Kathleen M. Pike, PhD

The First Lady of Mental Health

The young man in the photo below with US First Lady Rosalynn Carter is my dear friend and colleague, Dr. Harold Pincus. This photo hangs adjacent to his office door. Over the years, I have passed it too many times to count. It has prompted many stories about mental health advocacy. Harold was a young psychiatrist and Robert Wood Johnson Fellow who had the opportunity to work with Mrs. Carter on the 1978 President’s Commission on Mental Health. Talk about being in the right place at the right time!

The smiles on their faces tell a story of victory. They were celebrating a major milestone in Mrs. Carters’ lifelong advocacy for mental health. She has had many more occasions to celebrate in the ensuing decades. To recognize the extraordinary impact that Mrs. Carter has had advancing mental health, last month at the 2021 World Health Assembly, WHO Director General Dr. Tedros Adhanom Ghebreyesus honored Mrs. Carter for her more than fifty years of championing improved access to healthcare for individuals with mental and substance use issues.

1. 1970. Rosalynn Carter’s service as a mental health advocate began as First Lady of Georgia. From the beginning, she adopted mental health as her foremost issue. She was appointed to the Governor’s Commission to Improve Services for the Mentally and Emotionally Handicapped, and many of the Commission’s recommendations were approved and became law. The improvements in care for children as a result of this work were among her proudest achievements. 

2. 1977. During her first interview with the press as First Lady of the United States, Mrs. Carter declared that her priority would be a focus on mental health. She stated that her goal as an advocate was, “For every person who needs mental health care to be able to receive it close to his home, and to remove the stigma from mental health care so people will be free to talk about it and seek help. It’s been taboo for so long to admit you had a mental health problem.” She quickly got to work at the national level.

3. 1978. Mrs. Carter served as honorary chairperson of the President’s Commission on Mental Health. Although Presidential Commissions are not uncommon, this one was groundbreaking. Under President Kennedy, Congress established the Joint Commission on Mental Illness and Mental Health that set the stage for JFK’s landmark Community Mental Health Act of 1963. What distinguishes the work led by Mrs. Carter is that it was the first time that a Presidential Commission focused on mental health care. It is also notable that, convened over forty years ago, this first Presidential Commission on mental health already prioritized diversity and disparities. The report paid major attention to what we now call social determinants of health, such as education, unemployment, discrimination, and poverty. The commission had twelve men and eight women, including three African American, two Hispanic, and one Native American commissioner.

4. 1982. When Mrs. Carter and her husband left Washington, DC, they returned to Georgia where they co-founded The Carter Center, a private, not-for-profit organization. Among other priority issues of the Center, Mrs. Carter’s greatest investment has been in the mental health program. She created and chairs The Carter Center Mental Health Task Force, an advisory board of experts, consumers, and advocates promoting positive change in the mental health field. She also established the Rosalynn Carter Fellowships for Mental Health Journalism to support journalists working to increase public awareness and reduce stigma of mental health issues.

5. 2007. Mrs. Carter’s tireless commitment to improving access to mental health care propelled her to testify before Congress in July 2007. She had been there before as a mental health advocate. This time she was joined by David Wellstone (son of former US Senator Paul Wellstone) to persuade Congress to pass legislation that would require insurers to cover mental health services. When the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 passed, it put mental health coverage on par with coverage for other health conditions – when insurance policies included both types of coverage. Loopholes limited its impact, but the intent of the policy was unmistakable.

In the Pirke Avot, a collection of teachings from the Jewish Talmudic sages, Rabbi Tarfon, who lived 2,000 years ago, says, “It is not your duty to finish the work, but neither are you at liberty to neglect it.” It is in that spirit that I wish to congratulate, salute, and thank Rosalyn Carter for her lifelong commitment to mental health.

Kathleen M. Pike, PhD

Kathleen M. Pike, PhD

Kathleen M. Pike, PhD is Professor of Psychology and Director of the Global Mental Health WHO Collaborating Centre at Columbia University.

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