issues

 Needing Clinical Mental Health Counselors’ Attention

By Jim Messina, Ph.D., CCMHC, NCC, DCMHS



You will learn the answers to the following questions:

  1. What does it mean for a Clinical Mental Health Counselor to engage in professional advocacy?
  2. What does AMHCA says about its professional members engaging in advocacy for their clients?
  3. What soul searching questions CMHCs must ask themselves as they forge ahead to do social advocacy?
  4. What are the various means and methods by which CMHCs can engage in social advocacy?
  5. What are some major issues around which CMHCs can engage in social advocacy?
  6. What did the UN’s Universal Declaration of Human Rights have to say in 1948 and why it is still relevant to this day?
  7. What have been and still are some major social advocacy issues which AMHCA and the field of CMHC dealt with since its initiation in 1976?
  8. What are some good references you can use to learn more in-depth information about the social advocacy for CMHCs?

What is CMHC Professional Advocacy?

Advocacy-oriented Clinical Mental Health Counselors (CMHCs) recognize the profound and lasting impact that economic, cultural, social and political realities of life have on their clients.  CMHCs who commit to an advocacy orientation are not only interested changing the realities in the systems which impact their clients but they are also committed to empowering their clients so that they are capable and willing to advocate for themselves. CMHCs empower their clients by helping them understand better what needs to be changes in the systems which impact them so that they are better able to advocate for such changes (Lewis, Arnold, House & Toporek, 2003). It is unhealthy for CMHCs to believe that their work with their clients is the be all and end all of their professional responsibilities. Ethically it is important the CMHCs not place all responsibility for change on their clients because this can “do harm” to these clients because it is based on a faulty assumption that change most always solely occur with the individual regardless of the environment which might be oppressive socially, culturally or economically (Chang, Crethar & Ratts, 2010). Social Justice has been defined as “the fundamental valuing of fairness and equity in resources, rights, and treatment for marginalized individuals and groups of people who do not share equal power in society” (Nilsson, Schale & Khamphakday-Brown, 2011, p. 413). CMHC’s then are called to advocate for social justice for their clients.


AMHCA Code of Ethic (2010)

 Statement on CMHC Advocacy

2. Advocate

Mental health counselors may serve as advocates at the individual, institutional, and/or societal level in an effort to foster sociopolitical change that meets the needs of the client or the community.

a)    Mental health counselors are aware of and make every effort to avoid pitfalls of advocacy including conflicts of interest, inappropriate relationships and other negative consequences. Mental health counselors remain sensitive to the potential personal and cultural impact on clients of their advocacy efforts.

b)    Mental health counselors may encourage clients to challenge familial, institutional, and societal obstacles to their growth and development and they may advocate on the clients’ behalf. Mental health counselors remain aware of the potential dangers of becoming overly involved as an advocate.


With the AMCHA Code of Ethics directives on advocacy in mind, often times it is not enough for CMCHs to treat individuals in isolation from their social milieu given that their clients’ issues stem from the oppression these individuals experience from the stereotypes, prejudice, and discrimination present in their social settings. These oppressive treatments are often embedded in their social or cultural settings due to societal norms and values or their institutional (ie: work, school or community organizational) settings set by their rules and policies (Ratts & Hutchins, 2009).


Social Advocacy writers hold that traditionally intrapsychic or deficit-oriented approaches to mental health care use of culturally biased diagnostic criteria perpetuate social injustice and cultural oppression within the counseling profession (Greenleaf & Williams, 2009). Advocates point out that various diagnoses, such as depression, anxiety, and oppositional defiant disorder are social indicators of the stress experienced by populations that lack power, are oppressed and/or are underprivileged (Greenleaf & Williams, 2009). Advocates also point to research which has shown how marginalized populations are eith under, over, or misdiagnosed with psychopathology within the health care professions (Greenleaf & Williams, 2009).


Ratts and Hutchins (2009) present two levels of competencies of CMHC social advocacy competencies:

  1. Empower client self-advocacy: This effort is focused on empowering clients who are marginalized in society. The advocacy efforts entails helping these clients recognize their inner strengths to counter any internalized oppression they might fee. The effort is to help them recognize the impact of sociopolitical forces on their self-esteem development. The effort helps clients understand their lives in context which helps them grow in self-advocacy skills, and learning to work with others in developing and implementing a self-advocacy plan of action.
  2. Advocacy for clients: CMHCs are trained to understand human development, multicultural and social justice issues and are encouraged to become systems change agents by being given the technology and research skills needed to promote such change. These advocacy skills help CMHC’s promote social, psychological and physical wellbeing of individuals, families, communities and organizations. This type of advocacy might entail working with relevant community bodies to establish needed services for clients, or helping clients to gain access to already existing community services by identifying barriers clients have to accessing such resources and helping such services develop ways of lowering such barriers to make entry into them less burdensome (Ratts & Hutchins, 2009).


The purpose of advocacy by CMHC’s either through empowering their clients or by advocating directly for them is to increase clients’ sense of empowerment and to encourage sociopolitical changes that are responsive to the needs of the CMHCs client (Kiselica & Robinson, 2001).


