Over the coming decade professional psychology will increasingly embrace its generic health psychology expertise. As Education Directorate visionary Cynthia Belar has noted: "There is nothing new about interprofessional education, team based care, or integrated care. What is new is the national recognition of its importance for 'Crossing the Quality Chasm' (Institute of Medicine (IOM)) and the increasing calls for such by leaders in medical education. Psychologists in health settings have often provided team based care, but training for such has usually begun at the internship or postdoctoral levels. With the focus on interprofessional competencies there are increased demands for interprofessional education in the earliest stages of training, where students can learn with and from each other and before stereotypes get rigidified. Early involvement in interprofessional education provides a challenge for doctoral programs housed in colleges of arts and sciences or universities without other health professions students, but one not impossible to meet. In fact the Graduate Psychology Education (GPE) program of HRSA, of which APA was the architect, has since its inception required the training of psychologists with at least two other health professions for receipt of grant funds. We have said before how federally qualified health centers (FQHCs) and departments of internal medicine, pediatrics, and family practice can provide invaluable experiences in training for team-based primary care. Programs that want to prepare health service providers should run, not walk, to these settings and work to establish collaborative opportunities for training." President Obama's landmark Patient Protection and Affordable Care Act (ACA), with its distinct emphasis upon increasing access to patient-centeredprimary health care, provides a number of incentives for interdisciplinary care and interdisciplinary training. We would suggest that this (re)volution provides the public sector with an unprecedented opportunity to demonstrate critical clinical leadership while developing truly innovative partnerships with psychology's (and professional nursing's) training institutions, in order to effectively deliver gold standard care for its beneficiaries.
The IOM recently issued another futuristic report "Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation." Two-thirds of adults and almost one-third of children in our nation today are overweight or obese. This epidemic of excess weight is associated with major causes of chronic disease, disability, and death. Its annual cost is estimated at $190.2 billion. After reviewing hundreds of prior strategies for their promise in accelerating obesity prevention, the IOM mapped out how the most promising interacted with, reinforced, or slowed each other's progress. This "systems approach" resulted in several specific recommendations including: * Make physical activity an integral and routine part of life. * Create food and beverage environments that ensure that healthy food and beverage options are the routine, easy choice. * Transform messages about physical activity and nutrition. * Expand the roles of health care providers, insurers, and employers. And, * Make schools a national focal point. The IOM stressed that because obesity is such a complex and stubborn problem, a bold, sustained, and comprehensive approach is needed. Action must occur at all levels – individual, family, community, and the broader society – with ongoing assessment of progress being key as efforts move forward. Obesity risks are often disproportionate among minority, low-income, less educated, and rural populations, due to inequitable distribution of health promotion resources and community risk factors that contribute to disparities in obesity prevalence. We would suggest that those individuals and their families who primarily rely upon the services of the public sector would be particularly at risk and that the psychosocial and behavioral skills of advanced practice nurses and psychologists could be extraordinarily cost-effective. University of Hawaii President MRC Greenwood served as vice chair of the IOM committee.
Those in attendance at the APA Orlando Opening Ceremonies could clearly appreciate that addressing obesity was an extremely high priority for President Suzanne Bennett Johnson. Suzanne bestowed well deserved Lifetime Recognition awards on Kelly Brownell and Rena Wing for their decades of pioneering, standard-setting work. And yet, we are also aware of significant emotional "push back" she has received from a vocal subset of the membership. Perhaps this contingent, which does not believe that obesity should be of serious concern to psychology, feels that it is a "medical" problem and that we only deal with "mental health" issues. Or, perhaps they feel that talking about obesity "stigmatizes" individuals and therefore by addressing psychology's potential contribution, one is being discriminatory. A smaller subset apparently even believes that "obesity is a myth," notwithstanding considerable scientific and clinical evidence to the contrary. Thankfully, our next generation continues to expand their horizons. Lia Billington, who is a prescribing psychologist in New Mexico, is currently conducting a fellowship with the Society of Teachers of Family Medicine. As part of this experience, she is working on a "scholarly project" to be presented at their national meeting this summer. Her hypothesis is that there are a number of prescribing/medical psychologists who are significantly contributing to Medical Education (formally or informally) and is attempting to track them down [lia.billington@gmail.com].
Impressive Learning Opportunities in the Public Sector: "After the War – The Uniformed Services University of the Health Sciences (USUHS) Medical and Clinical Psychology Department provided a recent seminar from the perspective of a Wounded Warrior's family member. Stacy Fidler is the mother of Marine Lance Corporal Mark Fidler, who was severely wounded in Afghanistan on the 3rd of October, 2011, while on foot patrol, after being in country less than two weeks. While the initial blast took off one leg below the knee and the other leg above the knee, the extensive and complicated injuries to his entire body required that the surgeons amputate from the pelvis down. Considered a miracle by many in the medical community, Mark was not expected to survive. Stacy's unflagging support and advocacy are, no doubt, an integral part of his survival and her continued dedication to her son ensures that he receives the best care available.
