“IF YOU DON’T KNOW WHERE YOU ARE GOING”
These are “interesting” times. On January 27, 2017, President Trump issued a National Security Presidential Memorandum: “Policy: To pursue peace through strength, it shall be the policy of the United States to rebuild the U.S. Armed Forces.” He has continued to reaffirm his commitment to repealing the Affordable Care Act. Undoubtedly, victory will eventually be proclaimed. The details, however, will be critical. Does the Administration appreciate the strategic importance of a robust international humanitarian presence to national security, the long-term benefits of preventive health care, or the effectiveness of integrated behavioral health care? APA is very fortunate that President Susan McDaniel possessed the vision during her tenure to make a special effort to actively encourage interactions with our international colleagues, as well as to invite Jeff Goodie of the Uniformed Services University of the Health Sciences (USUHS) to co-chair her efforts to establish a curriculum for an Interprofessional Seminar on Integrated Primary Care. Colleagues within the VA had the opportunity to engage with her during their 2016 VA Psychology Leadership (AVAPL) conference in San Antonio. Yet, APA still does not have an office of Veterans or Military Affairs.
The Fiscal Year 2017 National Defense Authorization Act (P.L. 114-328) foreshadows significant change within the military health care system. The conferees: “After careful study and deliberation, the conferees conclude that a single agency [Defense Health Agency] responsible for the administration of all MTFs [military treatment facilities] would best improve and sustain operational medical force readiness and the medical readiness of the Armed Forces, improve beneficiaries’ access to care and the experience of care, improve health outcomes, and lower the total management cost of the military health system. The conferees believe that the current organizational structure of the military health system – essentially three separate health systems each managed by one of the three Services – paralyzes rapid decision-making and stifles innovation in producing a modern health care delivery system that would better serve all beneficiaries. A streamlined military health system management structure would eliminate redundancy and generate greater efficiency, yielding monetary savings to the Department while leading to true reform of the military health system and improving the experience of care for beneficiaries.”
The law further repealed the statutory specification of general flag officers for various corps specific leadership positions (i.e., two-star rank for the dental and nursing corps and one-star rank for the veterinary corps). The conferees also removed the statutory general officer grade requirement associated with the military Surgeon Generals. Of particular interest to mental health, the final agreement included a provision which authorized the Secretary to conduct a pilot program to assess the feasibility and advisability of expanding the use of physician assistants (PAs) specializing in psychiatric medicine at medical facilities of the Department of Defense. If the Secretary decides to conduct this pilot program, a report is to be submitted to the Congressional Committees on Armed Services of the Senate and House of Representatives within 90 days of completion of the program.
This January, several faculty and students from our health policy class at USUHS had the opportunity to tour the aircraft carrier USS George H.W. Bush (CVN 77) on which psychologist Navy Lieutenant Amanda Berg, along with 5,500 Navy colleagues (approximately 80% of whom are less than 25 years old), serves. “Mental health on an aircraft carrier takes psychologists out of the office and onto the deckplates to the heart of human experience. Mental health professionals in these settings are on the front line of preventive medicine and in vivo training to enact change and reinforce healthy behaviors. The embedded psychologist becomes an accessible resource for Sailors dealing with stressors as well as leaders seeking ways to enhance the performance of their ‘organization.’ By living and working together around the clock, this nontraditional approach to mental health care breaks down the barriers of seeking help from experts in human behavior, emotions, cognitions, and motivation to promote individual and group development. These nontraditional practices parallel movements across the field of psychology which is becoming to note the ‘value added’ by mental health through integration in primary care settings and multidisciplinary teams.” Gary VandenBos and I co-edit the Division 18 journal Psychological Services and we would love to receive submissions describing similar unique training and service opportunities from our public service colleagues.
National Guard: During our nation’s longest armed conflict, the role and expectations for the National Guard have been dramatically transformed. This was evident in the briefing our class received from U.S. Army Major Jamie Cook, chief of Behavioral Health for the Army National Guard and at the Sirius XM radio broadcast “Changing the Culture of Mental Health: It’s Time,” hosted by Barbara Van Dahlen of Give an Hour (who recently received the Secretary of the Army’s Public Service Award) featuring Dr. Jill Biden. “The Biden family is a National Guard family. Eight years ago, our son Beau proudly deployed for a year to Iraq with the Delaware Army National Guard 261st Signal Brigade…. When Beau returned home – knowing that Mrs. Obama and I had begun to plan the work eventually known as Joining Forces – he asked that we especially focus on de-stigmatizing and addressing the wounds that could not be seen: such as PTSD and TBI. The length of those wars and multiple deployments had naturally taken its toll. And we needed to address the mental wellbeing of our military upfront with dignity and respect.” “Any road can take you there.” Aloha,
Pat DeLeon, former APA President – Division 19 – February, 2017
