Anxiety disorders are the most common mental health condition in the United States, affecting approximately one-third of the population.¹ They frequently co-occur with depression, substance, and other anxiety-related conditions. Anxiety disorders are disproportionately associated with a variety of chronic disease risk factors, such as nicotine use, alcohol consumption, and sedentary behaviors, and chronic diseases, such as cardiovascular disease, diabetes, and asthma.² The public health impact of untreated anxiety disorders is staggering. The adjusted estimated annual economic impact of anxiety disorders is $62 billion through disability, lost wages, and healthcare costs.³ Although highly effective treatments exist for anxiety, only a minority of patients with clinical anxiety receive some form of care. Unfortunately, even among those individuals being actively treated for their anxiety disorder, very few are receiving pharmacotherapy and/or psychotherapy that meet evidence-based practice guidelines.⁴

Cognitive behavioral therapy (CBT), especially exposure-based interventions, is the most effective treatment for anxiety disorders. ⁵ CBT is highly acceptable to patients, and typically outperforms evidence-based pharmacotherapy in the longer-term maintenance of treatment gains.⁶ Although access to CBT remains challenging, large-scale efforts are being made to change health care delivery systems to improve the dissemination of evidence-based treatments.

The original intent of this article was to inform MPA’s membership of our promotion from the Health Care Reform Task Force to the Health Care Reform Committee (HCRC), describe the HCRC’s relatively short history, and report current/future goals (but more about that later in this article).

Given recent changes announced by Medicare, however, it seems more prudent to focus providing information gleaned by the HCRC (and other MPA member/committees) regarding such.  Trisha Stark, Ph.D., L.P., provided the following link for the HCRC’s 5/2/16 monthly call-in committee meeting:  http://healthaffairs.org/blog/2016/04/29/breaking-down-the-macra-proposed-rule/   Dr. Stark is chair of MPA’s Electronic Healthcare Records Task Force and an HCRC committee member. 

Award:  Susan T. Rydell Outstanding Contribution to Psychology Award (two award winners)

Winners:  Rochelle Brandl, Ph.D., L.P. and Mary Tatum Howard, Ph.D.

Hello to all, my name is Steve Girardeau and I am your president-elect for MPA.  I will serve my presidential year in 2017 beginning my presidency at the same time as the individual we elect to be our next national president.  I offer the observation not because I think my presidency will be as important or impactful for the nation but to connect the processes of the national, state and local elections to our national and state associations. 

In both arenas there has been a great deal of polarization and acrimonious shouting about issues rather than a drive to participate in a rationale discourse on the issues that face us both as a nation and more to the point of this article, as an association.  MPA has weathered a difficult year, the year of EHR implementation, thanks to the strong leadership of Scott Palmer.  The most striking news of 2015 being that quite a few vocal individuals who had not been all that involved in MPA seemed to believe that MPA was a silent partner to the Minnesota Department of Health in the creation and implementation of the EHR mandate.  Having been active in the legislative committee and governing council, and having attended MPA conventions in the years leading up to 2015, I was surprised at their surprise.  MPA had informed the membership of the process as it proceeded, requested feedback, and provided informational content at the conferences in those years.  There was little notice paid and little concern expressed.  It was only after implementation was upon us and there was a direct impact on people’s immediate practice that there was surprise, disappointment and frustration that, “something should have been done.”

I always have thought of MPA’s Annual Convention as much like the Minnesota State Fair for psychologists.  Complete with psychology’s version of admission discounts, a Mid-way area, a Grandstand line-up, vendors displaying items of interest to just about anyone, games of skill and chance, and blue ribbon awards. This year’s MPA Annual Convention has something for every Minnesota Psychologist.  We even will have our own version of free entertainment!  Please play along with me as I expand upon this fun analogy.

When you arrive at The Crowne Plaza Minneapolis West Hotel in Plymouth on April 15 & 16, you will check in at the registration table where you will be given a nametag, your pre-purchased ticket to everything at the convention.  If for some reason you haven’t yet purchased a ticket, no worries!  Rhea Sullivan, MPA’s Administrative Director, and one of the convention Visitor Guides, will help you get registered so that you will be ready for two days of action-packed fun!  And, if you are new to MPA, she also will let you know about the huge membership discount available to you only at the convention.  Yes, that’s right.  If you have never been a member of MPA, or if your membership lapsed at least three years ago, you can become a full dues-paying MPA member for a discount of $200.  It’s a bargain only offered during the Great Minnesota Psychology Get-Together!