The goal of social justice CMHC counseling would be to ensure that clients have the opportunity to reach their personal, social, career potential free from unnecessary barriers. “This perspective is rooted in the belief that every individual has a right to a quality education, healthcare services, and employment opportunities regardless of race, ethnicity, sex, sexual orientation, gender identity, gender expression, economic status, and creed” (Lewis, Ratts, Paladino & Toporek, 2011). Ratt (2009) refers to social justice counseling as a fifth force in the counseling profession in that it follows the psychodynamic, cognitive behavioral, existential-humanistic, and multicultural counseling forces that exist in the counseling professionand is shaping how human behavior is explained and the ways in which counseling is currently being practiced (Ratt, 2009).


When CMHCs are working with their clients they often focus on helping their clients change the way they think and feel about life so that they can change their behaviors to be more rational and reasonable in response to the challenges which life throws them. Some advocates refer to this reframing as social constructivism. Social constructivism believes that cognitive functions originate in and are explained as products of social interactions. Reality is constructed through human interaction and is a reflection of socially constructed concepts. Social Constructivist Advocates conclude that reality is flexible and changeable according to the social, cultural, historical context in which individuals interact with others and that social advocacy works to help reconstruct healthier realities for CMHC clients (Chang, Hays & Millikin, 2009). CMHC social advocacy efforts include such advocacy, prevention, social action research, program evaluation, and community interventions (Murray, Pope & Rowell, 2010).


It is important for CMHCs to have attributes and skills necessary for social justice counseling, including being able to “appreciate human suffering; using effective communication skills; maintaining a multisystems perspective; having individual, group, and organizational intervention skills; understanding how to use technology and the media; and having advocacy-oriented assessment and research skills” (Brubaker, Puig, Reese & Young, 2010, p. 90). It is important for CMHCs to develop a style of social justice work that works for them and if this means that they are quiet and persistent in their advocacy by working with clients through a psycho-educational model of teaching them self-advocating this can be as if not more effective than by them being extremely vocal out in the public sector (Glosoff & Durham, 2010).


It is also imperative that CMHC’s avoid the pitfalls and limitations of social advocacy which Smith, Reynolds and Rovnak (2009) identified:

  1. Hidden agendas (e.g., personal goals, retribution or stonewalling);
  2. Self-promotion (recognition for one’s efforts is a secondary gain of social advocacy should be avoided);
  3. Increasing in privilege and power (privilege and immunity granted as a special benefit should be avoided);
  4. Power (power often gained with privilege by being a social advocate);
  5. Notoriety (implies over time status which instead of going towards the group being advocated for goes to the advocate instead);
  6. Disenfranchisement of those not involved in the social advocacy effort (which is the opposite of the goal of social advocacy and CMHC’s need to be sure their advocacy is a broad blanket covering as many of the marginalized and disenfranchised members of their community as possible);
  7. Lack of choice in advocacy (where a profession dictates what and how social issues should be advocated for, rather than allowing professional members the freedom to choose specific areas and methods of advocacy. CMHCs should never have to face an “either be an advocate for this issue the way our profession dictates or if you choose not to accept what is being dictated to advocate for, then don’t advocate at all”);
  8. Dichotomous roles and camps (the belief that “if someone advocates for something or someone, then that person advocates against something or someone else.” Such thinking limits the scope of social advocacy since it dictates the what and how one can advocate and pigeon holes individuals who chose to advocate for their clients who do not want to get caught up with the roles and camps of the dichotomous thinking within the professional advocating community);
  9. Promotion of elitism (the establishing of an in-group and out-group dichotomy within professional ranks where the elite group members are blind to their own issues, prejudices and biases and turning off those professionals who are not members of that elite corps);
  10. Redefining the role of counseling (encouraging CMHCs to engage in social advocacy is seen as challenging traditional roles, skills and interventions of counseling. However as long as CMHCs focus much of their social advocacy on training their clients to be self-advocates in a healthy way this effort supports the therapeutic process of counselo-client relationship and accepts that social forces do impact the mental health of CMHCs’ clients.)
It is imperative that CMHC’s avoid the preceding pitfalls and limitation of social advocacy so that they can be as productive and success in their social advocacy efforts for their clients. 

Social Advocacy Issues for which CMHCs could advocate

The following is a sample list of specific populations, cultures, issues, and problems for which CMHCs can promote social justice advocacy:


