THE AGE OF AQUARIUS

Over the years, MPA has provided outstanding vision and leadership at the national level. During my tenure on the APA Board of Directors, I had the pleasure of working closely with future APA Presidents Norine Johnson, Gerry Koocher, and Ron Levant.  MPA members have chaired a number of the major APA policy boards and committees.  Having spent my undergraduate years in your state, I might admittedly be a little biased; however, it did not surprise me that it was the Massachusetts Nurses Association that ultimately convinced their national association to support the independent practice of Advanced Nurse Practitioners.  A number of underlying features of President Obama's landmark Patient Protection and Affordable Care Act (ACA) were undoubtedly inspired by Governor Romney's Massachusetts Health Care Reform legislation.  Collectively, you have a long history of seeing the "bigger picture."  And of course, Great Barrington is the home of Alice's Restaurant – in celebration of which Arlo Guthrie has embarked on the 50^thanniversary tour.

            Times do change.  The APA Council of Representatives has reconstituted its role in order to focus primarily upon major policy issues, and we understand from Dolly Sadow that the Council will be focusing upon "translating Science into Policy" as a mega issue.  The broader underlying issue will be developing Council as a policy making and disseminating body, rather than serving as a passive reactor to initiatives perceived as not of its own making.  How will Council facilitate policy initiatives that are consistent with APA's strategic plan and which speak to society's real needs? – that is the challenge ahead.  As perhaps a first step in this radical paradigm shift, during their February meeting Council heard directly from those who have spent their professional lives being engaged in shaping national policy.  Without question, this is an exciting evolution which will take time to effectively implement.

Reflecting upon our personal interest in policy development, several of us at the Uniformed Services University of the Health Sciences (USUHS) (DoD) recently reviewed the psychology literature on teaching health policy.  Last year, under Nadine Kaslow' s leadership, Council endorsed moving towards Competency-Based education, similar to that which almost all of the other health professions have embraced and which is a cornerstone of the ACA.  Whereas the study of health policy is, for example, a required competency within professional nursing and a priority of public health and social work education, we could find very few references to this notion within psychology.  There were, of course, articles on political advocacy (which in our judgment represents only a small subset of health policy) and an increasing number of social psychology experiments – with the plea that if only used by policy makers these could make a real difference.  However, the fundamental notion of educating future members of the psychology profession about the profession of health policy which possesses its own unique history, language, and nuances seems to be, at best, an afterthought.  Accordingly, Council's new vision truly does represent a major paradigm shift.

            Another graduate from one of the Commonwealth's finest institutions of higher education (albeit not from the oldest women's college in the nation), Heather O'Beirne Kelley heads up APA's Military & Veterans Policy (MVP) team which is working to support military personnel and veterans, their families, and their communities, as well as the psychologists who conduct research with and provide direct services to these populations.  Their priorities for this year range from funding for research at the Departments of Veterans Affairs (VA) and Defense (DoD), to provision of timely, high-quality mental health care in the service member and veterans communities, and establishment of prescription authority (RxP) for appropriately trained and certified psychologists in the VA, matching that which DoD has granted for 17 years.  [Personally, we continue to wonder why MPA has not made this a priority, especially following the impressive success in Illinois last year spearheaded by Beth Rom-Rymer, who incidentally was honored by President Barry Anton at the February Council meeting.]

In terms of research funding, the President's newly released FY'16 budget proposed a nice increase for the VA's intramural research program, so APA and the larger veteran community will support that request.  However, the Administration's budget also proposed a cut to DoD basic research, which the scientific and university community will urge Congress to restore in its annual appropriations process this spring.  APA supports military personnel in seeking and receiving high-quality, effective mental and behavioral healthcare throughout their careers – from enlistment/commissioning through pre-deployment, deployment, and transition to veteran status.  MVP advocacy efforts thus are particularly focused on garnering Administration and Congressional support for issues such as mental health screening and follow-up; access to care; suicide prevention; provision of TRICARE benefits; and supporting communities and other systems (including educational, health, and legal) in understanding and working with veterans.  Your former MPA Executive Director Elena Eisman, who has also served on the APA Board of Directors, picked a fascinating time to transition to our nation's Capital.  Aloha,

Pat DeLeon, former APA President – MPA – February, 2015

 

ALICE’S 50th ANNIVERSARY TOUR

 Having A Timely and Visual Presence:  One of the most exciting aspects of being personally involved in the public policy/political process, which definitely would include participating in the APA governance, is having the opportunity to listen to, and spend unforgettable time with, visionaries who are truly dedicated to their cause.  Psychologists often do not appreciate that they are among our nation's educated elite and as such, have a special responsibility to provide proactive leadership in addressing society's most pressing needs.  I was particularly fortunate to serve as APA President just prior to Norine Johnson's term.  Norine truly appreciated how the nation would benefit from psychology's calming presence right after the horrific 9/11events and with Rhea Farberman's steady guidance, passionately addressed the concerns of our nation's children and their families by engaging the media.