MPA members received the APA Division 31 APAGS Award for an Outstanding State, Provincial, or Territorial Association of the Year at the APA State Leadership Conference in Washington, D.C. Front row, from left to right: BraVada Garrett-Akinsanya, Cynthia (C.J.) Swanlund, Robin McLeod, Sy Gross.  Back row, from left to right: Matthew Syzdek, Daniel Kessler, Yasmine Moideen, Bruce Bobbitt and Willie Garrett.

The Minnesota Psychological Association (MPA) is pleased to announce the formation of the new division, Psychologists in Healthcare Organizations (PHO). The PHO division was developed to serve as a resource for psychologists employed in health care settings or interested in working in health care settings, and to assist with the growth and integration of behavioral medicine services into medical practices, clinics, and centers.

The landscape of health care continues to change, and as part of it, delivering effective, yet affordable and safe health care has received greater emphasis. This has been a focus of both government agencies and the private sector alike. Behavioral medicine has attempted, with mixed results, to address this area for years by forging relationships with medical practices. In primary care settings, psychologists screen medical patients for mental health conditions and triage to appropriate mental health care. In neurology groups, psychologists assist with diagnosing patients and making treatment recommendations. In Sleep Centers, psychologists treat insomnia patients, in lieu of prescription sleep medications. Despite these additions, the overall integration of psychologists into medical centers has been slow, uneven, and mostly untapped.

The social revolution of the 1970s coined the word “marginalized” to describe the experiences of those who live on the fringe of mainstream America.  Such persons are systematically excluded from full participation in the American dream and consequently lack the self-efficacy to improve their life situation.  In the end, society pays the costs when people encounter barriers to achieving their potential.  The term marginalized has expanded from originally referring to minorities and persons from poverty, to include a long list of cultures and populations.  Here is a sample of the most common marginalized groups:

• GLBT
• Senior citizens
• Racial/Cultural minorities
• Military Combat Veterans
• Persons of below average intelligence
• Hearing, visually, and Physically  Challenged Persons
• Persons with a serious and Persistent Mental Illness (SPMI)
• Persons with Cognitive Impairments
• Gamblers and Substance Abusers
• Autism Spectrum Persons
• Gifted and Talented Persons
• Persons with disfigurements
• Persons Living in Poverty
• Sex Offenders
• The Homeless
• Felons

While this is only a listing of those most commonly referred to as marginalized, there are other individual people who just do not fit into mainstream culture, and suffer the same consequences. Such persons are all around us but virtually invisible…unless they cause problems or disrupt the lifestyles of mainstream persons.

The Minnesota Psychological Association recognizes the many years of service to the people of Minnesota with his passing on March 13, 2016. He was an exceptional person and served us with dignity and caring. He was in the U.S. Congress 28 years, 1979-2006, after extensive service in the Minnesota legislature. Congressman Sabo, and his staff, were supportive to the position and visits by Minnesota psychologists sharing his wisdom and time. At one visit during the APA State Leadership Conference he spent more than an hour with two of us, Steve Peltier, Ph.D., L.P. and Sy Gross, Ph.D., L.P., which is  much more time than typical, then or now. We benefitted from his informed ideas about fiscal integrity necessary to seek legislation with his service on the key House Appropriations Committee all of his career in Congress, and Chair of Budget Committee, 1993-94.  He appreciated the challenge faced by psychologists.  His successor in the U.S. Fifth District, Rep. Keith Ellison, has continued being supportive to professional psychology. The Minnesota Psychological Association honors and respects Congressman Martin Olav Sabo.

Written by Sy Gross, Ph.D., L.P., who is the Current Federal Advocacy Coordinator for MPA for the past 12 years, a previous MPA President, and on the Council of Representatives for APA.  His doctoral degree was received from the University of Minnesota Clinical Psychology program and he currently does clinical work at Hennepin County Mental Health Center. His specialization is with persons who are homeless.

MISSION

Minnesota’s Health Professionals Services Program protects the public by providing monitoring services to regulated health care professionals whose illnesses may impact their ability to practice safely.

