“AROUND NASSAU TOWN WE DID ROAM”

 2016 is a Presidential election year and it is rarely to either party's advantage to be engaged in a prolonged legislative session, rather than being "freed up" to be back home mingling with voters.  One would expect the Department of Defense (DoD) appropriations and authorization bills will be quickly "marked-up" and incorporated in a short-term Continuing Resolution (i.e., funding made available for FY'17) until after the election, with the Congress then returning to complete their deliberations quickly – the ultimate decisions depending upon how the nation voted.  The recent Committee "requests" for personal Member recommendations is consistent with this scenario.  Working on the Hill provides one with an appreciation for the gradual "waves of change" which can result in substantive modifications in the status quo.  One can almost feel when this "ebb and flow" occurs.

            A Changing Dialogue:  One of Senator Inouye's first amendments to the DoD CHAMPUS program, back in the late 1970's, was to allow beneficiaries direct access to the services of certified nurse midwives.  When he offered that amendment he had also included a provision to recognize psychiatric mental health nurse practitioners.  His colleagues were very hesitant to support the latter; however, they enthusiastically endorsed the nurse midwifery provision with several senior members commenting that they themselves had been delivered by a nurse midwife.

Times have changed, especially surrounding our nation's dialogue on mental/behavioral health.  When President Obama addressed the adverse consequences of solitary confinement, he was alluding to introductory psychology.  Mental health courts, including those for Veterans, are increasing in number.  Earlier this year, the U.S. Preventive Services Task Force recommended for the first time that women be screened during pregnancy and after childbirth for depression as part of their normal health-care routine.  Neil Kirschner, a former APA Congressional Science Fellow, facilitated the American College of Physicians (ACP) support for the integration of behavioral health care into primary care and having all health care professionals consider the behavioral and physical health of their patient if they are to be treated as a "whole person."  Leading the way was U.S. Army Surgeon General Patty Horoho's vision of the healthcare "Lifespace" where individuals and their families make the choices that really impact their lives and health, and her personal collaboration with Barbara Van Dahlen of Give an Hour.

            During deliberations on the FY'16 DoD Appropriations bill, the U.S. Senate included several provisions which are directly relevant to military psychologists and behavioral health providers.  This in itself is most impressive.  "The Committee recognizes that servicemembers and their families face unique stresses beyond those of everyday life.  After over a decade of war, the need for mental health professionals in the Department is at an all-time high, and the Committee believes that every beneficiary of the Military Health System should have timely access to mental health services.  However, the Committee is concerned with the Department's inability to recruit and retain enough psychiatrists, psychologists, social workers, nurse practitioners and registered nurses to provide adequate mental healthcare….  (T)he Assistant Secretary of Defense (Health Affairs) is directed to prepare… a review of these estimates as well as an outline of current challenges in recruiting and retaining mental health professionals by the Department of Defense."

            The Uniformed Services University of the Health Sciences (USUHS):  USUHS's mission is to be responsive to the unique needs of DoD and the USPHS; the four Surgeon Generals serving on its Board of Regents.  There have been increasing collaborative efforts between the leadership of the department of psychology and psychiatric nursing, focusing upon interprofessional models of care and training, which are a high priority for the University's President.  For example, they jointly utilize the simulation center with its standardized patients (i.e., skilled actors) and have participated together in the signature training event "Operation Bushmaster."

Recently, David Riggs, newly appointed psychology chair, and his nursing counterpart, Jess Calohan, have begun exploring ways to expand these earlier efforts; perhaps by having targeted modules integrated into their respective curricula.  It would be relatively straightforward to re-start the psychopharmacology training program given that USUHS nurses are already trained to provide that clinical service.  Of interest, the Senate Appropriations Committee had noted: "Prescription Effectiveness of Psychotropic Medications. – The Committee supports the Department's efforts to treat patients diagnosed with behavioral health disorders and believes that the ongoing efforts to use database-supported methods in order to increase the accuracy and effectiveness of prescription practices for mental health medications may not only achieve cost savings but also improve patient care.  The Committee encourages the expansion of this research to additional sites as preliminary findings have shown promising results."

We would rhetorically ask: Does psychology want to be involved and remain relevant?  At one point, we asked: Where in this discussion were those psychologists who were themselves Veterans?  William Danton, a veteran and former Associate Chief of Staff for Mental Health in the VA, responded that he is vehemently opposed to RxP for psychologists precisely because he values quality of care!  During our subsequent discussion: "Of course I value my colleagues and I'm sure they could do as well or better than our psychiatry brethren.  It is the plethora of dangerous and often ineffective psychiatric medications I object to.  It is the clear and inappropriate influence of pharma that will indiscriminately poison practitioners of all professions.  If only psychologists were immune to that.  However, as we have seen from the DoD debacle, money often drives practice."  Reasonable professionals can clearly differ.

Watching the Shifting Currents:  Last year the DoD Appropriations conferees included language that may be prophetic.  "Concerns remain regarding the transfer of funds from the In-House Care budget sub-activity to pay for contractor-provided medical care.  To limit such transfers and improve oversight within the Defense Health Program operation and maintenance account, the agreement includes a provision which caps the funds available for Private Sector Care under the TRICARE program subject to prior approval reprogramming procedures."  On August 21, 1959 Hawaii achieved Statehood.  Citizens living on the neighboring islands who required inpatient care relied upon the State to provide these services, as one of its most basic responsibilities.  On January 14, 2016 Hawaii's Governor signed a transfer agreement allowing Kaiser Permanente to assume control of the three financially-struggling public hospitals on Maui.  This action is estimated to save the State $260 million over 10 years.  Whether in the long run this is a good policy or not, rests upon one's fundamental belief in the role of government.  We would proffer that a similar debate exists regarding the delivery of health care to our nation's active duty personnel, their families, and our Veterans.  "I feel so broke up, I wanna go home."  Aloha,

Pat DeLeon, former APA President – Division 19 – February, 2016

 

 

Sent from my iPhone

Division 29 February, 2016 column

“THESE BOOTS ARE MADE FOR WALKIN’”

            For the past several conventions, I have had the exciting opportunity to join with visionary colleagues (from a broad range of professional backgrounds) hosting symposia addressing the wide range of issues surrounding “meaningful retirement.”  All of us have noticed that a number of our well-known senior colleagues have “opted out” of their historical involvement within the APA governance, with even some Past Presidents no longer attending the annual conventions – perhaps as a result of “physical challenges.”  Involvement in APA has historically provided meaningful social and emotional support for all of us, not to mention considerable status and societal respect.  As psychologists, we know that this is important for one’s health and well-being.

