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
