“AND WHEN I REACH THE OTHER SIDE”
An Inspirational National Vision: This fall a number of faculty and graduate students in psychology and nursing at the USUHS were invited to attend Give an Hour’s “A Celebration of Service” highlighted by a special Benefit Concert at the Daughters of the American Revolution (DAR) Constitution Hall by Chris and Morgan Stapleton. Give an Hour Founder and President Barbara Van Dahlen and her colleagues have now provided over 200,000 hours of free mental health care (valued at over $20 million) to our nation’s active duty personnel, veterans, and their families. What began as a focus on providing needed clinical services has evolved over the past 11 years into an impressive national Campaign to Change Direction focused on how all of us view mental health care. Barbara has constantly reminded her audiences that the stigma surrounding mental health care is not limited to the military population, nor are the 20 suicides a day by Veterans an isolated problem. As President and Michelle Obama have movingly proclaimed, all Americans must learn to pay attention to their emotional well-being. Integrated care, and especially addressing the psychosocial-cultural-economic aspects of primary care, is a high priority of the President’s landmark Patient Protection and Affordable Care Act (ACA).
This year Barbara has focused upon the role of motion pictures in shaping our nation’s attitudes and expectations (i.e., our culture). Last year Brian Wilson of the Beach Boys personally participated in Give an Hour events bringing a personal face to the challenge of coping with mental illness in the bio-pic about his life, Love & Mercy. This year Academy Award nominated filmmaker Oren Moverman discussed the emotional messages incorporated into a number of his films, including one (Time Out of Mind) in which Richard Gere played the role of a homeless individual – experiencing thousands of New Yorkers walking on-bye completely ignoring him (as if he simply did not exist). Randi Silverman’s No Letting Go, also showcased at this year’s Celebration of Service, was particularly moving in describing one family’s struggle to cope with their son’s emotional instability – they possessed financial resources, but for so long could not find the necessary appropriate care.
To date, over 330 organizations, including the American Psychological Association (APA), have joined with Give an Hour to “walk the talk.” We were proud to see special events hosted at both the Canadian Embassy and APA’s new Spire conference center where psychologist and Give an Hour Advisory Board member Randy Phelps served as master of ceremonies for an evening that was attended by APA Interim CEO Cynthia Belar and Nick Puente, the APA’s President-Elect’s son, since Hurricane Matthew prevented Tony’s presence. These partnerships across the public, private, and international sectors are critical to Changing the Direction. The Five Signs of emotional suffering are -- Change in Personality; Agitation; Withdrawal; Lack of Personal Care; and, Hopelessness. Just as we all know the signs of a heart attack, all Americans – civilians, service members, and Veterans – must now learn the signs of emotional suffering.
A Critical Local Vision: Over the years, we have come to appreciate that in order to accomplish substantive policy change, one must possess both a broad overarching objective and the equally important ability to engage those on the front-line in implementing the necessary foundational steps. Division 55’s former President (2004) and current Council of Representatives member (2017-2019) Beth Rom-Rymer and her Illinois colleagues were successful during the summer of 2014 in having their prescriptive authority (RxP) legislation enacted into public law. Currently, they are in the midst of their implementation process, which includes accelerating support for continuing legislative changes.
Beth: “We held a networking event in Chicago this fall. Attendees included: prescribing psychology trainees from around the State of Illinois; graduate students who are hoping to enroll in training programs to become prescribing psychologists; leaders from the Illinois Psychological Association; prescribing psychology trainees from other states and Canada; leaders in Illinois and elsewhere who are creating educational and training opportunities for the prescribing psychology trainees; a key researcher who will be working with us to assess the effectiveness of prescribing psychologists; and supporters of our prescriptive authority Movement. Seventy-five people attended the event. The excitement in the room was palpable!”