This year in Denver, long time public servant Rod Baker will discuss his evolution towards writing that novel that he had always thought he would do in retirement – finding fun and a sense of accomplishment and purpose, such that he now looks forward to spending most of his time in retirement with that activity.  Walter Penk, last year’s recipient of an APF Gold Medal Award and now in his 80’s, continues to work tirelessly on behalf of our nation’s Veterans and especially those returning to universities as students.  Walter embraces three goals -- reading, writing, and running.  Running, as physical and mental health are essential; not just when young, but especially when older.  Ellen Cole has undertaken the challenge of confronting Aging Discrimination.  Still academically-based, the highlights of her journey include teaching Introductory Psychology to high school students, going back to school to earn her Master’s degree in Applied Positive Psychology (her biggest adventure), and continuing her active journal involvement.  Our audiences seem to enjoy themselves, suggesting additional topics for the following year; for example, the stress of dealing with major physical difficulties.  From our perspective, these thought-provoking discussions touch upon foundational issues that will increase in importance for all professional associations, as their membership gradually ages and their next generation matures and takes center stage.

            Over the years, APA has had truly outstanding individuals serving for a year in Washington, DC under its Congressional and Executive Branch Science Fellowship program.  During the 2003 Toronto convention, Fellow Neil Kirschner has opined: “More often than not, research findings in the legislative arena are only valued if consistent with conclusions based upon the more salient political decision factors.  Thus, within the legislative setting, research data are not used to drive decision-making decisions, but more frequently are used to support decisions made based upon other factors.  As psychologists, we need to be aware of this basic difference between the role of research in science settings and the legislative world.  It makes the role of the researcher who wants to put ‘into play’ available research results into a public policy deliberation more complex.  Data needs to be introduced, explained, or framed in a manner cognizant of the political exigencies.  Furthermore, it emphasizes the importance of efforts to educate our legislators on the importance and long-term effectiveness of basing decisions on quality research data.  If I’ve learned anything on the Hill, it is the importance of political advocacy if you desire a change in public policy.”  Neil will soon be “retiring” from the American College of Physicians (ACP) on his 70^th birthday.

            Under Neil’s guidance, the ACP Health and Public Policy Committee recently recommended: * That ACP support the integration of behavioral health care into primary care and encourage its members to address behavioral health issues within the limits of their competencies and resources.  * That ACP recommend that public and private health insurance payers, policymakers, and primary care and behavioral health care professionals work toward removing payment barriers that impede behavioral health and primary care integration.  Stakeholders should ensure the availability of adequate financial resources to support the practice infrastructure required to effectively provide such care.  * That ACP encourage efforts by federal and state governments, relevant training programs, and continuing education providers to ensure an adequate workforce to provide for integrated behavioral health care in the primary care setting.  * That ACP recommend that all relevant stakeholders initiate programs to reduce the stigma associated with behavioral health.  These must address the negative perceptions held by the general population and by many physicians and other health care professionals.  And, * Physicians and other health care professionals will have to consider the behavioral and physical health of the patient if they are to be treated as a “whole person.”

            Another psychologist visionary, Mitch Prinstein, recently conducted a survey of psychologists for Division 53 (the Society of Clinical Child and Adolescent Psychologists) exploring their perceptions of how the field will change in the next couple of decades.  There was a very impressive response rate with 619 individuals participating; 46.0% indicated they were practitioners, while 17.3% were students.  Independent practice and university-research were their two top workplaces.  When asked: “As compared to now, clinical psychologists will be engaged in much MORE... in 2032”; Clinical Services (26%) and Interdisciplinary Collaboration (21%) were the two top noted.  When asked: “In 2032, clinical psychologists will need to be much more competent in….”; Interdisciplinary Collaboration and Psychopharmacology, Prescribing, Medical Settings, received 10% of the vote.  Clinical Services received 23% of the vote; and of those votes, Technology Based Work received 16.2%, second only to Evidence-Based Practice in Psychology (EBPP) which received 30.9%.  Clearly, there is the growing perception in the field that significant change is upon us.

            The Next Generation:  Today’s champion for prescriptive authority (RxP) is Beth Rom-Rymer, a longtime member of the Council of Representatives.  “Probably my greatest inspiration, as I criss-cross Illinois and our country, talking about the mounting enthusiasm for prescriptive authority, are the words, themselves, of our (more than 100) prescribing psychologists in training:  ‘My decision to seek prescriptive authority is part of the natural evolution in my continuing efforts to serve underserved and Spanish-speaking communities.  It is borne from personal experience with trauma, as well as from my many work experiences in which I’ve seen patients wait for extended periods of time, and/or travel over 2 hours, one way, for a psychiatric appointment.  In my current and recent jobs, our institutions have struggled to hire psychiatrists.  However, we could not locate any candidates in over 2 years of active recruitment.  I want to meet these glaring needs.  As Illinois progresses, I look forward to collaborating with colleagues in other states so that prescribing psychologists become a national healthcare standard.’

