Land of 10,000 Lakes and Exceptional Vision

Having the 121st Annual APA Convention in Honolulu, Hawaii was extraordinarily memorable for the 11,400 registrants and HPA.  The vision, vitality, and enthusiasm of the next generation were infectious.  From a health policy perspective, it was especially gratifying to see the extent to which new career psychologists and graduate students were actively embracing the notion of integrated, patient-centered care which is the hallmark of President Obama’s landmark Patient Protection and Affordable Care Act (ACA).  Unprecedented change, driven primarily by historically escalating costs and a new appreciation for the potential contribution of the advances occurring in communications technology (i.e., electronic health records, comparative effectiveness research, and telehealth), is rapidly impacting the nation’s healthcare environment.  Cynthia Belar described how from the APA Education Directorate’s vantage point, psychology’s training institutions and internship sites are successfully adapting to the changing demands of the 21st century.  Personally, one of the most gratifying presentations at the convention was the symposium chaired by Patti Johnson, who has now served in the U.S. Army for over 20 years, addressing the unique psycho-social needs of military families and especially their children.  The nation’s protracted conflicts have had a significant impact upon the behavioral health of military children and youth.  Patti’s panel discussed a number of innovative programs that were making a real difference.  All of psychology owes President Don Bersoff our gratitude for his vision and passion in developing special Presidential programmatic initiatives focusing upon how psychology can contribute to the nation’s responsibility for our Wounded Warriors and their families.

I currently have the opportunity of serving at the Uniformed Services University of the Health Sciences (USUHS) (DoD) where psychology and nursing have made a special, and in my judgment visionary, commitment to fostering true interdisciplinary training.  “As a graduate student in the clinical psychology doctoral program at USUHS, I study alongside advanced nursing students.  Participating in interdisciplinary classes has taught me that psychology and nursing share similar goals and pursue complementary research questions.  When looking for allies to improve the health care of our warriors and our nation, nurses and psychologists have to look no further than to each other.  And, by collaborating in our formative years, we maximize our impact as team-based healthcare providers (Joanna Sells).”

A Breath of Populism 

During the nearly four decades that I had the honor of working for U.S. Senator Daniel K. Inouye, I found that his colleagues from Minnesota were truly inspirational in their commitment to providing high quality health care for all Americans.  In the early days, right across the corridor was the office of Senator Walter Mondale – a definite friend of psychology.  Senator Hubert Humphrey, who was eventually honored by having the headquarters of the Department of Health and Human Services named after him, was forever actively engaged in numerous policy debates.  Senator David Durenberger, in his Senate Finance Committee capacity, was a visionary in fostering comprehensive bipartisan health care initiatives – perhaps, having seen first-hand the extraordinary accomplishments of the world-renowned Mayo Clinic.

The Wellstone Legacy

Those of us who choose careers in psychology and thereby learn to appreciate the value of the behavioral sciences owe so much to Senator Paul Wellstone, who worked tirelessly across the political aisle with Senator Pete Domenici to enact their far reaching Mental Health Parity legislation.  This effort ultimately led to the critical integration of mental (behavioral) health care into the mainstream of primary care as envisioned in the President’s ACA.  Over the years there has been much discussion regarding the unfortunate stigma associated with receiving mental health treatment.  Ken Pope recently shared that change may finally be coming.  Mental health and substance addiction treatment has long been the stepchild of our health care system.  However in 2009, public and private mental health spending totaled approximately $150 billion, more than double its level in inflation-adjusted terms in 1986.  The ACA will provide the largest expansion of mental health and substance use disorder coverage in a generation, with 32.1 million Americans gaining access to these services, while another 30.4 million currently with some coverage will gain federal parity protection.  This Fall, the Military Officers Association of America and the National Defense Industrial Association hosted their 2013 Warrior-Family Symposium “Mental Health: Linking Warriors and Their Families, Government and Society.”  The program took a broad look at mental health and the challenges ahead, particularly in a post-war environment.  They addressed: 1) What is the scope of mental health among our military members, veterans, and their families?  2) What are the mental health implications to individuals, government, and society?  And, 3) What are some of the innovative solutions taking place in the mental health field?  This is a call-to-action on ways that individuals and organizations can affect change to help warriors and their families today and tomorrow.  When I arrived on Capitol Hill, on the first day of the infamous Watergate hearings, such a public discussion of mental health issues would have been unheard of.  The efforts of Senator Wellstone and his colleagues have made a real difference.  Mahalo.

RxP – An Evolution

There were also a number of exciting presentations in Hawaii addressing the maturation of psychology’s prescriptive authority (RxP) agenda, which directly relates to the profession demonstrating a “value-add” contribution (citing Katherine Nordal) within integrative healthcare delivery systems.  Bob McGrath, who directs the Fairleigh Dickinson University RxP training program, estimates that 60 percent of the mental health medications prescribed today are ordered by primary care providers who possess considerably less mental/behavioral health training than psychologists or advanced practice mental health nurses.  Illinois’s Beth Rom-Rymer coordinated a number of these visionary programs and noted the importance of remembering those who demonstrated vision long before their cause became popular.  “I very much appreciate the emphasis on RxP in our federal systems.  Bob Ax, Randy Taylor, and Kathy McNamara deserve commendation for initiating the conversation about opening up the federal agencies to RxP and keeping these conversations in the forefront of our intentions.  It was Bob and Randy who put out the RFP in 2007 for psychopharm training programs to offer scholarships to psychologists in public service venues who wanted to be RxP trained.  And, then, it was CSPP at Alliant International University that was awarded the opportunity to search for major gifts so that Alliant/CSPP could train these 100 public service psychologists.  Alliant/CSPP has now trained about 50 public service psychologists.  I’m certain that more psychologists will want to be trained when we have additional states and federal agencies hiring RxP psychologists.  As we know, there is a desperate need for RxP in the VA as well as in the prison system.”  Over my years of involvement within the public policy process, I have come to appreciate that those with vision and persistence do extraordinarily well in our evolving health care environment.  Aloha.

Pat DeLeon served as APA President in 2000.  He retired recently as chief of staff after 38-plus years working for US Senator Daniel K Inouye.  He is a member of the Institute of Medicine.  This year he received the APA Gold Medal Award for Practice.   

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The Minnesota Psychological Association actively encourages the participation of all psychologists regardless of age, creed, race, ethnic background, gender, socio-economic status, region of residence, physical or mental status, political beliefs, religious or spiritual affiliation, and sexual or affectional orientation.Although we are an organization of individuals from diverse cultures and backgrounds, the Minnesota Psychological Association also recognizes our core unifying identities as Psychologists who practice in America. We also recognize that we may hold unintentional attitudes and beliefs that influence our perceptions of and interactions with others. Within this context of unity and self-exploration, we are committed to increasing our sensitivity to all aspects of diversity as well as our knowledge and appreciation of the unique qualities of different cultures and backgrounds.We aspire to becoming alert to aspects of diversity, previously unseen or unacknowledged in our culture. In this spirit, we are committed to collaborating with multicultural groups to combat racism and other forms of prejudice as we seek to promote diversity in our society. To this end, we are dedicated to increasing our multicultural competencies and effectiveness as educators, researchers, administrators, policy makers, and practitioners.