In April, 1974 Marc Lalonde, your Minister of National Health and Welfare, released his visionary report "A New Perspective on the Health of Canadians." Four decades later, one can appreciate that from a health policy perspective he foresaw the potential contributions of psychology to the health and well-being of society, more clearly than most elected officials and health care professionals. "Past improvement has been due mainly to modification of behaviour and changes in the environment and it is to these same influences that we must look particularly for further advance." "When the full impact of environmental and lifestyle has been assessed, and the foregoing is necessarily but a partial statement of their effect, there can be no doubt that the traditional view of equating the level of health in Canada with the availability of physicians and hospitals is inadequate." In 1979 the U.S. Surgeon General's report "Healthy People" proffered: "Prevention is an idea whose time has come. We have the scientific knowledge to begin to formulate recommendations for improved health…. In fact, of the 10 leading causes of death in the United States, at least seven could be substantially reduced if persons at risk improved just five basic habits…." Integration of psychology within primary care is essential. Former APA President Nick Cummings reported that in the usual primary-care health system, physicians identify about 40% of their patients as needing some form of mental health treatment, but less than 10% actually see a mental health provider. However, when a physician can just walk a patient a few steps down the hall to a psychologist's office, he found that 85% to 90% who needed psychotherapy, and are so walked down the hall, enter treatment.
Times are definitely changing. Cynthia Belar, Executive Director of the APA Education Directorate, has been alerting our educational community to the importance of the next generation being active participants within health caresystems. Team based collaborative care (which requires interprofessional competencies), accountability (which requires skills in quality improvement and assessment of patient outcomes), a population based perspective (which requires an understanding of public health), etc. are skills which must be in the psychologist's toolbox. President Obama's landmark Patient Protection and Affordable Care Act (ACA) encourages the development of patient-centered, integrated systems of care in which data-driven clinical decisions will become integral to "quality care." Interdisciplinary teams will replace solo practices. Health information technology (HIT) infrastructure allowing cross-diagnostic and cross-provider comparisons will be developed. Cynthia's public health/population-based emphasis will be increasingly utilized in establishing programmatic priorities; as will capitalizing upon the potential in the unprecedented advances occurring within the communications and technology fields (i.e., telehealth services, virtual reality consultations, and active patient engagement). Prevention, wellness, and family-oriented care will be the priority. The "gold standard" of care of tomorrow will be based upon findings from competitive effectiveness research protocols. For psychology, involvement in primary care will be an absolute necessity.
Few appreciate that it was the vision of President Lyndon Johnson during his Great Society Era -- at a time when psychologist John Gardner served as Secretary of the Department of Health, Education, and Welfare -- that the network of federally qualified community health centers (FCHCs) was established. Today there are over 9,000 rural and urban communities across the United States receiving high quality, comprehensive care (including behavioral and mental health care) from FCHCs. The magnitude of change was noted in 2006 by the President of the Institute of Medicine. "Dealing equally with health care for mental, substance-use, and general health conditions requires a fundamental change in how we as a society and health care system think about and respond to these problems and illnesses. Mental and substance-use problems and illnesses should not be viewed as separate from and unrelated to overall health and general health care. Building on this integrated concept… the Institute of Medicine will itself seek to incorporate attention to issues in health care for mental and substance-use problems and illnesses into its program of general health studies."
Those fortunate to attend the annual Practice Directorate State Leadership Conferences – which I feel are one of highlights of APA's year – have heard Katherine Nordal passionately remind us: "January 1st is really just a mile marker in this marathon we call health care reform [the ACA implementation date]. We're facing uncharted territory with health care reform, and there's no universal roadmap to guide us. Our practitioners increasingly will need to promote the value and quality they can contribute to emerging models of care. We are a highly educated and talented discipline, and we need to identify and create opportunities to make others aware of the skills and strengths we can contribute to health care. I believe that if we are not valued as a health profession, it will detract from our value in other practice arenas as well. No one else is fighting the battles for psychology… and don't expect them to. We can't hope to finish the marathon called health care reform if we're not at the starting line."
Last year I had the pleasure of participating in the Canadian Psychological Association annual convention in Quebec City. It was a wonderful event and brought home that you are facing challenges very similar to those of colleagues in the United States – especially having society and their elected officials appreciate how psychology can significantly impact the quality of health care, but only if citizens have timely access to our services. Your "Mind Your Mental Health" campaign is extraordinarily timely and important for all of us. The value of appreciating the past was recently underscored by Mike Feuerstein: "Especially in psychology, sorry to say. Someone's innovation is another's past effort. Maybe that is how progress occurs in life and why it takes so long. Can be frustrating but you don't get to see it until you are 'older.'"
Two living former APA Presidents are Canadian (born and raised there) -- Albert Bandura and Frank Farley. Frank, whose father was born in Manitoba, teaches a History & Systems course for which Al (at age 88) joins him via speakerphone every Spring Semester. I had the privilege of serving with Frank on the Board of Directors during his Presidency. His vision and passion truly served both of our nations admirably. The late Donald O. Hebb was the first Canadian elected APA President. Aloha,
Pat DeLeon, former APA President – Manitoba Psychological Association – February, 2014