            “Two of the largest Illinois State Universities (with tens of thousands of undergraduate students) have added undergraduate concentrations in a ‘pre-prescribing psychologist’ curriculum; and more than 20 hospitals and medical centers, statewide, are working, in collaboration with the Illinois Psychological Association (IPA), to provide medical rotations for the prescribing psychologist trainee.  While organized medicine and psychiatry had vociferously opposed the Illinois bill during the lobbying effort, now that the law has passed, both general medicine and psychiatry have been working hand-in-hand with us to implement the law and accelerate the integration of prescribing psychologists into the healthcare provider network statewide.

            “Under the leadership of prominent healthcare economist, Uwe Reinhardt, scholars at Princeton University’s Center for Health and Well-Being have been doing extensive research on the effects of healthcare providers’ expanded scope of practice on health status.  An article, soon to published, has been provisionally titled: ‘Just What the Nurse Practitioner Ordered: Independent Prescriptive Authority and Population Mental Health.’  One of the stunning preliminary results of this research (looking at mortality data from 1990 to 2013) is that states ‘that grant independent prescriptive authority to nurse practitioners experience, on average, a 12% reduction in ‘mental-health-related mortality’ (including suicides, deaths of unknown intent, and accidental deaths).  The results are more pronounced in areas with a low psychiatrist-to-population ratio and among populations with low levels of education.’  These scholars will also be looking at similar health status data from states that have granted prescriptive authority to psychologists.”

            Additional Reflections on the Hoffman Report:  Those attending the Toronto convention had to be impressed by the energy generated surrounding the release of the Hoffman Report.  Very dedicated and sincere colleagues were passionate about their conflicting views of what had transpired and what were the underlying causes/issues.  Accordingly, I subsequently asked a long-time colleague, whom I have tremendous respect for, for his/her perspective.  “Discussions regarding the Hoffman report continue.  In October, four psychologists named in the report issued a response that provided documentation refuting Hoffman’s central conclusion, namely, that military psychologists worked to keep ethics guidelines ‘loose’ in order to enable detainee abuse.  In fact, it appears that the very psychologists under scrutiny assisted in drafting Department of Defense policies designed to prevent detainee abuse.  One such policy, which US Army COL (Ret) Dr. Debra Dunivin helped draft, was itself contained in the Hoffman report supplemental materials and prohibited the very interrogation techniques Mr. Hoffman alleged military psychologists sought to permit.  In November, Division 19, the Society for Military Psychology, issued its own response to the Hoffman report which provided examples of what the Division felt was a deep seated anti-military bias in the report.  APA has yet to respond publicly to the substantive and compelling criticisms of the Hoffman report in either of these documents.  According to The New York Times, Mr. Hoffman has declined to comment on these points.

            “In addition, the Pentagon has brought forth serious concerns about the 2015 APA policy.  It seems that when they voted, many Council members did not realize the 2015 resolution would prevent military psychologists from providing psychological services to detainees.  In a letter to APA, Pentagon officials pointed out that this aspect of the resolution appears to violate Common Article 3 of the Geneva Conventions.  The Pentagon has asked APA to reconsider the blanket prohibition against psychologist involvement in interrogations.  The plan is for APA and DoD representatives to meet soon regarding APA policy and DoD concerns.  It will be critical for both sides to listen to one another carefully in order to craft policies that successfully integrate national security and respect for human rights.  As it moves forward, APA will need to consider how it views the appropriate role of a member association, that is, whether the association’s primary focus should be on promoting human rights, or rather on advancing the legitimate interests of all of its members.”  “Start Walkin’!”  Aloha,

Pat DeLeon, former APA President – Division 29 – February, 2016

 

 

THESE BOOTS ARE MADE FOR WALKIN’

For the past several conventions, I have had the exciting opportunity to join with visionary colleagues (from a broad range of professional backgrounds) hosting symposia addressing the wide range of issues surrounding "meaningful retirement."  All of us have noticed that a number of our well-known senior colleagues have "opted out" of their historical involvement within the APA governance, with even some Past Presidents no longer attending the annual conventions – perhaps as a result of "physical challenges."  Involvement in APA has historically provided meaningful social and emotional support for all of us, not to mention considerable status and societal respect.  As psychologists, we know that this is important for one's health and well-being.

This year in Denver, long time public servant Rod Baker will discuss his evolution towards writing that novel that he had always thought he would do in retirement – finding fun and a sense of accomplishment and purpose, such that he now looks forward to spending most of his time in retirement with that activity.  Walter Penk, last year's recipient of an APF Gold Medal Award and now in his 80's, continues to work tirelessly on behalf of our nation's Veterans and especially those returning to universities as students.  Walter embraces three goals -- reading, writing, and running.  Running, as physical and mental health are essential; not just when young, but especially when older.  Ellen Cole has undertaken the challenge of confronting Aging Discrimination.  Still academically-based, the highlights of her journey include teaching Introductory Psychology to high school students, going back to school to earn her Master's degree in Applied Positive Psychology (her biggest adventure), and continuing her active journal involvement.  Our audiences seem to enjoy themselves, suggesting additional topics for the following year; for example, the stress of dealing with major physical difficulties.  From our perspective, these thought-provoking discussions touch upon foundational issues that will increase in importance for all professional associations, as their membership gradually ages and their next generation matures and takes center stage.

            Over the years, APA has had truly outstanding individuals serving for a year in Washington, DC under its Congressional and Executive Branch Science Fellowship program.  During the 2003 Toronto convention, Fellow Neil Kirschner has opined: "More often than not, research findings in the legislative arena are only valued if consistent with conclusions based upon the more salient political decision factors.  Thus, within the legislative setting, research data are not used to drive decision-making decisions, but more frequently are used to support decisions made based upon other factors.  As psychologists, we need to be aware of this basic difference between the role of research in science settings and the legislative world.  It makes the role of the researcher who wants to put 'into play' available research results into a public policy deliberation more complex.  Data needs to be introduced, explained, or framed in a manner cognizant of the political exigencies.  Furthermore, it emphasizes the importance of efforts to educate our legislators on the importance and long-term effectiveness of basing decisions on quality research data.  If I've learned anything on the Hill, it is the importance of political advocacy if you desire a change in public policy."  Neil will soon be "retiring" from the American College of Physicians (ACP) on his 70^th birthday.

