“EACH TIME A MAN STANDS UP FOR AN IDEAL….”
With Experience Comes A Renewed Focus: It is intriguing to see some of psychology’s historical trail blazers, now, later on in their careers, becoming engaged in broader, international agendas. Barbara Van Dahlen, Founder and President of Give an Hour, recently signed a memorandum of understanding (MOU) with the United Kingdom’s Ministry of Defence, pursuant to their Global Summit on Mental Health Culture Change scheduled for London. This MOU will allow the United Kingdom Ministry of Defence to adopt Give an Hour’s signature public health initiative, the Campaign to Change Direction, to ensure that all within the British Military “Know the Five Signs of Emotional Suffering.” The Ministry of Defence: “We recognize the importance of mental fitness and want to ensure it’s emphasized on par with physical fitness.” Indeed, the Give an Hour model, which Barbara developed from the simple idea of asking mental health professionals to “give an hour” of their time each week to provide free mental health care to those who serve and their families, is now expanding to serve other populations – including at-risk teens, at risk-women and girls, survivors of gun violence, and victims of natural and man-made disasters – here at home and abroad.
Former APA President Alan Kazdin has been increasingly grappling with how to transform our historical office-based, individually-oriented approach exponentially in order to expand quality psychological care to those most in need – appreciating that the status quo is drastically inadequate to meet the nation’s (and world’s) pressing needs. “Our focus on treatment needs to begin with the concern about scalability and reaching people in need of services. New treatments, evidence-based or not, will not be very useful if they cannot reach people in need. We begin with the view that most people in need of psychological services receive nothing. That is, standard care or ‘treatment as usual’ for the vast majority of our citizens (more than 70%) is no treatment. Disseminating treatments to all mental health professionals, while clearly important, does not address the salient issue; namely, people in need of care do not usually see mental health professionals. They do not go to treatment at least in that form. We must consider what treatments can reach the people rather than how people reach the treatments. There are tried models of delivery we could use now (e.g., task shifting, best-buy interventions; disruptive innovations, social networks) to deliver the treatments psychologists and others have worked so hard to develop and evaluate.”
Evolving Opportunities -- Bipartisanship and Vision: On May 23, the U.S. Senate passed by a vote of 95-0 bipartisan legislation to fund a critical Tribal Housing initiative (S. 1333). The Tribal HUD-VA (Supportive Housing) initiative will provide rental and housing assistance to homeless and at-risk homeless Veterans. The Chairman and Ranking Member of the Senate Veterans Affairs Committee noted: “It is critical that we work to strengthen resources and opportunities for those who have courageously served our country. This legislation will bring certainty to an important housing program for Native American Veterans, who serve in our nation’s Armed Forces in higher numbers than any other ethnic group.” “Tribal members in New Mexico and throughout Indian Country have a proud history of military service, and they have served our nation with valor and distinction. Unfortunately, Native Veterans are disproportionally affected by homelessness and this is simply unacceptable… I am deeply grateful that we can honor all our Veterans with passage of this important bipartisan legislation that ensures that Native service men and women have full access to well-deserved housing resources when they return home.” Those of our colleagues working with this special population appreciate that Native Americans serve in the military at a higher percentage than any other ethnic demographic. And, that their healthcare needs are extraordinarily significant.
The following day, the U. S. House of Representatives passed the National Defense Authorization Act for FY’ 2019 (H.R. 5515) by a vote of 351-66. “The Committee remains concerned about the high rate of suicides in the reserve component and specifically, within the Army National Guard. The Committee is aware of numerous efforts by the Chief of the National Guard Bureau to increase access and resources for Guardsmen to receive behavioral health treatment and support. The Committee also supports the establishment of a more integrated and holistic approach to resilience and fitness across the National Guard to better assess and improve the operational readiness of Guardsmen by carrying out pilot programs as required. Therefore, the Committee directs… a report to the House Committee on Armed Services not later than 1 March, 2019 on the effectiveness of National Guard Bureau behavioral health programs like resiliency, suicide prevention, and other mental health outreach efforts.”
The House also included: “Comprehensive Women’s Health for Active Duty. The committee recognizes that as the population of women in the military increases and more women seek additional opportunities in direct combat units and throughout the joint force, it is critical that women’s health is addressed comprehensively to optimize health and readiness. The committee notes the efforts of Navy Medicine with the establishment of the Women’s Health Clinical Community and the piloting of a comprehensive clinic at Naval Medical Center, San Diego, to address the complex needs of the Active Duty female population. Guided by feedback from clinical and non-clinical stakeholders and evidence-based research, the comprehensive women’s health clinic addresses women’s health in a patient-centered manner integrating perinatal, women’s health, mental health, and force readiness. As the Military Health System transitions military treatment facilities from the services to the Defense Health Agency, the committee encourages the inclusion of similar health clinics where appropriate to improve the readiness of women in the force.”
A Continuing and Steady Focus: It is important for the next generation of our colleagues, and especially those who will be serving within the public sector, to appreciate that their clinical services are never provided in a clinical or policy (i.e., political) vacuum. One aspect to be considered, and hopefully addressed, is society’s ever-slowly changing appreciation for the expertise of non-physician healthcare providers and the impact of continuing gender stereotypes. We recently attended the George Washington University School of Nursing press conference: “On May 8, 2018 I attended a press conference. The Woodhull Study Revisited: Nurses’ Representation in Health News Media, at the National Press Club in Washington, DC. In 1998, the original study examined journalists’ use of nurses as a source in print media. Diana Mason and her research team replicated the original study, conducted a qualitative study of journalists’ experiences with nurses in print media, and analyzed the top 50 schools of nursing tweets. The researchers found nurses to be consistently underrepresented in health news stories. Nurses were seldom the source for topics related to health policy, care, or research.
“In 1998, nurses were the primary source in four percent of health-related articles, but only two percent in September, 2017. Nursing and the nursing profession are, however, now mentioned in 13%. Today, twenty years later, nurses were still only mentioned rarely in articles on research (9%), policy (4%), the Affordable Care Act (4%), and Business (3%). In addition, the researchers found that journalists do not understand the overall role, work, and education of nurses. Journalists do not know how to find nurses and have limited time to look for them. Nurses and their associations are not actively engaging with journalists. Over 79.8% of the tweets coming from schools of nursing were inward-facing and only 1.15% were followed by journalists. Nursing represents the largest group of health professionals (approximately 3.5 million, almost 90% of whom are women). Not surprisingly, regardless of profession, men were quoted roughly twice as often as women (65% and 34% respectively). Men were in 72% of media images and women in 48%. Interestingly, women also continue to be underrepresented in newsrooms (24%). My experience at the press conference in this historical building was very rewarding. I was able to meet key nurse leaders and learn about the research at George Washington University and even invite one of nursing’s ‘living legends’ to participate at a forthcoming health policy class as the Uniformed Services University” (Maj. Theresa Bedford, USAF, GSN). “He sends forth a tiny ripple of hope.” (Robert Kennedy, University of Cape Town, 1966). Aloha,
Pat DeLeon, former APA President – Division 18 – June, 2018