Potential Targets for Social Advocacy by CMHCs

  • Overcoming the stigma of seeking out mental health services for one’s self or one’s family members
  • Helping parents and children to cope with the emotionally impactful reality of parental discord, separation and divorce
  • Assisting proactively the victims of: (1) physical abuse of children and/or adults; (2) sexual abuse of children and/or adults; (3) domestic violence by spouses or significant others; (4) human trafficking; (5) all sorts of crimes against persons, organizations, and things etc.
  • Reduction of bullying in the schools, on social media and in the community
  • Overcoming the Impact of “thin is in” advertising on the body image of our youth which feeds an increase in feeding and eating disorders and body dysmorphic disorders
  • Addressing our country’s obesity epidemic
  • Overcoming discrimination, stereotyping and bigotry against members of: ethnic, cultural, racial, nationality, and religious minorities
  • Supporting the mental health of legal and illegal immigrants and their families
  • Issues of women: single, married, single parents, divorced, etc
  • Needs of the lesbian, gay, bisexual and transgendered (LGBT) populations
  • People who are unemployed, underemployed, retired, or in need of training to gain employment
  • People who are underprivileged, poor, and marginalized
  • People who are not able to afford health insurance for themselves and their family members
  • Poor people in states who are not eligible for health insurance due to their states not accepting the federal support for Medicaid under the Affordable Care Act
  • People who have chronic and persistent mentally illness who end up homeless due to lack of public housing and mental health services established to meet their needs
  • Children and adult who have cognitive and/or physical disabilities
  • Veterans and their families of the Iraq and Afghanistan Wars and other prior wars
  • Gun control in relation to people with severe mental health disorders
  • People who are susceptible to social pressure to engage in a variety of potentially addictive behaviors such as use of alcohol, tobacco, marijuana, inhalants, cocaine, crack, hallucinogens, PCP, pain medications (opioids), sedatives (barbiturates and non-barbiturates), hypnotics (benzodiazepines); anxiolytics (anti-anxiety meds), stimulants, and caffeine
  • People with gambling addiction fed by both legalized gambling in states (lotteries, casinos etc) and illegal gambling (bookmaking, computer gambling etc)
  • Helping children and families of individuals who have been incarcerated in state and federal prisons
  • Inequity due to disproportionate numbers of African American males imprisoned for drug infractions that marginalizes them over their life-time
  • Prevention of teen unplanned pregnancy through prevention programming
  • Assisting hard to place children gain adoptions in “forever families”


Social advocacy for any of the above groups or issues needs to be done initially at the client level using appropriate self-empowerment techniques. CMHCs also need to be ready to work at the community level when the above issues need voices who will rationally and intelligently press for changes and solutions which will support and improve the lives of their clients.

Consumer Groups with whom AMHCA should partner in their Social Advocacy
The following constituency groups which advocate for mental health services are outstanding candidates for AMHCA and its State Chapters to partner up with to promote those issues which affect the underserved, most in need and disenfranchized populations in our society. It is especially important to reach out to these client representatives who serve the under served populations who miss out on mental health services due to Clinical Mental Health Counselors not being Medicare Providers. Such groups include: 
  1. National Alliance on Mental Illness (NAMI):
  2. AARP:
  3. Mental Health America:
  4. Parity Implementation Coalition:
  5. National Association of Psychiatric Health Services (NAPHS):
  6. National Association of Rural Mental Health (NARMH):
  7. National Association of County Behavioral Health & Developmental Disability Directors:

  8. National Association of State Mental Health Program Directors:
  9. National Council for Community Behavioral Healthcare:
  10. Depressive and Bipolar Support Alliance: 
  11. Anxiety Disorders Association of America: 
  12. American Association for Suicidology:
  13. Mental Health Liaison Group:
  14. National Association of Anorexia Nervosa and Associated Disorders:
It is important for AMHCA's Legislative Lobbying Team to assist in getting the word out to the various client constituent representative groups to enlist their support to expand the list of providers for Medicare to include Clinical Mental Health Counselors. 
What issues should CMHC's consider to advocate for? 

So what is the field of Clinical Mental Health Counseling doing about the issue of Social Justice for its clients? AMHCA and ACA have:

  • provided their membership with resources which will enable them to adequately advocate for changes in our society for their clients
  • taken up the cause of the marginalized and disadvantaged
  • worked to get coverage for the marginalized by getting the Federal Government to cover the services of Clinical Mental Health Counselors under Medicare and Medicaid
  • worked to get active military and veterans to be afforded the clinical services of Clinical Mental Health Counselors through advocating and achieving coverage for services of CMHCs by Tricare, and the Veterans Hospital System
  • worked to increase public awareness for the needs of the people needing mental health services by the national establishing of May as the National Mental Health Awareness Month
  • worked to get mental health counselors licensed in all 50 since 1976 so as to insure good accountability for the services delivered by Mental Health Counselors
  • actively participated in any public policy programming available to identify the needs of their clinical constituencies in the national and their respective state capitals
Core Provider Status
According to the Congressional Research Services 2015 manual: The Mental Health Workforce: A Primer, by Elayne J. Heisler and  Erin Bagalman, (which is available to download at: ) that there is no consensus agreement as to which professions currently are considered as Core Providers by Congress. This manual considered for congress' review the following Core Professions:  clinical social workers, clinical psychologists, marriage and family therapists, psychiatrists, and advanced practice psychiatric nurses. They did not mention or cover clinical mental health counselors in this review. This review looked at the Institute of Medicine (IOM), SAMSHA, and The Health Resources and Services Administration (HRSA) definitions of mental health service practitioners concluding there is no clear consensus which can be found. For this reason they selected the HRSA's recommendations of the five: clinical social workers, clinical psychologists, marriage and family therapists, psychiatrists, and advanced practice psychiatric nurses. Their document will be utilized by Congress to address the under-met needs of citizens needing mental health services in the USA. This is a very shocking finding given the importance of getting laws passed to include Clinical Mental Health Counselor listed as providers under Medicare so as to better serve the undeserved Elderly Populations in rural and socioeconomic marginalized communities.