            Under Neil's guidance, the ACP Health and Public Policy Committee recently recommended: * That ACP support the integration of behavioral health care into primary care and encourage its members to address behavioral health issues within the limits of their competencies and resources.  * That ACP recommend that public and private health insurance payers, policymakers, and primary care and behavioral health care professionals work toward removing payment barriers that impede behavioral health and primary care integration.  Stakeholders should ensure the availability of adequate financial resources to support the practice infrastructure required to effectively provide such care.  * That ACP encourage efforts by federal and state governments, relevant training programs, and continuing education providers to ensure an adequate workforce to provide for integrated behavioral health care in the primary care setting.  * That ACP recommend that all relevant stakeholders initiate programs to reduce the stigma associated with behavioral health.  These must address the negative perceptions held by the general population and by many physicians and other health care professionals.  And, * Physicians and other health care professionals will have to consider the behavioral and physical health of the patient if they are to be treated as a "whole person."

            Another psychologist visionary, Mitch Prinstein, recently conducted a survey of psychologists for Division 53 (the Society of Clinical Child and Adolescent Psychologists) exploring their perceptions of how the field will change in the next couple of decades.  There was a very impressive response rate with 619 individuals participating; 46.0% indicated they were practitioners, while 17.3% were students.  Independent practice and university-research were their two top workplaces.  When asked: "As compared to now, clinical psychologists will be engaged in much MORE... in 2032"; Clinical Services (26%) and Interdisciplinary Collaboration (21%) were the two top noted.  When asked: "In 2032, clinical psychologists will need to be much more competent in…."; Interdisciplinary Collaboration and Psychopharmacology, Prescribing, Medical Settings, received 10% of the vote.  Clinical Services received 23% of the vote; and of those votes, Technology Based Work received 16.2%, second only to Evidence-Based Practice in Psychology (EBPP) which received 30.9%.  Clearly, there is the growing perception in the field that significant change is upon us.

            The Next Generation:  Today's champion for prescriptive authority (RxP) is Beth Rom-Rymer, a longtime member of the Council of Representatives.  "Probably my greatest inspiration, as I criss-cross Illinois and our country, talking about the mounting enthusiasm for prescriptive authority, are the words, themselves, of our (more than 100) prescribing psychologists in training:  'My decision to seek prescriptive authority is part of the natural evolution in my continuing efforts to serve underserved and Spanish-speaking communities.  It is borne from personal experience with trauma, as well as from my many work experiences in which I've seen patients wait for extended periods of time, and/or travel over 2 hours, one way, for a psychiatric appointment.  In my current and recent jobs, our institutions have struggled to hire psychiatrists.  However, we could not locate any candidates in over 2 years of active recruitment.  I want to meet these glaring needs.  As Illinois progresses, I look forward to collaborating with colleagues in other states so that prescribing psychologists become a national healthcare standard.'

            "Two of the largest Illinois State Universities (with tens of thousands of undergraduate students) have added undergraduate concentrations in a 'pre-prescribing psychologist' curriculum; and more than 20 hospitals and medical centers, statewide, are working, in collaboration with the Illinois Psychological Association (IPA), to provide medical rotations for the prescribing psychologist trainee.  While organized medicine and psychiatry had vociferously opposed the Illinois bill during the lobbying effort, now that the law has passed, both general medicine and psychiatry have been working hand-in-hand with us to implement the law and accelerate the integration of prescribing psychologists into the healthcare provider network statewide.

            "Under the leadership of prominent healthcare economist, Uwe Reinhardt, scholars at Princeton University's Center for Health and Well-Being have been doing extensive research on the effects of healthcare providers' expanded scope of practice on health status.  An article, soon to published, has been provisionally titled: 'Just What the Nurse Practitioner Ordered: Independent Prescriptive Authority and Population Mental Health.'  One of the stunning preliminary results of this research (looking at mortality data from 1990 to 2013) is that states 'that grant independent prescriptive authority to nurse practitioners experience, on average, a 12% reduction in 'mental-health-related mortality' (including suicides, deaths of unknown intent, and accidental deaths).  The results are more pronounced in areas with a low psychiatrist-to-population ratio and among populations with low levels of education.'  These scholars will also be looking at similar health status data from states that have granted prescriptive authority to psychologists."

            Additional Reflections on the Hoffman Report:  Those attending the Toronto convention had to be impressed by the energy generated surrounding the release of the Hoffman Report.  Very dedicated and sincere colleagues were passionate about their conflicting views of what had transpired and what were the underlying causes/issues.  Accordingly, I subsequently asked a long-time colleague, whom I have tremendous respect for, for his/her perspective.  "Discussions regarding the Hoffman report continue.  In October, four psychologists named in the report issued a response that provided documentation refuting Hoffman's central conclusion, namely, that military psychologists worked to keep ethics guidelines 'loose' in order to enable detainee abuse.  In fact, it appears that the very psychologists under scrutiny assisted in drafting Department of Defense policies designed to prevent detainee abuse.  One such policy, which US Army COL (Ret) Dr. Debra Dunivin helped draft, was itself contained in the Hoffman report supplemental materials and prohibited the very interrogation techniques Mr. Hoffman alleged military psychologists sought to permit.  In November, Division 19, the Society for Military Psychology, issued its own response to the Hoffman report which provided examples of what the Division felt was a deep seated anti-military bias in the report.  APA has yet to respond publicly to the substantive and compelling criticisms of the Hoffman report in either of these documents.  According to The New York Times, Mr. Hoffman has declined to comment on these points.