In late 2015, NAMI Minnesota received another MNsure grant to help people with mental illnesses and their family members obtain health insurance. In addition, NAMI Minnesota is working to educate individuals on how insurance works and how to utilize the benefits offered.  Two fact sheets on health insurance basics have been written, are on our website, and can be sent on request. Presentations are also being offered. Here are some health insurance terms that you or your clients will learn with these fact sheets and at these presentations:

Premium – Monthly amount paid for health insurance plan. This amount must be paid whether or not you actually use your health insurance.

As Chair of the Oklahoma Colleague Assistance program for the Oklahoma Psychological Association, I have been involved in helping establish a colleague assistance program over the past several years.  A critical turning point in my efforts occurred while working clinically with other health care professionals.  I began to examine the practice acts for various disciplines (i.e., medicine, nursing, pharmacy) and this led me to wonder how our psychology practice act compared.  I determined six areas in which we differed significantly from our health professional peers in Oklahoma.  I have posed these in the form of questions below.  Even if you have a formal Colleague Assistance Program (CAP) in your state, it may be useful to review your state’s practice act as it lines up with the workings of your CAP.  It may help to obtain a copy of your state’s psychology practice/licensing act as you read through the list.

1. Does your practice act contain a reference to practicing with skill and safety that can be compromised by substance abuse and/or a psychiatric condition?  Does your state practice act go further to include medical conditions and neurocognitive conditions which can impair functioning?  Language about impairment is fairly commonplace in practice acts, but knowing how impairment is defined in your practice act is important.
2. What does your state practice act say about reporting an impaired colleague?  In Oklahoma, there is no explicit mandate in their licensing act for psychologists to report.  Other professions in Oklahoma are explicit about a mandate to report impaired colleagues, and some professionals (e.g., physicians) are required to report across health profession lines.  In some states, like Oregon, there is a requirement to make such reports within a specific time period, 10 days (ORS 676.150, signed into law January 1, 2010).
3. Related to reporting an impaired colleague, does your state practice act grant civil and criminal immunity if the report is made in good faith?  In our Oklahoma psychology practice act, this is not addressed.
4. Will your colleague know that you reported her/him to the licensure board? In Oklahoma, the psychologist being reported to the licensure board will receive a copy of the Request for Inquiry (i.e., complaint form) that is sent to the board.  This complaint form contains a description of what is being alleged and the name and contact information of the person making the report.  Other boards in Oklahoma provide statutory protection of the identity of the person filing a complaint.  This of course, lowers the threshold for reporting.
5. Does your state practice act require you to answer questions upon annual renewal of your license regarding impairment, treatment, or current suitability to practice with skill and safety?  In Oklahoma, this is not addressed in the practice act.  Other health professional boards do include a section in their practice act regarding continued suitability to practice with skill and safety. In addition, the licensee is required to complete an annual attestation about suitability or continued ability to practice with skill and safety, among other questions such as legal problems.
6. Does your state practice act empower your state licensure board to create or affiliate with an entity that can aid in addressing impairment among psychologists?  In Oklahoma, the ability of our licensure board to affiliate with a program was not explicitly outlined in the practice act or Rules of the Board. An interpretation of the board rules by the State Attorney General’s Office determined that the licensure board had the authority to establish such an affiliation. Consequently, our licensure board moved forward with an agreement that allows psychologists to participate in the state's physician monitoring program. 

Examining our psychology practice act in Oklahoma and comparing it to the practice act of our healthcare professional peers illuminated some stark differences.  When I presented these differences at our annual state psychological association meeting several years ago it created strong momentum to make changes. 

1)    What is your background in psychology (e.g., education)?

I work as a psychologist, speaker, author, and art playgroundist. The common thread through out these is my colorful pursuit of the human heart: to listen deeply for the stunning beauty within, to address what may be getting in the way of seeing the beauty and fully living it out, and to reflect it back to people with spoken and published words, art, and even in my colorful clothing. My education is from the University of Minnesota’s Ed Psych/CSPP program.  I’ve counseled 22 years since then, and am currently in a solo St. Paul private practice.