In the days and weeks following, APA, with Norine as its national spokesperson, was active with the news media to help the American public understand the traumatic effect the attacks would have on some individuals.  In the first three days, APA received 166 interview requests.  In one lead interview Norine was part of an hour long CNN special segment.  By mid-October, she had done a number of national interviews and over 2,000 APA members had been interviewed on both the 9/11 and the anthrax attacks.  At her behest, the Public Communications Office created a public information brochure containing advice on how to deal with trauma, what is normal traumatic response, and how to recover.  APA teamed with the Advertising Council and the National Mental Health Association on a public service announcement encouraging parents to talk with their children about the events of 9/11.  Norine also understood the fundamental changes gradually occurring within our nation's health care environment and worked tirelessly to have the APA Council of Representatives, and ultimately the full membership, include "promoting health" in our Association's bylaws.  As President Obama's Patient Protection and Affordable Care Act (ACA) is now being steadily implemented, Norine's vision of more than a decade ago is clearly coming to fruition.

            The Administration's Budgetary Priorities:  The Administration's Fiscal Year 2016 budget request for the Substance Abuse and Mental Health Services Administration (SAMHSA) is $3.7 billion, which includes an additional $103 million funding for its top behavioral health priorities – strengthening crisis systems, addressing prescription drug and opioid abuse, expanding the behavioral health workforce, and fostering tribal behavioral health.  The Administrator: "The impact of untreated behavioral health conditions on people, communities, and healthcare costs in the United States is staggering.  For example, costs for Medicaid enrollees with common chronic conditions and co-occurring mental and substance use disorders are two to four times higher than average Medicaid enrollees….  (A)ddressing behavioral and physical health issues together can reduce costs and improve overall health."

            SAMHSA's budget emphasizes that addressing mental health and substance abuse is critical to the health of individuals and families.  Prevention, treatment, and recovery support services for behavioral health are essential components of health service systems.  Behavioral health remains one of America's most pressing needs, yet it is also one of the most undervalued and least-addressed.  The ACA, in conjunction with the Mental Health Parity and Addiction Equity Act, has the potential to create or enhance access to coverage for behavioral health services for 62 million Americans, nearly one-fifth of the nation's population.  The current behavioral healthcare infrastructure and workforce, however, will need additional capacity to absorb the influx of patients who now will have the coverage to seek treatment.  Behavioral health can, and should, be addressed as a public health issue by ensuring that the programs and policies focus on these tenets: Behavioral health is essential to health; Prevention works; Treatment works; and People Recover.

            "It has been 50 years since President Kennedy first challenged government to do more for individuals with behavioral health conditions.  In recent decades, seeking behavioral health services has become more acceptable and the science that addresses these conditions has advanced….  Many people receive this treatment within the general healthcare system allowing the specialty behavioral health system to focus on the needs of people with the most severe illnesses and/or addictions.  However, even with expanded access to treatment, more than half of people with mental illnesses and 90 percent of people with substance use disorders do not get the services they need.  The nation can do better."

Norine's vision of her profession embracing its role within the nation's evolving health care system was most prophetic.  On a recent HRSA national advisory committee conference call it was emphasized that: "Mental health disorders rank in the top five chronic illnesses in the U.S.  An estimated 25 percent of U.S. adults currently suffer from mental illness and nearly half of all U.S. adults will develop at least one mental illness in their lifetime.  In 2007, over 80 percent of individuals seen in the emergency room (ER) had mental disorders diagnosed as mood, anxiety and alcohol related disorders."  We would suggest that integrated care will become the vehicle for psychology's expansion into the more generic health care environment of the next decade.

Being At The Table:  Heather O'Beirne Kelly heads up APA's Military & Veterans Policy (MVP) team, devoted to supporting military personnel and veterans, their families, and their communities, as well as psychologists who conduct research with and provide direct services to these populations.  Her priorities for the coming year range from funding for research within the VA and DoD, the provision of high quality mental health care in the Service Member and Veterans communities, and establishment of prescription authority for appropriately trained and certified psychologists in the VA, matching that which DoD has granted for 17 years.

            Voices For The Future:  It is similarly informative to reflect upon the views proffered by those colleagues who have expressed a willingness to run for the APA Presidency, which is actually a very small and select group.  Jack Kitaeff, a lawyer and former U.S. Army psychologist, expressed his deep and abiding respect for those who have put themselves "in harm's way" and feels that the issue of veteran's mental health should be of monumental importance.  He would press for psychologists to be trained in treatment regimens targeting post-traumatic stress disorder (PTSD), including prolonged-exposure therapy, cognitive-processing therapy, and cognitive restructuring.  Amazed by how many psychologists are not members of APA, or have never considered becoming involved in the governance, he would seek to actively attract colleagues back to the Association and demonstrate to members that "they are indeed valued."  He would also focus on addressing the chronic shortage of professional psychologists dedicated to serving diverse and marginalized communities (e.g., the poor, those with HIV, diverse family structures, and the workplace), as well as underserved regions of the country.  And finally, Jack called for psychology to remain scientific and affirmatively seek to avoid allowing its advocacy efforts to be driven by ideology rather than science.  Throughout these enumerated aspirations are a number of national policy agendas which could serve the profession admirably.  "And friends they may think it's a movement.  And that's what it is…." (Ron Levant, Opening Session, 2005).  Aloha,