            "In addition, the Pentagon has brought forth serious concerns about the 2015 APA policy.  It seems that when they voted, many Council members did not realize the 2015 resolution would prevent military psychologists from providing psychological services to detainees.  In a letter to APA, Pentagon officials pointed out that this aspect of the resolution appears to violate Common Article 3 of the Geneva Conventions.  The Pentagon has asked APA to reconsider the blanket prohibition against psychologist involvement in interrogations.  The plan is for APA and DoD representatives to meet soon regarding APA policy and DoD concerns.  It will be critical for both sides to listen to one another carefully in order to craft policies that successfully integrate national security and respect for human rights.  As it moves forward, APA will need to consider how it views the appropriate role of a member association, that is, whether the association's primary focus should be on promoting human rights, or rather on advancing the legitimate interests of all of its members."  "Start Walkin'!"  Aloha,

Pat DeLeon, former APA President – Division 29 – February, 2016

 

Sent from my iPhone

ALOHA - CDP

REFLECTIONS FROM THE PAST, OR PERHAPS THE FUTURE?

            For nearly four decades, I had the honor of serving on the staff of the late-U.S. Senator Daniel K. Inouye, retiring in the fall of 2011 as his chief of staff.  During that time, I was actively involved within the governance of the American Psychological Association (APA) and served as its President in 2000.  Over the years, we have observed many changes within the field of mental health, both from the “front line” and at the all-important health policy level.  Perhaps the most significant of these changes has been external to any of the mental health disciplines – it is the gradual acceptance by society of the importance and appropriateness of receiving quality mental health care, in the same manner that it is now “all right” to openly discuss receiving treatment for cancer or diabetes.  I cannot help but believe that a major factor in this evolution has been the extent to which our nation has become increasingly educated.  My mother, for example, was the second female attorney in the State of Connecticut; her mother had considerably less formal education.  Both of our children have advanced professional degrees – law and social work.

Changing The Direction:  A little more than a decade ago, psychologist Barbara Van Dahlen established the non-profit organization Give an Hour, in order to effectively link-up those veterans, service members, and their families who desired mental health services with practitioners within their local community from all disciplines.  At the time of the celebration of Give an Hour’s tenth anniversary, over 175,000 hours of free mental health care had been provided.  It might be said that Barbara is on a mission (or crusade) to Change the Direction of how our nation views mental health – as is Bill Pohlad, the director of the moving film Love and Mercy, which highlights the struggles of Brian Wilson of the Beach Boys.  He and Brian Wilson were present at Barbara’s moving celebration.  Does each of us know “The Five Signs” which Barbara constantly highlights?  We all should.  President and Michelle Obama have publicly talked about their importance on several occasions.

Barbara has often stated: “We must change our culture if we are to succeed in saving lives and ending suffering.  We must come to accept that mental health and mental illness are elements of the human condition – just as physical health and disease are.”  Today we know that less than half of the veterans (23% to 40%) who are experiencing mental health problems are likely to seek professional mental health care for fear of stigma or other related barriers to care.  The unprecedented advances occurring almost daily within the communications and technology fields – whether this is telehealth or health care apps – has revolutionized our practitioners’ ability to effectively address their potential clients’ concerns.  And yet, we have learned that change often takes considerably more time than one would originally expect and further, that fundamental change can be quite unsettling to those who are vested in the status quo.

State Licensure Restrictions:  State scope of practice laws should be carefully scrutinized to ascertain whether specific limitations on the scopes of practice of the various mental health disciplines actually address consumer protection or quality of care concerns, or do they, instead, represent historical efforts to protect the status quo and thereby prevent competition.  Psychology and psychiatry proclaim that the doctoral degree represents their minimum standard for independent practice.  And yet, few appreciate the policy significance of the fact that nursing, clinical pharmacy, and more recently social work, have also adopted the doctoral standard.  It is estimated that today there are 150-200,000 advanced practice nurses, 19,000 of whom specialize in mental health.  Nursing essentially has obtained prescriptive authority in every state, under differing conditions.  And, there has recently been considerable Congressional interest in having the various federal health care systems increase their number of marriage and family therapists and physician assistants in a concerted effort to address demonstrated mental health provider shortages.  One might wonder: Do the different mental health disciplines actually provide qualitatively different types of care?

Having had the opportunity to work over the past several decades with individuals who have made a real difference at the national level, it has become quite clear that sustainable change requires commitment at the local, individual-to-individual level, as well as responding to a national vision.  This summer, the White House released its report Occupational Licensing: A Framework for Policymakers, which was prepared by the Department of the Treasury Office of Economic Policy, the Council of Economic Advisers, and the Department of Labor.  Not surprisingly, issues surrounding the licensure of health care professionals were addressed throughout the report, including licensure mobility and the variations found in professional scopes of practice within the states.

“While quality can be defined in many ways and is often difficult to measure, the evidence on licensing’s effect on prices is unequivocal: many studies find that more restrictive licensing laws lead to higher prices for consumers.”  “(S)ince each State sets its own licensing requirements, these often vary across State lines, and licensed individuals seeking to move to another State often discover that they must meet new qualifications (such as education, experience, training, testing, etc.) if they want to continue working in their occupation.”  “Scope of practice has long been a particular focus in the health care context, in large part because of concerns about access to primary care.  Current scope of practice laws for advanced practice registered nurses – nurses such as nurse practitioners (NPs) with master’s degrees or more – vary dramatically by State, both in terms of their substantive content and the level of specificity that they provide.  But State-level evidence suggests that easing scope of practice laws for APRNs represents a viable means of increasing access to certain primary care services.  Research finds that APRNs can provide a broad range of primary care services to patients as effectively as physicians.”

Given the growing national interest in addressing the extraordinarily high cost of health care – unfortunately, without what should be expected demonstrable positive clinical outcomes – is it not time to seriously consider adopting national licensure standards, as well as fostering interdisciplinary competence?  These policy questions were raised in December, 1998 by the Pew Health Professions Commission.  Fundamental change of this magnitude will undoubtedly require the dedication and commitment of concerned citizens who are no longer satisfied with the status quo.