Until relatively recently, yoga, meditation, and non-traditional spirituality – as opposed to classical religious practices – were widely perceived in the West as esoteric pursuits with little to offer mainstream society. Now they are highly-valued, prominent fields of endeavor with massive cultural buy-in. Having dedicated 40+ years to this “questionable arena,” it is rewarding to note the positive shift in public opinion, and, the appreciable enhancement such activities have made on so many lives. In fact, writing an article like this is challenging because there is no longer a dearth of information on the topic but, rather, an exhaustive volume of research requiring extensive time to read, process, and apply. On the up side, an abundance of scientific literature now attests to a range of psycho-social and body/mind benefits resulting from meditation and Sacred practices, (i.e., pertaining to religion or spirituality). Fortunately, these positive outcomes are no longer points of anecdotal testimony subject to academic dispute, but, matters of established fact. For psychologists then, several especially relevant questions arise regarding how to include this domain within the scope of practice. Specifically, when is it appropriate to engage patients on topics pertaining to the Sacred, meditation, and related activities? When is it viable to suggest patients explore such in adjunctive alignment with on-going therapy? And, when should these topics or practices not be addressed?

Such questions require more time and space to address than this brief article allows. Accordingly, readers may find additional value and a more comprehensive understanding of these issues in theAPA Handbook of Psychology, Religion, & Spirituality (Pargament, 2013).  However, to capsulize two key areas let me answer the last question first: Psychotic patients and those with too severe a character disorder are best served by not engaging in mystical or meditative pursuits as such activities could de-stabilize their mental coherence or trigger added psychiatric complications. However, many less severe patients confronting depression, anger, anxiety, stress, hypertension, addiction, insomnia, chronic pain, or, mild-to-moderate neuroses, defensiveness, compromised self-awareness, and self-destructive behaviors may benefit considerably from intelligently applied meditation if they are sufficiently motivated to practice. There is even related evidence suggesting that therapists who engage in meditative practices themselves, or hold to compassionate spiritual paradigms, may passively contribute to enhanced therapeutic outcomes.

1)  What is your background in psychology (e.g., education)?

I’m currently a student at St. Mary’s University – Rochester. I am working on my bachelors in psychology and plan to obtain my Master’s degree in Organizational Psychology.

The Society of Behavioral Medicine (SBM) and American College of Sports Medicine (ACSM) recently released a position statement calling for health plan coverage for exercise interventions for serious mental illness (Pratt et al., 2015).  The position statement states that, “The Society of Behavioral Medicine and the American College of Sports Medicine encourage legislation and policies for Medicare, Medicaid, and private insurers to reimburse exercise programming for people with serious mental illness treated in community mental health programs.”  Currently, exercise programs designed to treat mental illness are not reimbursable through Medicaid, Medicare, or private insurers.

Research indicates that exercise is related to improvements in both physical and mental health (Lobelo et al., 2014).  Specifically, lack of exercise is related to several health issues including increased risk of heart disease, hypertension, and stroke (AHA, 2015).  Regarding mental health, exercise is effective for treating depression (Cooney et al., 2013).  Furthermore, studies have found that exercise is just as effective as antidepressant medication for treating depression (Blumenthal et al., 2007).  Despite these benefits, only 20% of individuals with serious mental health illness exercise at the recommended levels to obtain these health benefits and over 80% are overweight or obese (Bartels & Desilets, 2012; NIH, 2013).  The recommendation is that healthy individuals engage in five or more day of moderate intensity physical activity for at least 30 minutes each session or three or more days of vigorous intensity physical activity for at least 20 minutes per session (Haskell et al., 2007).  Behavioral interventions are efficacious for increasing exercise among individuals with severe mental illness (Rosenbaum et al., 2014); however, these types of interventions are typically not reimbursed by health insurers.

Nominations for each of three MPA Teaching Awards (Graduate Faculty in Psychology, Mink Outstanding Undergraduate Teacher Award, Outstanding Teaching of Psychology in Community/Two-Year Colleges) should be submitted to the MPA Office no later than Friday, March 4, 2016.  The criteria and nomination process for each award are outlined below.  Questions can be directed to Jack Rossmann at Macalester College ([email protected]).

MPA Award for Outstanding Graduate Faculty in Psychology

Most people enjoy dogs and find great pleasure in having them around. All of that is fine, but there is a growing trend among those who want to be with their dogs that should be of particular concern for psychologists.

Psychologists are frequently being asked by their patients to attest to their need for an Emotional Support Animal (ESA) for mental health purposes, which allows that animal to be present in what previously would have been a restricted environment.