“As one psychologist wrote: ‘I enjoyed meeting so many wonderful people and appreciate being a part of such an important movement. I am always moved and inspired by the passionate unwavering drive to enhance the care and reach underserved populations.’ Another psychologist wrote: ‘It was nice to see others appreciate what has been accomplished: bringing psychopharmacology to psychology and to those who are underserved. It’s going to be so important for mental health moving forward! I’m really proud to witness it up close as it emerges.’ Yet another psychologist, who, at 84, is our oldest psychologist in training to become a prescriber, wrote: ‘I wish I had spoken more about all the wonderful things I have learned at FDU [The program founded by Bob McGrath at Fairleigh Dickinson University] and the benefit to me and my patients. I know, for example, that I collaborate more expertly, now, with physicians because of my newly-acquired knowledge of pharmacokinetics and pharmacodynamics – I shared [your recognizing my accomplishments] with my granddaughter who is a pre-med freshman this fall. I will take my [PEP] exam in 2017…. Meeting you changed my life in so many ways.” Finally, ‘The evening was delightful, as always, and the purpose, excellent. It was nice to see others appreciate what I have seen you accomplish. You could, in fact, move the masses to bring democracy to a small country. (Maybe that’s next?!)’ And, that is only the beginning.”
An Inclusive Perspective: The specifics of the Illinois RxP legislation were crafted to address their state’s unique political and social-environmental context, particularly with its emphasis upon undergraduate education. One must appreciate that there are numerous ways to approach providing increased access to quality psychopharmacological therapies. Our clinical pharmacy colleagues, for example, have generally taken the Pharmacist Collaborative Practice Agreement (CPA) approach, with almost every state (except Alabama) now having enacted some form of this legislation and regulations. CPAs effectively: * Create a formal relationship between pharmacists and physicians or other providers. * Define certain patient care functions that a pharmacist can autonomously provide under specified situations and conditions. And, * Many are used to expand the depth and breadth of services the pharmacist can provide to patients and the healthcare team.
Psychology should appreciate that collaborative team-based care represents another express priority of the ACA. Psychologist Karen Pellegrin, at the University of Hawaii at Hilo Daniel K. Inouye College of Pharmacy, conducted a two year evaluation of the cost-effectiveness of medication management services provided by specially trained hospital and community pharmacists (Pharm2Pharm). Slightly over 2,000 elderly high-risk patients were involved. The Pharm2Pharm model resulted in an estimated 36% reduction in the medication-related hospitalization rate for older adults and a 2.6:1 return on investment, highlighting the value of pharmacists as drug therapy experts in geriatric care. The estimated annualized cost of avoided admissions was $6.6 million. Karen’s findings are very impressive! We would rhetorically ask: Are our state psychological and nursing associations conducting joint psychology/nursing-pharmacy initiatives, including providing interdisciplinary collaborative panel presentations at their respective annual state association meetings?
That Personal Perspective: As Barbara keeps stressing, mental health issues impact all Americans. “Thank you so much for advocating for and helping people with mental illness. I am the sister of a bright, creative, kind, and loving woman with bi-polar disorder, who is actually doing remarkably well right now. There was a time though, when she wasn’t. For many, many years she struggled with clinical depression, suicide ideation, delusions, paranoia, anxiety, and more. She has been in and out of hospitals, worked with dozens of doctors, tried many different meds and combinations, and even ECT. We are so thankful that she has finally found effective treatment, a great team of health care providers, and has been well for several years. I remember watching my sister change during her early 20s… and witnessing the bi-polar disorder present. My role shifted from her 19 year old, little sister to her relentless advocate and caregiver for more than a decade. That experience shaped my career path (into social work), and more importantly, my passion for helping people with mental illness and their families. I want to share with you a blog that Susan Reinhard and I recently posted: The Most Invisible Family Caregivers. In it, we focus on the people who provide care and support to adults with mental health issues, discuss the unique challenges they face, provide resources and encourage dialogue… all in the hopes of reducing stigma and isolation.” “And I’ll be back again, again, and again…” [Jennifer Peed, AARP Public Policy Institute]. Aloha,
Pat DeLeon, former APA President – Division 55 -- October, 2016