            An Exciting Opportunity:  Psychology’s quest for prescriptive authority (RxP) can be said to have begun with the November, 1984 address by U.S. Senator Daniel Inouye at the Hawaii Psychological Association annual convention at which time he urged the profession to seek prescriptive authority.  Since then, legislation has been enacted in Indiana, Guam, New Mexico, Louisiana, and Illinois; although several statutes are yet to be implemented.  Bob McGrath, one of the original architects of psychology’s far reaching RxP training initiatives, estimates that two years ago there were approximately 1750 graduates of psychology’s training programs, with growing interest since the passage of the Illinois law this past year.  The first two Department of Defense (DoD) prescribers, Navy Commander John Sexton and Lt. Commander Morgan Sammons, graduated in June, 1994.  Over the succeeding two decades, they and their federal colleagues clearly demonstrated their clinical competence to utilize psychotropic medications.  And yet, resistance from organized medicine and some psychologists continues; notwithstanding positive clinical outcomes.

            Earlier this year, former USAF Prescribing Psychologist Elaine Foster shared her personal frustration: “After graduating from the DoD Psychopharmacology Demonstration Project (PDP) I served as a prescribing psychologist in the Air Force for over 20 years.  I continued to serve our active duty military after retiring, again as a prescribing psychologist under contract with the Air Force.  During that time, I prescribed for our veterans when we had space available at our military clinic….  If I walked across the hospital parking lot to our annexed VA clinic, I could no longer prescribe to that same patient I’d been prescribing to while he or she was active duty.  The current VA restrictions are illogical….  Because New Mexico recognizes prescribing psychologists, I can now prescribe to our veterans, but only in New Mexico, and only through a third party contractor….  This just does not make sense and is a clear waste of federal funds.”  One rhetorically wonders: Where are the collective voices of those psychologists who are themselves veterans?  Don’t they believe in their own profession and the importance of quality care?

            Integration Of Mental Health Services:  Another substantive change that we have observed over the years has been the growing appreciation at both the clinical and health policy level of the inter-connectedness of the “mind and body.”  Historically, at the federal level this was reflected in the Community Mental Health Center movement initiated by the vision of President John F. Kennedy; whereas, the Community Health Center (FQCHC) initiative was an outgrowth of President Lyndon B. Johnson’s Great Society Era.  Federal funding for these two important efforts (including the all-important training component) was housed in different elements of the Department of HEW/HHS and different reimbursement models were adopted under Medicare and Medicaid.  Fortunately, signs of change are definitely evident -- especially with the enactment of President Obama’s Patient Protection and Affordable Care Act (ACA).  Although once again, seemingly rational changes will take longer to implement than one might anticipate – especially in the financial/reimbursement arena.

            In 2006, the then-President of the Institute of Medicine (IOM) proclaimed: “(T)he link between mental and substance-use problems and illnesses and general health and health care is very strong.  This is especially true with respect to chronic illnesses, which now are the leading cause of illness, disability, and death in the United States….  (I)mproving our nation’s general health and the quality problems of our general health care system depends upon equally attending to the quality problems in health care for mental and substance-use conditions….  (This) requires a fundamental change in how we as a society and health care system think about and respond to these problems and illnesses….  To this end, the Institute of Medicine will itself seek to incorporate attention to issues in health care for mental and substance-use problems and illnesses into its program of general health studies.”

            Marc Lalonde, then-Minister of National Health and Welfare for Canada, noted in 1974: “Good health is the bedrock on which social progress is built….  For these environmental and behavioural threats to health, the organized health care system can do little more than serve as a catchment net for the victims.  Physicians, surgeons, nurses and hospitals together spend much of their time treating ills caused by adverse environmental factors and behavioural risks….  The Government of Canada now intends to give to human biology, the environment and lifestyle as much attention as it has to the financing of the health care organization so that all four avenues to improved health are pursued with equal vigour.  Its goal will continue to be not only to add years to our life but life to our years, so that all can enjoy the opportunities offered by increased economic and social justice.”

This fall, the U.S. Army Surgeon General Patricia Horoho met with our nursing and psychology health policy students at USUHS.  As she has testified before the Congress, she emphasized: “Long term success in Army Medicine lies in our ability to effectively impact the ‘Lifespace.’  It is in the Lifespace where the choices we make impact our lives and our health.  We understand the patient healthcare encounter to be an average interaction of 20 minutes, approximately five times each year.  Therefore, the average annual amount of time spent with each patient is 100 minutes; this represents a very small fraction of one’s life.  It is in between the appointments – in the Lifespace – where health really happens and where we desire a different relationship with Soldiers, Families, and Retirees.  We need to reach beyond the physical boundaries of our medical treatment facilities.  In other words, we want to partner with those entrusted to our care during the other 525,500 minutes of the year where people are living their lives and making their health choices.”  Without question, our nation’s health care system is steadily evolving in fundamental ways.  Those with vision who specialize in mental health are facing unprecedented challenges and opportunities.  Aloha,

Pat DeLeon, former APA President – Center for Deployment Psychology – December, 2015

 

REFLECTIONS FROM THE PAST, OR PERHAPS THE FUTURE?

For nearly four decades, I had the honor of serving on the staff of the late-U.S. Senator Daniel K. Inouye, retiring in the fall of 2011 as his chief of staff.  During that time, I was actively involved within the governance of the American Psychological Association (APA) and served as its President in 2000.  Over the years, we have observed many changes within the field of mental health, both from the "front line" and at the all-important health policy level.  Perhaps the most significant of these changes has been external to any of the mental health disciplines – it is the gradual acceptance by society of the importance and appropriateness of receiving quality mental health care, in the same manner that it is now "all right" to openly discuss receiving treatment for cancer or diabetes.  I cannot help but believe that a major factor in this evolution has been the extent to which our nation has become increasingly educated.  My mother, for example, was the second female attorney in the State of Connecticut; her mother had considerably less formal education.  Both of our children have advanced professional degrees – law and social work.

