Former APA President Ron Fox recently addressed our health policy class at the Uniformed Services University of the Health Sciences (USUHS). Responding to a question regarding the future of professional psychology, given the apparent ever increasing interest in master's level practitioners, the former Dean was quite optimistic. He proffered that the "tools" psychology is teaching its future generations will be very valuable. The challenge will be developing effective venues to utilize these skills beyond boutique practices where, for example, those specializing in serving children will undoubtedly always be able to find concerned "loved ones" willing to pay for quality care. Ron emphasized the importance in today's health care environment of psychology's practitioners being able to work collaboratively within medical systems, which the President's recently enacted Patient Protection and Affordable Care Act (ACA) would undoubtedly consider providing "integrated" patient-centered care.
From a health policy perspective, thereis considerable interest in utilizing the skills of alternative providers. In the Department of Defense, for example, Behavioral Health Technicians (BHTs) have had impressive success in providing treatment for patients with behavioral health problems such as substance abuse, sexual assault and domestic violence, social issues, and posttraumatic stress disorder (PTSD). These practitioners collect the required data from clients and are responsible for unit training on various behavioral health topics. Under the supervision of a licensed provider (including mental health nurses), the enlisted BHTs conduct initial interviews, perform assessments, provide follow-up care, administer psychological tests, assess patient response to rehabilitation or treatment, co-facilitate group therapy sessions, and perform Combat and Operational Stress Control (COSC) functions. Perhaps most surprising for USUHS students was the realization of how much independent work the BHTs perform while deployed. Due to the lack of licensed mental health providers, they work alone for weeks or months at a deployed site where they conduct the initial assessment, create a treatment plan, conduct individual or group therapy, and even make medication recommendations. They work under the auspice of the behavioral health provider assigned to that camp or region through a precept method. The Army and Navy currently employ approximately 1200 BHTs between them.
Earlier this year the U.S. Senate conducted a hearing "Assessing the State of America's Mental Health System." SAMHSA Administrator Pamela Hyde noted that behavioral health is essential to an individual's overall health and that the ACA will provide one of the largest expansions of mental health and substance abuse coverage in a generation by extending health coverage to over 30 million Americans, including an estimated 6-10 million with mental illness. She pointed out that Medicaid is the largest payer of mental health services, with the ACA extending Medicaid coverage to as many as 17 million additional individuals and their families. And, she expressed her willingness to take a leadership role in funding "Mental Health First Aid" training for teachers. Project AWARE proposes $15 million for training teachers and other adults who interact with youth to detect and respond to "mental illness," including how to encourage adolescents and families experiencing these problems to seek treatment.
Another witness expressed considerable enthusiasm for this initiative, describing it as evidence-based practice that represents early intervention and early detection that – if implemented broadly enough -- could permit America's community mental health providers to help millions in distress. The 12 hour training was described as somewhat similar to first aid classes taught by the Red Cross for physical health conditions. The importance of having a diverse array of training audiences is the key to the program's public health approach. In Colorado, instructors have conducted training with the State Sheriff's Association and the Colorado Department of Corrections, with the goal of training all of the State's corrections and parole officers. A number of the Governor's Cabinet and Department Heads have received the training and plans are underway to train all rabbis in the Denver Metropolitan area, as well as various school district and higher education personnel. The unfortunate Aurora shooting has been a critical catalyst. We would rhetorically ask: Are our State Psychological Associations involved in this potentially exciting "grass roots" movement? Aloha,
Pat DeLeon, former APA President – Division31 – March, 2013