Medicare Coverage for Clinical Mental Health Counselors
An excellent video on the need to include Clinical Medical Health Counselors under Medicare to serve the undeserved populations was put out by the Gulf Coast Mental Health Counselors Association in Lee county and you can view it at:   

Medicare is the largest health care program in the country, covering more than 40 million people. However, Medicare does not reimburse Clinical Mental Health Counselors (CMHC's) for outpatient behavioral health services. Medicare currently recognizes psychiatrists, psychologists, clinical social workers and psychiatric nurses for outpatient mental health services. Medicare is the country’s flagship health care program, and Clinical Mental Health Counselor inclusion is key to its parity with other professions. Only a federal law can accomplish this. Nearly 30 bills have included language adding CMHC's and Marriage and FamilyTtherapists (MFTs) to Medicare, and the legislation has passed both the Senate and House twice, but never concurrently.

AMHCA under Jim Finley's (their lobbyist) efforts, has been working with Congress to get a bill passed in the last 10 years. AMHCA in 2016 has been pressing for inclusion of their Medicare provider status bill in the broader “Murphy bill.” The most effective way to make it happen was to generate more grassroots messages to congressional offices urging co-sponsorship of their Medicare provider status bill: In the Senate: S.1830 - Seniors Mental Health Access Improvement Act of 2015 and in the House: H.R.2759 - Mental Health Access Improvement Act of 2015  (S. 1830/HR. 2759). Congressional offices told AMHCA they needed to hear more support from their constituents for these bills. AMHCA members need to more proactively use  grassroots messages in support of Medicare recognition.

Clearly the undeserved and the marginalized citizens in our country will benefit if Clinical Mental Health Counselors are recognized as providers under Medicare.

Uptodated Briefing on AMHCA's Medicare Provider Status Legislative Efforts

AMHCA Medicare Briefing

April 6, 2016

Action Requested

Legislation strongly supported by AMHCA has been introduced by Senators John Barrasso (R-WY) and Debbie Stabenow (D-MI) in the Senate and by Representatives Chris Gibson (R-NY) and Mike Thompson (D-CA) in the House. The legislation extends independent provider status to mental health counselors (MHCs) and marriage and family therapists (MFTs) services under part B of the Medicare program. The time for Medicare recognition of MHCs and MFTs is now. The identical bills are numbered S.1830/HR.2759 and are known as “The Seniors Mental Health Access Improvement Act of 2015.”

Background and Justification

About 50 percent of rural counties have no practicing psychiatrists or psychologists. MHCs and MFTs are often the only mental health providers in many communities, and yet they are not now recognized as covered providers within the Medicare program. These therapists have equivalent or greater training, education and practice rights as currently eligible provider groups that can bill for mental health services through Medicare.

Other government agencies already recognize these professions for independent practice, including the National Health Service Corps, the Dept. of Veterans’ Affairs and TRICARE. Medicare needs to utilize the skills of these providers to ensure that beneficiaries have access to necessary mental health services.

• Lack of Access in Rural and Underserved Areas--Approximately 77 million older adults live in 3,000 mental health professional shortage areas. Fully 50 percent of rural counties in America have no practicing psychiatrists, psychologists, or social workers. However, many of these mental health professional shortage areas have MHCs whose services are underutilized due to lack of Medicare coverage.

• Medicare Inefficiency--Currently, Medicare is a very inefficient purchaser of mental health services. Inpatient psychiatric hospital utilization by elderly Medicare recipients is extraordinarily high when compared to psychiatric hospitalization rates for patients covered by Medicaid, VA, TRICARE, and private health insurance. One-third of these expensive inpatient placements are caused by clinical depression and addiction disorders that can be treated for much lower costs when detected early through the outpatient mental health services of MHCs.

• Underserved Minority Populations--The United State Surgeon General noted in a report entitled Mental Health: Culture, Race, and Ethnicity that “striking disparities in access, quality, and availability of mental health services exist for racial and ethnic minority Americans.” A critical result of this disparity is that minority communities bear a disproportionately high burden of disability from untreated or inadequately treated mental disorders.

• Medicare provider eligibility for MHCs and MFTs is long overdue--These two professions represent over 40 percent of today’s licensed mental health practitioners. Unfortunately, Medicare has not been modernized to recognize their essential contribution in today’s health delivery system. Congressional scoring rules obscure the dollars saved by utilizing their services to treat mental health conditions before they exacerbate physical disorders or become more serious mental illness.

Please direct inquiries to James K. Finley, Associate Executive Director:

The Baby Boomers

A Living Example of a Population Needing Social Advocacy

By: James J. Messina, Ph.D., CCMHC, NCC, DMHCS


Aging is a powerful social force affecting every aspect of our society. Our society is being forced by the presence of large numbers of older people (formerly known as the Baby Boomers) to confront and examine the nature of productivity, consumption, employment, physical functioning, government services and finances, family relations, and community life. For the first time in history, most humans will experience a new phase of life known as "retirement" which is a time that can include more leisure time and expanded opportunities for productivity, but also reduced financial resources and greater functional limitations (Whittington & Kunkel., 2013). It is imperative that Clinical Mental Health Counselors are knowledgeable about this worldwide revolution in aging, both for its personal implications and for its likely impact on the field of both mental and physical health in our nation.


A real obstacle of graduate trainees in Clinical Mental Health Counseling being fully prepared to work with the Baby Boomers is that there low status and low pay associated with geriatric care and this contribute to the perception that gerontology studies in CMHC training is not viable and this deters qualified faculty from specializing in the field of Geriatric Clinical Mental Health Counseling. Few academic institutions, even in the United States, have sufficient faculty expertise in the array of disciplines constituting gerontology and geriatrics (Perkinson. 2013).