Changing The Direction:  A little more than a decade ago, psychologist Barbara Van Dahlen established the non-profit organization Give an Hour, in order to effectively link-up those veterans, service members, and their families who desired mental health services with practitioners within their local community from all disciplines.  At the time of the celebration of Give an Hour's tenth anniversary, over 175,000 hours of free mental health care had been provided.  It might be said that Barbara is on a mission (or crusade) to Change the Direction of how our nation views mental health – as is Bill Pohlad, the director of the moving film Love and Mercy, which highlights the struggles of Brian Wilson of the Beach Boys.  He and Brian Wilson were present at Barbara's moving celebration.  Does each of us know "The Five Signs" which Barbara constantly highlights?  We all should.  President and Michelle Obama have publicly talked about their importance on several occasions.

Barbara has often stated: "We must change our culture if we are to succeed in saving lives and ending suffering.  We must come to accept that mental health and mental illness are elements of the human condition – just as physical health and disease are."  Today we know that less than half of the veterans (23% to 40%) who are experiencing mental health problems are likely to seek professional mental health care for fear of stigma or other related barriers to care.  The unprecedented advances occurring almost daily within the communications and technology fields – whether this is telehealth or health care apps – has revolutionized our practitioners' ability to effectively address their potential clients' concerns.  And yet, we have learned that change often takes considerably more time than one would originally expect and further, that fundamental change can be quite unsettling to those who are vested in the status quo.

State Licensure Restrictions:  State scope of practice laws should be carefully scrutinized to ascertain whether specific limitations on the scopes of practice of the various mental health disciplines actually address consumer protection or quality of care concerns, or do they, instead, represent historical efforts to protect the status quo and thereby prevent competition.  Psychology and psychiatry proclaim that the doctoral degree represents their minimum standard for independent practice.  And yet, few appreciate the policy significance of the fact that nursing, clinical pharmacy, and more recently social work, have also adopted the doctoral standard.  It is estimated that today there are 150-200,000 advanced practice nurses, 19,000 of whom specialize in mental health.  Nursing essentially has obtained prescriptive authority in every state, under differing conditions.  And, there has recently been considerable Congressional interest in having the various federal health care systems increase their number of marriage and family therapists and physician assistants in a concerted effort to address demonstrated mental health provider shortages.  One might wonder: Do the different mental health disciplines actually provide qualitatively different types of care?

Having had the opportunity to work over the past several decades with individuals who have made a real difference at the national level, it has become quite clear that sustainable change requires commitment at the local, individual-to-individual level, as well as responding to a national vision.  This summer, the White House released its report Occupational Licensing: A Framework for Policymakers, which was prepared by the Department of the Treasury Office of Economic Policy, the Council of Economic Advisers, and the Department of Labor.  Not surprisingly, issues surrounding the licensure of health care professionals were addressed throughout the report, including licensure mobility and the variations found in professional scopes of practice within the states.

"While quality can be defined in many ways and is often difficult to measure, the evidence on licensing's effect on prices is unequivocal: many studies find that more restrictive licensing laws lead to higher prices for consumers."  "(S)ince each State sets its own licensing requirements, these often vary across State lines, and licensed individuals seeking to move to another State often discover that they must meet new qualifications (such as education, experience, training, testing, etc.) if they want to continue working in their occupation."  "Scope of practice has long been a particular focus in the health care context, in large part because of concerns about access to primary care.  Current scope of practice laws for advanced practice registered nurses – nurses such as nurse practitioners (NPs) with master's degrees or more – vary dramatically by State, both in terms of their substantive content and the level of specificity that they provide.  But State-level evidence suggests that easing scope of practice laws for APRNs represents a viable means of increasing access to certain primary care services.  Research finds that APRNs can provide a broad range of primary care services to patients as effectively as physicians."

Given the growing national interest in addressing the extraordinarily high cost of health care – unfortunately, without what should be expected demonstrable positive clinical outcomes – is it not time to seriously consider adopting national licensure standards, as well as fostering interdisciplinary competence?  These policy questions were raised in December, 1998 by the Pew Health Professions Commission.  Fundamental change of this magnitude will undoubtedly require the dedication and commitment of concerned citizens who are no longer satisfied with the status quo.

            An Exciting Opportunity:  Psychology's quest for prescriptive authority (RxP) can be said to have begun with the November, 1984 address by U.S. Senator Daniel Inouye at the Hawaii Psychological Association annual convention at which time he urged the profession to seek prescriptive authority.  Since then, legislation has been enacted in Indiana, Guam, New Mexico, Louisiana, and Illinois; although several statutes are yet to be implemented.  Bob McGrath, one of the original architects of psychology's far reaching RxP training initiatives, estimates that two years ago there were approximately 1750 graduates of psychology's training programs, with growing interest since the passage of the Illinois law this past year.  The first two Department of Defense (DoD) prescribers, Navy Commander John Sexton and Lt. Commander Morgan Sammons, graduated in June, 1994.  Over the succeeding two decades, they and their federal colleagues clearly demonstrated their clinical competence to utilize psychotropic medications.  And yet, resistance from organized medicine and some psychologists continues; notwithstanding positive clinical outcomes.

            Earlier this year, former USAF Prescribing Psychologist Elaine Foster shared her personal frustration: "After graduating from the DoD Psychopharmacology Demonstration Project (PDP) I served as a prescribing psychologist in the Air Force for over 20 years.  I continued to serve our active duty military after retiring, again as a prescribing psychologist under contract with the Air Force.  During that time, I prescribed for our veterans when we had space available at our military clinic….  If I walked across the hospital parking lot to our annexed VA clinic, I could no longer prescribe to that same patient I'd been prescribing to while he or she was active duty.  The current VA restrictions are illogical….  Because New Mexico recognizes prescribing psychologists, I can now prescribe to our veterans, but only in New Mexico, and only through a third party contractor….  This just does not make sense and is a clear waste of federal funds."  One rhetorically wonders: Where are the collective voices of those psychologists who are themselves veterans?  Don't they believe in their own profession and the importance of quality care?

