The enthusiasm for the future which was so palpable among the Early Career attendees at our recent Honolulu convention was similarly evident within that subset of the approximately 325 participants this Fall at the Illinois Psychological Association (IPA) annual convention, "Advocating for Psychology and Our Community: The Time is Now." There can be little question that the enactment of President Obama's landmark Patient Protection and Affordable Care Act (ACA) will bring unprecedented change to our nation's health care environment. The law envisions educated consumers (i.e., patients) taking responsibility for their own health care, including capitalizing upon the advances occurring almost daily within the communications and technology fields. We will gradually transform from a fundamentally illness-oriented approach to one which places a priority upon prevention, wellness, and data-based care that emphasizes holistic, interdisciplinary, and integrated services. Educational institutions will have to carefully consider whether they are really exposing their students to healthcare information and experiences (e.g., nutrition, exercise, resilience, etc.) or are they merely reinforcing an illness-oriented status quo that is comfortable.
Building upon the current Medicaid system, the ACA will provide for the largest expansion of mental health and substance-use 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. Under the law, insurance offered in the new marketplace must cover a core set of "essential health benefits," which includes mental health and substance-use disorder services. Within this overarching federal framework, the implementation process now moves to the individual state level. Historically, unfortunately, organized psychology has been less than enthusiastic about serving the Medicaid and Medicare beneficiary populations. Change is always unsettling and takes time, often far longer than one might initially expect, especially fundamental change. Today's practitioners will undoubtedly experience significant "pain" as the projected changes are steadily implemented. The next generation, however, will thrive – as long as the field of psychology remains relevant and continues to attract "the best and brightest." The ACA provides significant challenges and for those with vision, exciting opportunities. Especially, we would suggest, for those with an underlying commitment for serving society.
IPA's Call to Action: "Why am I such a strong proponent of advocacy for ourselves, as psychologists? Because if we don't advocate for ourselves, who will? We advocate for ourselves because we identify ourselves in the world as psychologists. We as individuals feel more empowered when we stand up, publicly, and declare that psychologists can make a difference in the world: with our patients, in the business and corporate world, in community agencies, in the criminal justice and civil litigation system, in government, in medicine. How do we advocate for ourselves? We develop a statement of purpose and a rationale. We talk to friends and colleagues and we sign up a core group of interested people, who will hopefully become a group of highly enthusiastic, fervently committed, deeply engaged, inner circle people! We figure out a plan for implementation. Why should we advocate for others? Because we are not solitary figures in our world. We depend on others and others depend on us. Because we are compassionate in the face of suffering. We advocate for others because, as we strengthen others, we strengthen ourselves. Today, we help others. Tomorrow, others help us. Insularity is suffocating. Personal gain only is short-sighted and limiting. We live in an interdependent world where there is knowledge and richness in diversity and pallor in sameness. Why must we advocate, now, for our community and our profession? There is no time to lose. Our national healthcare system is at a critical juncture. Hundreds of thousands of new patients will join the state Medicaid rolls as of January 1st. Approximately 250,000 of them will be diagnosed with a mental illness. Our mental health system is not equipped to care for these new patients. We, as psychologists, can make a difference and it is up to us to be at the forefront of change in the ways in which mental health care is delivered in our state. Obtaining prescriptive authority is a critical step. Either we rise to meet the challenge of our society's healthcare crisis or we run the risk of getting swept away by the incoming tide of change. There is no other time but now [IPA President Beth Rom-Rymer]."
The Illinois Psychological Association prescriptive authority legislation (RxP), after considerable open and public debate, passed their Senate by a vote of 37-10-4. Their chief Senate Sponsor is Don Harmon, the President Pro-Tem of the Senate. With their lobbyists, IPA's leadership made the critical strategic decision to spend the next 12 months educating psychologists and legislators around the state on RxP issues, rather than immediately press for a House vote. Theirs is a two year legislative session. As always, "we live in interesting times."
The Educator's Voice: "We don't hear nearly as much about RxP in APA as we once did. I think the combination of a long lull in getting bills passed, combined with continuing criticism of RxP by what turns out to be a pretty tiny group, has taken some of the wind out of the sails. Sometimes these days when we're talking about planning for the future of the profession, RxP feels to me a little bit like your crazy Uncle Alfred. Everybody knows it's still around and going strong, but you're not supposed to mention it in polite company. It's too bad, because instead we should be celebrating the accomplishments of our prescribing psychologists. We have several who have been decorated by the military. We have brethren who have joined the Indian Health Service (IHS) for the opportunity to work in truly disadvantaged communities. We have prescribers in Federally Qualified Community Health Centers and in Cancer Care Centers, and who have been deployed to help in major disasters. We should be proud of our 20+ year record as a prescribing profession, not making believe it's not there [Bob McGrath, Director of the Fairleigh Dickinson University Clinical Psychopharmacology and Integrated Primary Care programs]."
A Voice from The Past: "Volunteering is a wonderful vehicle for professional and community service. In retirement, the opportunities abound. Volunteering has afforded me many opportunities to find satisfaction and fulfillment in giving back to others. My experience volunteering in the community during my 'retirement' has given me a wonderfully fulfilling life outside of psychology. In Columbia, South Carolina, I deliver Meals on Wheels, exercise special needs dogs at Howlmore Animal Sanctuary, and teach line dancing. I have also coordinated group service opportunities through my church to persons who are homeless. I was recently honored to be the first 'runner up' for a national volunteer award given by the Meals on Wheels Association of America. I endorse Marian Wright Edelman's belief that 'Service is the rent we pay for living.' It has made retirement 'golden' for me, and many others [Mike Sullivan, former NYSPA President and APA State Advocacy guru for 13 years]." Aloha,
Pat DeLeon, former APA President – NYSPA – November, 2013