The "Baby Boomer" period, from 1946 to 1964, refers to a bubble of growth in the U.S. population. About 76 million baby boomers were born. In 2013 older Americans (65 and older) made up about 12% of the U.S. population. By 2030, when the baby boomers retire, the number of Americans aged 65 and older will more than double to 71 million or roughly 20% of the U.S. population (Calogero & Halfmann, 2009). A major public policy concern in the healthcare field is the potential burden this aging society will place on this care-giving system and public finances. The "2030 problem" involves the challenge of assuring that sufficient resources and an effective service system are available in 2030, when this aging elderly population will be at its peak (Knickman & Snell, 2002). The growing number of oldest-old adults with mental health needs will exacerbate the current shortfall of healthcare providers who have geriatric mental health expertise, raising critical questions about who will care for elders’ psychosocial and mental health needs (Hooyman & Unützer, 2010). There clearly is a need to train specialists in geriatric mental health care and further development and funding of models of care in which available specialists collaborate effectively with primary care and other healthcare providers should become a national priority (Hooyman & Unützer, 2010). When compared with the aging populations in ten countries in Europe, unfortunately American adults reported worse health than did European adults, as indicated by the presence of chronic diseases and by measures of disability. At all levels of wealth, Americans were less healthy than their European counterparts (Kinsella, Beard & Suzman, 2013).


The American Psychological Association (2008) offered a blueprint for achieving integrative healthcare solutions for older populations. An integrated healthcare model is characterized by a high degree of collaboration between various health professionals serving patients at all stages of care, including assessment, treatment planning and implementation, and evaluation of outcomes. It is more collaborative than hierarchical in its organization and has a strong capacity to flexibly meet challenges of diverse presentations and circumstances. This model is appropriate across a variety of settings (primary care, residential care) and could be adopted in both developed and developing nations as an aspirational model for excellence in geriatric care (APA, 2008). It appears that a major international trend is to consider using interdisciplinary care systems for both health and mental health care services for the emerging geriatric populations of the oldest of the old (Pachana, 2013).


What impact has the Baby Boomer Generation had on American Society you ask? First is Social change, this generation grew up in an era when attitudes were changing on a variety of issues. They grew up to be more tolerant of the differences among people and for that reason this generation has been responsible for changes in attitudes, opinions, and even laws that protect the rights of women, racial minorities and the LGBT community. Secondly this generation gave birth to a new way of making music from the psychedelic to folk music and they brought Rock and Roll into the music culture of American. Thirdly Baby Boomers have been successful economically, earning the highest wages in the history of this country and have contributed to about 77% of the wealth accumulated in America. Fourth this generation will have a major impact on the Social Security System due to their large numbers and there is a fear they will drain the social security system resulting in a need to explore new ways to secure retirees in the future. Lastly their biggest impact will be on Healthcare (Greenblatt, 2007). A Fifth issue is the diversity of religious and spiritual beliefs which Baby Boomer bring with them. Baby Boomrs bring a different spiritual and religious background with diverse beliefs about afterlife and different worldview which bring more challenges to healthcare professionals including Clinical Mental Health Counselors (Ai & McCormick, 2010).


The following Healthcare related facts about this age group make it clear that Clinical Mental Health Counselors will need to be open to providing Behavioral Medical Services to them since:

  • More than six of every 10 Boomers will be managing more than one chronic condition.
  • More than one out of every three Boomers – over 21 million – will be considered obese.
  • One of every four Boomers – 14 million – will be living with diabetes.
  • Nearly one out of every two Boomers – more than 26 million – will be living with arthritis (AHA, 2007).


There is an Ageist Myth that the oldest of the old have greatest mental health problems, but anxiety and depression prevalence rates published in numerous countries for diverse groups counter this, and yet a stereotype of depression and anxiety being "normal" in later life remains. The U.S. Centers for Disease Control (CDC, 2008) noted that contrary to popular belief, older adults older than age 65 do not report experiencing frequent mental distress, and lifetime histories of depression and anxiety are low (10.5 percent and 7.6 percent, respectively). These percentages are lower than those reported for adults ages 50 to 64 years (19.3 percent and 12.7 percent, respectively) (CDC, 2008).


Ageism is an issue which needs to be addressed when looking at the Baby Boomer Generation, there is an increased awareness of the legal consequences of global aging. One area of substantial legal activity in many countries regarding older persons is protection against discrimination. Discrimination on the basis of age may take place in housing, health and human services, insurance, income security, consumer transactions, and many more contexts. The sphere of actual or potential age discrimination that has drawn the most attention internationally is employment—particularly in this age of global economics (Kapp, 2013). Clinical Mental Health Counselors need to be equipped to assist this aging population as it faces blatant or not so blatant age discrimination in all aspects of their lives.


There is another consideration which must be considered namely despite variations, the cultural concept of retirement in most industrialized and many developing nations is bound to the existence of systems of economic support for elders. By scaling back or restricting access to these systems, cuts to entitlement programs would call into question deep-seated cultural assumptions about work, retirement, and age (McNamara, & Williamson, 2013). Clinical Mental Health Counselors must be ready to deal with emotional consequences among the Baby Boomer Generation if their entitlements experience funding cuts or even elimination. 


