SLOW DOWN, YOU MOVE TOO FAST
Give An Hour: This spring we had the unique opportunity to attend Give an Hour’s national conference highlighting their “Campaign to Change Direction” in the way that the nation talks about mental health. First Lady Michelle Obama was the inspirational keynote speaker. Other speakers included psychologists Barbara Van Dahlen, Founder and President of Give an Hour; Norman Anderson, Art Evans, and Randy Phelps. Most memorable were the testimonials from veterans who had personally experienced the anxiety, depression, and suicidal ideation of PSTD. Over 50 organizations were engaged that morning; the number now being in excess of 100.
Barbara: “Give an Hour’s work these last 10 years has taught us a very important lesson. The greatest barrier to ensuring proper mental health support for those who serve and their families is not a shortage of appropriately trained mental health professionals or the lack of effective treatments for specific conditions and concerns. The greatest barrier to effectively addressing the mental health needs of those who serve is the same barrier that prevents civilians with mental health concerns from receiving proper care. It is the same barrier that leads to 39,000 suicides each year in America, including the deaths of 22 veterans each day. The greatest barrier to ensuring the mental health well-being of all of our citizens, civilians and military, is our culture itself. The manner in which we view and respond to mental health prevents service members and their families, just as it prevents civilians, from recognizing and acknowledging the suffering that we see in ourselves and others. Until we change our culture so that mental health is viewed in the same way we view physical health – as one of many important elements of being human – we will continue to fail those in need.” Mrs. Obama rhetorically asked: “Should not mental health be viewed in the same manner as cancer, diabetes, and other physical ailments?” Barry Anton points out in his May Monitor Presidential column that 70 percent of primary-care visits stem from psychosocial factors.
“At the core of the campaign – and the cultural movement it is inspiring – is a plan to educate all Americans on the five signs of emotional suffering. Just as we recognize the signs that someone may be having a heart attack, we can learn the signs that may indicate that someone we know is in emotional pain and needs our help. And if we recognize these signs in others, we reach out, we connect, we offer to help. By creating a common language and the recognition that we can all pay attention to our mental well-being, we have the opportunity to reduce suffering and build healthy communities (Barbara).” Visit www.changedirection.org. A truly impressive vision, one which highlights the importance of psychology becoming integrated into primary care, for both the profession and our clients.
Another Exciting Vision: The former chief academic affiliations officer for the Department of Veterans Affairs (VA), Malcolm Cox, chaired the recent IOM report Measuring the Impact of Interprofessional Education on Collaborative Practice and Patient Outcomes. His report notes that much has changed over the past decade, necessitating new thinking. Innovators then stressed the importance of patient-centered care; today, they think of patients as partners in health promotion and health care delivery. Patients are now to be integral members of the care team, not solely patients to be treated; and the team is recognized as comprising a variety of health professionals. This changed thinking is the culmination of many social, economic, and technological factors that are transforming the world and forcing the fields of both health care and education to rethink long-established organizational models.
The VA has a very impressive record of integrating education and clinical care. Under Robert Zeiss’s leadership (2005-2013), and continuing today under Kenneth Jones, psychology’s post-doctoral training thrived with the annual number of funded positions increasing from 52 to 402, and with a significant increase being projected for future years. However, efforts to reform education of the health care workforce and redesign practice in the health care system need to be better aligned because change in one of these interacting systems inevitably influences the other. Efforts to improve Interprofessional Education (IPE), or collaborative practice, independently have fallen short. The IOM Committee felt that widespread adoption of a model of interprofessional education across the learning continuum is urgently needed. An ideal model would retain the tenets of professional identity formation, while providing robust opportunities for interprofessional education and collaborative care. Such a model would differentiate between learning outcomes per se and the individual, population, and system outcomes that provide the ultimate rationale for ongoing investment in health professions education. With a refreshing global perspective, the Committee proposed that once tested, such a model could be adapted to fit the particular needs of higher- and lower-resource settings around the globe. “It is no longer acceptable to think of either health or education in isolation. The final model must accommodate the reality of today’s globalized community.”
The Committee further noted that coordinated planning among educators, health system leaders, and policy makers is a prerequisite to creating an optimal learning environment and an effective health workforce. Educators need to be cognizant of health system redesign efforts; while health system leaders need to recognize the realities of educating and training a competent health workforce. Joint planning is especially important when health systems are undergoing rapid changes, as they are across much of the world today. IPE is particularly affected by the need for joint planning because the practice environment is where much of the imprinting of concepts such as collaboration and effective teamwork takes place. Despite calls for greater alignment, however, education reform is rarely well integrated with health system redesign. After an extensive literature search, the Committee concluded that it was currently unable to find any model that sufficiently incorporated all of the components needed to guide future efforts. A cautionary note: “Although there is widespread and growing belief that IPE may improve interprofessional collaboration, promote team-based health care delivery, and enhance personal and population health, definitive evidence linking IPE to desirable intermediate and final outcomes does not yet exist.” Thus, the fun and excitement of becoming personally involved in the health care public policy process.
The First Signs of Spring: At this year’s inspirational State Leadership Conference (SLC), former APA Board member Josephine Johnson and I reflected upon how SLC is one of the highlights of APA. “I’ve learned so much about advocacy and its importance – something we didn’t learn in graduate school.” Fittingly, the focus was Practice Innovation. Katherine Nordal: “Innovation involves new ideas and processes, change, upheaval, and transformation. To be innovators we need to shake off some old ways of thinking about traditional practice models. We also need to shake off the negative attitudes some of our colleagues have about what’s happening in health care. This world is changing. And health care is moving ahead – with or without psychology. Too many psychologists are stuck in the traditional 50-minute therapy box. And that box is way too confining. We need to think creatively about where psychology can best influence our evolving health care system… how we practice… where we practice… and what we practice.” All is groovy. Aloha,
Pat DeLeon, former APA President – Division 18 – June, 2015