"Stacy is not a professional speaker, but she has a way of relating her story to an audience. She sat on a chair in the middle of the stage and easily, but passionately, told the story of how her life has changed in the last year and a half. She discussed the initial shock and confusion she felt upon hearing the news that her son was seriously wounded in a blast. She recalled hastily packing a bag to travel to Walter Reed and the excruciatingly slow hours until she could see her son. She discussed the many painful surgeries that he has undergone, and the effects on him and those around him. Stacy shared how her son feels phantom pain in his missing legs every day, but how he fears the pain going away because then he won't feel his legs at all. Stacy discussed the need for healthcare providers to build rapport with the Wounded Warriors, and to never forget that they are still people, and not just a name on a round.
"Stacy also shared amusing stories about how Mark was in such pain that he could not see President Obama when he came to visit the Walter Reed hospital. This 'refusal' led to Mark being investigated and out on a watch list. Stacy discussed how her son had learned to adapt to his situation with his internal fortitude. For instance, he has surfed by standing on his hands. He also claims that push-ups are much easier now. It has been Mark's sense of humor that helps him through the toughest times. For instance, he likes to occasionally bark at people just to see what their reactions will be. Stacy was honest about the difficulties they have faced with coordinating care and finding resources. She discussed how the family and caretaker community help one another, both emotionally and also with information on programs, drug interaction, providers, and medical procedures. Stacy related the great need to never forget that a Wounded Warrior is not their injury. They have an injury, but they are still the person they were before. Mental health professionals working with these young men and women must keep in mind aspects that go beyond the direct injury. For instance, she shared the story of one 19-year-old Wounded Warrior who will never be able to have sex with his wife again, and the effects on that relationship and his own self-esteem.
"There were many more stories, each presented with candor, wit, and the bitter taste that only comes from experience. Yet, she also related humor, and the sweet feeling of hope that comes from strength. Stacy presented on the day that Mark was being prepped for another surgery, a skin graft for the severely burned areas of his back. The next day Mark had the surgery and he is recovering well. After a year and a half, Stacy and Mark's journey is still far from over, but it is obvious from whom Mark received his great strength and determination to continue. Even as a Wounded Warrior, Mark continues to exemplify the greatest characteristics of the Marine Corps and the military in general. And so does his mother, Stacy. To you both I say, 'Semper Fi' [Steven Brewer]." We would remind the readership that this is at a time when the media reports that more troops were lost to suicide in 2012 than in combat. "Knowing is not enough; we must apply. Willing is not enough; we must do" (IOM/Goethe).
The 113th Congress: On January 24, 2013 Pamela Hyde, Administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA), testified before the U.S. Senate that SAMHSA's mission is to reduce the impact of substance abuse and mental illness on America's communities. SAMHSA envisions a Nation that acts on the knowledge that: * Behavioral health is essential for health. * Prevention works. * Treatment is effective. And, * People recover from mental and substance disorders. In order to fulfill this mission, SAMHSA has identified eight Strategic Initiatives to focus the Agency's work on improving lives and capitalizing on emerging opportunities. SAMHSA's top Strategic Initiatives are: Prevention; Trauma and Justice; Health Reform; Military Families; Recovery Supports; Health Information Technology; Data, Outcomes and Quality; and Public Awareness and Support.
Acutely aware of the Newtown tragedy and citing the work of psychologist John Monahan, the Administrator noted that behavioral health research and practice over the last 20 years reveal that most people who are violent do not have a mental disorder and that most people with a mental disorder are not violent. In fact, those with mental illness are more likely to be the victims of violent attacks than the general population. Demographical variables such as age, gender, and socioeconomic status are more reliable predictors of violence than mental illness. She further testified that almost half of all Americans will experience symptoms of a mental health condition at some point in their lives. Yet today, less than one in five children and adolescents with diagnosable mental health problems receive the treatment they need. And, only 38% of adults with diagnosable mental health problems – and only 11% of those with diagnosable substance use disorders – receive needed treatment.
Integration -- Given that behavioral health is essential to an individual's overall health, SAMHSA administers the Primary and Behavioral Health Care Integration (PBHCI) program. The purpose of this program is to improve the physical health status of people with serious mental illnesses (SMI) by supporting communities to coordinate and integrate primary care services into publicly funded community mental health and other community-based behavioral health settings. It is focused on increasing the health status of individuals based on physical or behavioral health need, encouraging structural changes in existing systems to accomplish its goals. To date, the program has awarded 94 grants and 55% of awardees are partnering with at least one Federally Qualified Health Center (FQHC). [Recall Cynthia Belar's vision]. This integration has resulted in significant physical and behavioral health gains.
In concluding, the Administrator reaffirmed that President Obama's ACA advances the field of behavioral health by expanding access to behavioral health care; growing the country's behavioral health workforce; reducing behavioral health disparities; and implementing the science of behavioral health promotion. The most recent data indicates that the national expenditure on mental health care was $113 billion and for substance abuse $22 billion in 2005. With Medicaid already being the largest payer of mental health services, the ACA will extend Medicaid coverage to as many as 17 million hardworking Americans. SAMHSA's number one strategic initiative is Prevention of Substance Abuse and Mental Illness, including fulfilling the public health promotion component of ACA. Aloha,
Pat DeLeon, former APA President – Division 18 – February, 2013