The World Health Organization (WHO) has taken action to discover essentials needed to create age-friendly cities. WHO consultation among older adults, service providers, and other stakeholders in thirty-three countries resulted in an active aging framework defined as "... the process of optimizing opportunities for health, participation, and security, in order to enhance quality of life as people age" (WHO, 2007). This definition does not focus only on measures to be taken once an older person becomes disabled or is in great need, but advocates for care to be available earlier in life, as a person ages, so the chance for optimal health and well-being may be maintained as long as possible (Collins, Wacker & Roberto, 2013).


Clinical Mental Health Counselors need to understand that to effectively work with the Baby Boomer Generation will take a village. For example: the way work is organized can change to take advantage of older workers' potential. Education can change to foster lifelong learning. Healthcare can move toward an emphasis on preserving good health and promoting healthy lifestyles that reduce disabilities and dependency in later life. New technology can be developed that enables people in later life to experience fewer limitations. Public policy can change to provide incentives for volunteering in later life. Religious organizations can move beyond seeing older people merely as a group in need of help to seeing them as a resource for ministry (Uhlenberg, 2013).




Ai, A.L. & McCormick, T.R. (2010). Increasing diversity of Americans' faiths

alongside baby boomers' aging: Implications for chaplain intervention in health settings. Journal of Health Care Chaplaincy, 16(1/2), 24-41.  DOI: 10.1080/08854720903496126.


American Hospital Association and First Consulting Group. (2007). Report: Boomers

will change health care. Retrieved at:‎


American Psychological Association. (2008). Blueprint for change: Achieving integrated health care for an aging population. Washington, DC: Author.


Calogero, B. & Halfmann, A.M. (2009). Will the baby boom bust healthcare? Retrieved at:‎


Collins, S. M., Wacker, R.R. & Roberto, K.A. (2013). Considering quality of life for older Adults: A view from two countries. Journal of the American Society on Aging, 37(1), 80-86.


Finkelstein, E.S., Reid, M.C., Kleppinger, A., Pillemer, K. & Robison, J. (2012).

Are baby boomers who care for their older parents planning for their own future long-term care needs? Journal of Aging & Social Policy. 24(1), 29-45. DOI: 10.1080/08959420.2012.630905.


Greenblatt, A. (2007). Aging baby boomers: Will the ‘youth generation’ redefine old? CQ Researcher, 17(3), 865-888. Retrieved at:


Hooyman, N. & Unützer, J. (2010). A perilous arc of supply and demand: How can America meet the multiplying mental health care needs of an aging population. Journal of the American Society on Aging, 34(4), 36-42.

Kapp, M.B. (2013). Looking at age discrimination laws through a global lens. Journal of the American Society on Aging, 37(1), 70-75.


Kinsella, K., Beard .J. & Suzman, R. (2013). Can populations age better, Not just live longer? Journal of the American Society on Aging, 37(1), 19-26.


Knickman, J.R. & Snell, E.K. (2002). The 2030 problem: Caring for aging baby boomers.Health Services Research, 37(4), 849-884.


McNamara, T.K. & Williamson, J.B. (2013).  What can other countries teach us about retirement? Journal of the American Society on Aging, 37(1), 33-38.


Pachana, N.A. (2013). A global snapshot of mental health issues, services and policies. Journal of the American Society on Aging, 37(1), 27-32.


Pandey, S.K. (2002). Assessing state efforts to meet baby boomers’ long-term care needs: A case study in compensatory federalism. Journal of Aging & Social Policy, 14 (3/4), 161-179.


Perkinson, M.A. (2013). Gerontology and geriatrics education: New models for a

demographically transformed world. Journal of the American Society on Aging, 37(1), 87-92.


SangNam, A., Smith, M. L., Dickerson, J. B. & Ory, M. G., (2012) Health and health care utilization among obese and diabetic baby boomers and older adults.. American Journal of Health Promotion, 27 (2), 123-132. 10p. DOI: 10.4278/ajhp.111013-QUAN-366.


Uhlenberg, P. (2013).  Demography is not destiny: The challenges and opportunities of global population aging. Journal of the American Society on Aging, 37(1), 12-18.


U.S. Centers for Disease Control and Prevention and the National Association of Chronic Disease Directors. (2008). The state of mental health and aging in America. Issue brief: What do the data tell us? Atlanta, GA: National Association of Chronic Disease Directors.


Whittington, F.J. & Kunkel, S.R. (2013). Think globally, Act locally: The maturing of a

worldwide science and practice of aging. Journal of the American Society on Aging, 37(1), 27-32.


Winston, N.A. & Barnes, J. (2007). Anticipation of retirement among baby boomers. Journal of Women & Aging, 19 (3/4), 137-159.


World Health Organization (WHO). (2007) Global age-friendly cities: A guide, Retrieved at:

When engaged in social advocacy, it is important that CMHCs and CMHC students have an awareness of the international game changer for Human Right declared by the United Nations In 1948 (UN, 1948). It contains principles which CMHC’s need to use today when formulating their own plans for social advocacy.


Universal Declaration of Human Rights (UDHR) (UN, 1948)

Article 1: All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood.