Pat DeLeon, Former APA President – Division 42 – February, 2015

 

INTERPROFESSIONAL COLLABORATION – THE FUTURE

For our nation's health care professionals, these are very "interesting" times.  Change is always unsettling, especially when it is difficult to predict with any sense of certainty what the future will bring.  Under the visionary leadership of APA President Nadine Kaslow, the Council of Representatives endorsed moving towards Competency-Based Education, an approach which has been adopted by nearly every other health care profession.  At the end of last year, the Accreditation Council for Pharmacy Education, Commission on Collegiate Nursing Education, Commission on Dental Accreditation, Commission on Osteopathic College Accreditation, Council on Education for Public Health, and the Liaison Committee for Medical Education formed the Health Professions Accreditors Collaborative (HPAC).  They are committed to discussing important developments in interprofessional education and exploring opportunities to engage in collaborative practice around the common goal of better preparing students to engage in interprofessional collaborative practice.  They anticipate inviting other disciplines to join their effort later this year in response to inquiries.

If one reviews the training models of the other health professions, there is considerable interest (especially within nursing and public health) in exposing their next generation of practitioners to the nuances and importance of appreciating health policy – and how, for example, over the past decade various health policy experts have increasingly urged the nation to emphasize developing systems of care, rather than continuing to rely upon individual practitioner expertise.  Unfortunately, we have observed that such training is relatively rare within psychology's training programs.  Integrated and patient-centered, data-driven holistic primary care provided by interprofessional teams is one of the cornerstones of President Obama's Patient Protection and Affordable Care Act (ACA).  And, it has clearly been a high personal priority for U.S. Army Surgeon General Patty Horoho during her tenure.

Those colleagues trained in providing mental health and/or behavioral health care face significant challenges in effectively addressing our nation's pressing needs.  On a recent HRSA national advisory committee conference call it was noted: "Mental health disorders rank in the top five chronic illnesses in the U.S.  An estimated 25 percent of U.S. adults currently suffer from mental illness and nearly half of all U.S. adults will develop at least one mental illness in their lifetime.  In 2007, over 80 percent of individuals seen in the emergency room (ER) had mental disorders diagnosed as mood, anxiety and alcohol related disorders."

At the Uniformed Services University of the Health Sciences (USUHS), nursing and psychology are pursuing ways to systematically share expertise.  A number of courses are jointly taught and/or co-attended; e.g. Stress and Trauma in the Military Context, Introduction to Physiology, and Health Policy.  Mental health students enrolled in both training programs (Doctor of Nursing Practice/Clinical and Medical Psychologist) regularly utilize the university's simulation lab where live actors "play out" various symptomology for the trainees, while monitored on closed circuit television.  Discussions are currently underway to facilitate cross-professional critiques of these experiences.  An underlying question: Why should there be different training models?

A Very Far Reaching Vision:  In January of this year, the Military Compensation and Retirement Modernization Commission, a blue ribbon panel established by Congress in 2013, submitted its 302-page Final Report to the Administration and Congress.  Even a cursory review provides a sense of the unprecedented magnitude of their recommendations.  "Our volunteer Service members are the strength of our military, and it is our continuous duty and obligation to ensure that the Services are properly resourced….  In considering the military health benefit, we focused on sustaining medical readiness by recommending a new readiness command, supporting elements, and framework for maintaining clinical skills….

            "The critical nature of joint readiness, including the essential medical readiness… make it clear that four-star leadership is needed to sustain dedicated focus on the joint readiness of the force.  Ensuring that the hard-fought progress achieved during the past decade in the delivery of combat casualty care on the battlefield, the global capability for evacuating casualties and providing critical care while in transit, and the research that has led to advances in wound care and hemorrhage control, requires strong oversight at the highest level.  The Commission thoroughly evaluated the merits of a four-star joint medical command….  (M)edicine is only one component of joint military readiness.  The essential nature of military medicine by itself warrants four-star oversight, and the Commission concludes the best course of action is to create a four-star Joint Readiness Command to manage the readiness, as well as the interoperability, efficiency, and 'jointness' of the entire military force, including medical readiness….

"Health care is a constantly changing industry.  The features of health care, including technology and the models for paying for and delivering care, rapidly evolve.  Rather than attempting to replicate a private-sector health care system within DoD, and consequently following behind, the Commission believes beneficiaries would be better served by having direct access to the innovations found in private-sector health care.  Furthermore, under commercial insurance, carriers have the tools, including the advancements in payment and delivery models… and the monetary and nonmonetary incentives… to increase value by operating more efficiently."  'Cause I'm leavin' on a jet plane.  Don't know when I'll be back again.  Aloha,

Pat DeLeon, former APA President – Division 19 – February, 2015