THE IMPORTANCE OF COMMITMENT

    Lessons From The Past:  Recognizing the importance of addressing the federal government in its role as a "payer of care," in the mid-1970s psychology's visionary "dirty dozen" (Rog Wright, Nick Cummings, Herb Dorken, Gene Shapiro, Jack Wiggins, etc.) focused upon the necessity of having psychology recognized under the Department of Defense (DoD) Civilian Health and Medical Program of the Uniformed Services (CHAMPUS).  CHAMPUS provided reimbursement for the health care expenses of 7.9 million military dependents and retirees for those services they were not able to receive at military health care facilities.  In FY'1985, the CHAMPUS budget request was $1.4 billion.  Since Fiscal Year 1976, clinical psychologists have been expressly enumerated as autonomous providers with "medical or psychological" necessity being the recognized criteria for reimbursement.  Those actively involved in expanding psychology's legislative presence over the years, at the state and federal level, are well aware of how helpful this precedent has been.

            CHAMPUS has now evolved into TRICARE which currently provides necessary health care to over 9 million eligible beneficiaries, including active duty uniformed personnel and their dependents, eligible members of the Reserve Component and their dependents, and uniformed services retirees and their dependents and survivors.  It provides care through both military and nonmilitary hospitals, clinics, and other providers.  It is administered on a regional basis utilizing managed care support contractor networks of civilian providers in each of its North, South, and West regions.  There are three basic options for non-Medicare eligible beneficiaries.  Having worked closely with the leadership of TriWest (which is responsible for serving Hawaii), we are personally aware of how supportive they have been to psychology and other non-physician providers, as well as working closely with their community partners.  The FY'2013 budget request for TRICARE is $48.7 billion, a 300% increase over FY'2001.

A Vision of National Health Care:  During the Congressional deliberations on President Obama's landmark Patient Protection and Affordable Care Act (commonly known as the Affordable Care Act (ACA)), the military retiree community vocally resisted its programs being impacted by this new initiative.  However since ACA has become public law, strategic modifications have been evolving; for example, extending dependent coverage up to the age of 26.  And, as the decades-long efforts to revamp the military health care system into an integrated Defense Health Agency continue, as well as discussions regarding DoD and VA health initiatives becoming increasingly coordinated -- for example in the telehealth and electronic medical records areas -- psychology mustcontinue its efforts to systematically expand its presence in each of these critical federal initiatives.  Fundamental change as envisioned under ACA always takes time; however, especially with the unprecedented advances occurring within the communications and technology fields (i.e., Health Information Technology), the ultimate vision of an integrated federal health care delivery system is becoming increasingly robust.

A Very Real and Pressing Need:  The armed conflicts that our nation has been involved with over the past decade should highlight the need for psychology's active involvement with military personnel and their families.  Testifying before the Senate Armed Services Committee in June, 2010 the then-Vice Chief of Staff of the Army noted: "Our nation has asked a lot of our Soldiers and they have exceeded expectations by a long shot.  However, the prolonged demand on them –and on their families – continues to put a significant strain on our Force.  Many individuals have deployed multiple times.  They are tired.  A significant number of them suffer physical injuries….  Many more suffer from behavioral health issues, such as depression, anxiety, traumatic brain injury and post-traumatic stress – often referred to as the 'invisible wounds of war'….  Our overarching goals are to improve individuals' resiliency; eliminate the long-standing, negative stigma associated with seeking and receiving help; and, ensure Soldiers, Army Civilians and Family Members who may be struggling get the help that they need."

Experts report that since the start of the Iraq War in 2003, the rate of suicide among U.S. Army soldiers has soared, with an 80% increase between 2004 and 2008, paralleling increasing rates of depression, anxiety, and other mental health conditions.  Prior to 2003, their suicide rate closely matched the rate of suicide in the civilian population and was even on a downward trend.  Nurse researchers at theUniformed Services University of the Health Sciences (USUHS) report that deployment separation is definitely stressful on military families, with one fourth of military spouses reporting not being able to manage daily stress during deployment separation.  During the first Gulf War, spouses of deployed soldiers had stress scores nearly twice as high as spouses of nondeployed soldiers.  Eighty-five percent of Army wives listed deployment as the most stressful situation they had experienced in the past 5 years, with 70% of these spouses being symptomatic for depression and anxiety.  Unintended weight gain or loss is a problem to a large extent for 30% of Army spouses during deployment.  One of the major challenges of post 9/11 military life is repeated deployment separation and frequent extensions.

Being Present – Being Heard:  We have recently been informed that a number of our colleagues are experiencing significant difficulty in becoming recognized providers under TRICARE, with some even being informally led to believe that since sufficient numbers of psychologists have already been enrolled in the various panels, there is little contractor interest in accessing new providers.  Clearly, this stance is inappropriate from both a beneficiary and provider frame of reference.  We would suggest that it is psychology's responsibility to affirmatively address this issue and further, that those providers who feel that unrealistic barriers are being imposed upon them should bring this to the attention of DoD, probably most effectively through their own elected officials in the U.S. House of Representatives or U.S. Senate.  Members of Congress are extraordinarily responsive to concerns brought to their attention by theirconstituents.  If psychology does not collectively ensure that our practitioners are valued under TRICARE, why should we expect that other federal initiatives, especially in these extraordinarily tight budgetary times, will appropriately recognize our clinical expertise?  Given the demonstrated psychological needs of those serving our nation today and their families, we would also urge that serious consideration be given to working with (i.e., volunteering for) "Give an Hour."  Psychologist Barbara Van Dahlen has done a wonderful job in providing behavioral health care services to military personnel and their families, as well as systematically addressing the historical stigma noted by the former Army Vice Chief of Staff in his Congressional testimony.  A major responsibility of every learned profession is to provide proactive and visionary leadership in addressing society's needs.  Aloha,

 

Pat DeLeon, former APA President – National Register – March, 2012