Article 2: Everyone is entitled to all the rights and freedoms set forth in this Declaration, without distinction of any kind, such as race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status. Furthermore, no distinction shall be made on the basis of the political, jurisdictional or international status of the country or territory to which a person belongs, whether it be independent, trust, non-self-governing or under any other limitation of sovereignty.

Article 3. Everyone has the right to life, liberty and security of person.

Article 4. No one shall be held in slavery or servitude; slavery and the slave trade shall be prohibited in all their forms.

Article 5. No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment.

Article 6. Everyone has the right to recognition everywhere as a person before the law.

Article 7. All are equal before the law and are entitled without any discrimination to equal protection of the law. All are entitled to equal protection against any discrimination in violation of this Declaration and against any incitement to such discrimination.

Article 8. Everyone has the right to an effective remedy by the competent national tribunals for acts violating the fundamental rights granted him by the constitution or by law.

Article 9. No one shall be subjected to arbitrary arrest, detention or exile.

Article 10. Everyone is entitled in full equality to a fair and public hearing by an independent and impartial tribunal, in the determination of his rights and obligations and of any criminal charge against him.

Article 11. (1) Everyone charged with a penal offence has the right to be presumed innocent until proved guilty according to law in a public trial at which he has had all the guarantees necessary for his defence. (2) No one shall be held guilty of any penal offence on account of any act or omission which did not constitute a penal offence, under national or international law, at the time when it was committed. Nor shall a heavier penalty be imposed than the one that was applicable at the time the penal offence was committed.

Article 12. No one shall be subjected to arbitrary interference with his privacy, family, home or correspondence, nor to attacks upon his honour and reputation. Everyone has the right to the protection of the law against such interference or attacks.

Article 13. (1) Everyone has the right to freedom of movement and residence within the borders of each state. (2) Everyone has the right to leave any country, including his own, and to return to his country.

Article 14. (1) Everyone has the right to seek and to enjoy in other countries asylum from persecution. (2) This right may not be invoked in the case of prosecutions genuinely arising from non-political crimes or from acts contrary to the purposes and principles of the United Nations.

Article 15. (1) Everyone has the right to a nationality. (2) No one shall be arbitrarily deprived of his nationality nor denied the right to change his nationality.

Article 16. (1) Men and women of full age, without any limitation due to race, nationality or religion, have the right to marry and to found a family. They are entitled to equal rights as to marriage, during marriage and at its dissolution. (2) Marriage shall be entered into only with the free and full consent of the intending spouses. (3) The family is the natural and fundamental group unit of society and is entitled to protection by society and the State.

Article 17. (1) Everyone has the right to own property alone as well as in association with others. (2) No one shall be arbitrarily deprived of his property.

Article 18. Everyone has the right to freedom of thought, conscience and religion; this right includes freedom to change his religion or belief, and freedom, either alone or in community with others and in public or private, to manifest his religion or belief in teaching, practice, worship and observance.

Article 19. Everyone has the right to freedom of opinion and expression; this right includes freedom to hold opinions without interference and to seek, receive and impart information and ideas through any media and regardless of frontiers.

Article 20. (1) Everyone has the right to freedom of peaceful assembly and association. (2) No one may be compelled to belong to an association.

Article 21. (1) Everyone has the right to take part in the government of his country, directly or through freely chosen representatives. (2) Everyone has the right of equal access to public service in his country. (3) The will of the people shall be the basis of the authority of government; this will shall be expressed in periodic and genuine elections which shall be by universal and equal suffrage and shall be held by secret vote or by equivalent free voting procedures.

Article 22. Everyone, as a member of society, has the right to social security and is entitled to realization, through national effort and international co-operation and in accordance with the organization and resources of each State, of the economic, social and cultural rights indispensable for his dignity and the free development of his personality.

Article 23. (1) Everyone has the right to work, to free choice of employment, to just and favourable conditions of work and to protection against unemployment. (2) Everyone, without any discrimination, has the right to equal pay for equal work.(3) Everyone who works has the right to just and favourable remuneration ensuring for himself and his family an existence worthy of human dignity, and supplemented, if necessary, by other means of social protection. (4) Everyone has the right to form and to join trade unions for the protection of his interests.

Article 24. Everyone has the right to rest and leisure, including reasonable limitation of working hours and periodic holidays with pay.

Article 25. (1) Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control. (2) Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection.

Article 26. (1) Everyone has the right to education. Education shall be free, at least in the elementary and fundamental stages. Elementary education shall be compulsory. Technical and professional education shall be made generally available and higher education shall be equally accessible to all on the basis of merit. (2) Education shall be directed to the full development of the human personality and to the strengthening of respect for human rights and fundamental freedoms. It shall promote understanding, tolerance and friendship among all nations, racial or religious groups, and shall further the activities of the United Nations for the maintenance of peace. (3) Parents have a prior right to choose the kind of education that shall be given to their children.

Article 27. (1) Everyone has the right freely to participate in the cultural life of the community, to enjoy the arts and to share in scientific advancement and its benefits. (2) Everyone has the right to the protection of the moral and material interests resulting from any scientific, literary or artistic production of which he is the author.

Article 28. Everyone is entitled to a social and international order in which the rights and freedoms set forth in this Declaration can be fully realized.

Article 29. (1) Everyone has duties to the community in which alone the free and full development of his personality is possible. (2) In the exercise of his rights and freedoms, everyone shall be subject only to such limitations as are determined by law solely for the purpose of securing due recognition and respect for the rights and freedoms of others and of meeting the just requirements of morality, public order and the general welfare in a democratic society. (3) These rights and freedoms may in no case be exercised contrary to the purposes and principles of the United Nations.

Article 30. Nothing in this Declaration may be interpreted as implying for any State, group or person any right to engage in any activity or to perform any act aimed at the destruction of any of the rights and freedoms set forth herein.


The UDHR affirms the human dignity and worth of every person and these basic rights guarantee individual autonomy, full inclusion and participation in society, and the right to social development and higher standards of life and freedoms. As such, professionals must be taught to recognize human rights violations both abroad and within their own communities and areas of service (Barrett, 2011).


American Mental Health Counselors Association (AMHCA) (2010). AMHCA Code of

Ethics. Alexandria Virginia: AMHCA Retrieved from


Barrett, J. A. (2011). Multicultural social justice and human rights: Strategic

professional development for social work and counseling practitioners. Journal for Social Action in Counseling and Psychology3(1), 116.


Bruhaker, M.D., Puig, A., Reese, R.F. & Young, J. (2010). Integrating social justice into

counseling theories pedagogy: A Case Example. Counselor Education & Supervision, 50(December), 88-102.


Chang, C.Y. Crethar, H.C. & Ratts, M.J. (2010). Social justice: A national imperative for

counselor education and supervision. Counselor Education & Supervision,50(December), 82-87.


Chang, C. Y., Hays, D. G., & Milliken, T. F. (2009). Addressing social justice issues in

supervision: A call for client and professional advocacy. The Clinical Supervisor28(1), 20-35.


Crethar, H. C. & Ratts, M. (2008). Why social justice is a counseling concern. Retrieved

from, October 6, 2013.


Glosoff, H.L. &. Durham, J.C. (2010). Using supervision to prepare social justice

counseling advocates. Counselor Education & Supervision,50(December), 116-129.


Greenleaf, A. T., & Williams, J. M. (2009). Supporting social justice advocacy: A

paradigm shift towards an ecological perspective. Journal for Social Action in Counseling and Psychology, 2(1), 1-14.


Kiselica, M.S. & Robinson, M. (2001). Bringing advocacy counseling to life: The history,

issues, and human dramas of social justice work in counseling. Journal of Counseling & Development, 79(Fall), 387-397.


Lewis, J., Arnold, M. S., House, R., & Toporek, R. (n.d.). Advocacy competencies: Task

force on advocacy competencies. Retrieved October 14, 2013, from


Lewis, J. A., Ratts, M. J., Paladino, D. A., & Toporek, R. L. (2011). Social justice

counseling and advocacy: Developing new leadership roles and competencies. Journal for Social Action in Counseling and Psychology3(1), 5-16.


Lewis, J. A., Toporek, R. L., & Ratts, M. (2010). Advocacy and social justice: Entering

the mainstream of the counseling profession. ACA Advocacy Competencies: A social justice framework for counselors, 239-244.


Murray. C.E., Pope, A.L. & Rowell, P.C. (2010).Promoting counseling students’

advocacy competencies through service-learning. Journal for Social Action in Counseling and Psychology, 2(2), 29-47.


Nilsson, J. E., Schale, C. L., & Khamphakdy‐Brown, S. (2011). Facilitating trainees'

multicultural development and social justice advocacy through a refugee/immigrant mental health program. Journal of Counseling & Development89(4), 413-422.


Ratts, M. J. (2009). Social justice counseling: Toward the development of a fifth force

among counseling paradigms. The Journal of Humanistic Counseling, Education and Development48(2), 160-172.


Ratts, M.J. & Hutchins, M. (2009) ACA Advocacy competencies: Social justice

advocacy at the client/student level. Journal of Counseling and Development, 87(Summer), 269-275.


Ratts, M. J., Lewis, J. A., & Toporek, R. L. (2010). Advocacy and social justice: A

helping paradigm for the 21st century. ACA advocacy competencies: A social justice framework for counselors, 3-10.


Smith, S.D., Reynold, C.A. & Rovnak, A. (2009). A critical analysis of the social

advocacy movement in counseling. Journal of Counseling & Development, 87(Fall), 483-491.


United Nations (1948). The Universal Declaration of Human Rights. New York: UN

Retrieved at:





Now that you have read this section, in “My Graduate Training Journal” record your answers and reactions to the following questions:

  1. How will this information help me as a Clinical Mental Health Counselor?
  2. How open will I be once I become a Clinical Mental Health Counselor to engage in social advocacy?
  3. How responsive will I be to what AMHCA says about its professional members engaging in advocacy for their clients?
  4. Will I be willing to ask the soul searching questions that CMHCs must ask themselves as they forge ahead to do social advocacy?
  5. What means and methods will I be willing to use as a CMHCs if and when I engage in social advocacy?
  6. What are some major issues that I feel strongly about, that once I become a CMHC, I could engage in social advocacy?
  7. What did I take away from reading UN’s Universal Declaration of Human Rights of 1948?
  8. How much am I hearing about the major social advocacy issues which AMHCA and the field of CMHC has dealt with since 1976?
  9. What do I want to learn more about social advocacy for CMHCs?