            Integration Of Mental Health Services:  Another substantive change that we have observed over the years has been the growing appreciation at both the clinical and health policy level of the inter-connectedness of the "mind and body."  Historically, at the federal level this was reflected in the Community Mental Health Center movement initiated by the vision of President John F. Kennedy; whereas, the Community Health Center (FQCHC) initiative was an outgrowth of President Lyndon B. Johnson's Great Society Era.  Federal funding for these two important efforts (including the all-important training component) was housed in different elements of the Department of HEW/HHS and different reimbursement models were adopted under Medicare and Medicaid.  Fortunately, signs of change are definitely evident -- especially with the enactment of President Obama's Patient Protection and Affordable Care Act (ACA).  Although once again, seemingly rational changes will take longer to implement than one might anticipate – especially in the financial/reimbursement arena.

            In 2006, the then-President of the Institute of Medicine (IOM) proclaimed: "(T)he link between mental and substance-use problems and illnesses and general health and health care is very strong.  This is especially true with respect to chronic illnesses, which now are the leading cause of illness, disability, and death in the United States….  (I)mproving our nation's general health and the quality problems of our general health care system depends upon equally attending to the quality problems in health care for mental and substance-use conditions….  (This) requires a fundamental change in how we as a society and health care system think about and respond to these problems and illnesses….  To this end, the Institute of Medicine will itself seek to incorporate attention to issues in health care for mental and substance-use problems and illnesses into its program of general health studies."

            Marc Lalonde, then-Minister of National Health and Welfare for Canada, noted in 1974: "Good health is the bedrock on which social progress is built….  For these environmental and behavioural threats to health, the organized health care system can do little more than serve as a catchment net for the victims.  Physicians, surgeons, nurses and hospitals together spend much of their time treating ills caused by adverse environmental factors and behavioural risks….  The Government of Canada now intends to give to human biology, the environment and lifestyle as much attention as it has to the financing of the health care organization so that all four avenues to improved health are pursued with equal vigour.  Its goal will continue to be not only to add years to our life but life to our years, so that all can enjoy the opportunities offered by increased economic and social justice."

This fall, the U.S. Army Surgeon General Patricia Horoho met with our nursing and psychology health policy students at USUHS.  As she has testified before the Congress, she emphasized: "Long term success in Army Medicine lies in our ability to effectively impact the 'Lifespace.'  It is in the Lifespace where the choices we make impact our lives and our health.  We understand the patient healthcare encounter to be an average interaction of 20 minutes, approximately five times each year.  Therefore, the average annual amount of time spent with each patient is 100 minutes; this represents a very small fraction of one's life.  It is in between the appointments – in the Lifespace – where health really happens and where we desire a different relationship with Soldiers, Families, and Retirees.  We need to reach beyond the physical boundaries of our medical treatment facilities.  In other words, we want to partner with those entrusted to our care during the other 525,500 minutes of the year where people are living their lives and making their health choices."  Without question, our nation's health care system is steadily evolving in fundamental ways.  Those with vision who specialize in mental health are facing unprecedented challenges and opportunities.  Aloha,

Pat DeLeon, former APA President – Center for Deployment Psychology – December, 2015

 

Sent from my iPhone

ALOHA

“WOULDN’T IT BE NICE”

            One of the most satisfying aspects of serving at the Uniformed Services University of the Health Sciences (USUHS) is realizing the extent to which APA, APS, various national nursing organizations, and individual psychology and nursing leaders have been willing to go “that extra mile” for those who are serving our nation and oftentimes putting themselves in “harm’s way.”  Former APA Presidents Don Bersoff and Ron Fox have participated in our health policy seminar, as has APA President Barry Anton.  Nadine Kaslow has addressed a larger psychology colloquium; while Give an Hour Founder and President Barbara Van Dahlen has graciously participated in both venues.

Global Approaches to Integrated Health Care: Translating Science and Best Practices into Patient-Centered Healthcare Delivery:  This Fall, APA President Barry Anton graciously extended invitations to the USUHS community to participate in his two and one-half day working Summit.  Over 400 viewers, representing 36 countries, “streamed live” into the conference; which was held at the APA Capitol View Conference Center.  Video recordings of the summit sessions will soon be made available on the APA web.  Barry’s goal was to facilitate the sharing of best practices and innovations across disciplines, health care professions, health care settings, and countries.  Through the shared understanding of “patient-centered care” he envisions enhanced public expectations (and, in all candor given his long-time interest in the field, appetite) for the integration of health services, bringing together un-likeminded people and shareholders across the health care domain.  On his visionary planning committee was former APA Congressional Science Fellow Brian Smedley and Toni Zeiss, former head of mental health for the Department of Veterans Affairs (VA), both of whom have participated in our health policy seminar.  Two of the noteworthy keynote speakers were Ronalso Holer, MD, from the Pan American Health Organization (PAHO) and Sue Dopson, Ph.D. from the United Kingdom.  APA President-elect Susan McDaniel also actively participated, moderating panels on special populations and international perspectives.

USUHS student-participant views:  “The Summit brought together the pressing issues in healthcare integration.  The attendees demonstrated well-rounded ideas and approaches to healthcare and service delivery.  I learned about many new topics and ways to communicate.  For example, the role of entrepreneurship and business management is becoming increasingly indispensable for any clinician.  The experts expressed the pressing need of updating professional education with integrative science on what exactly ‘health,’ ‘wellness,’ ‘illness,’ and ‘patient-centered care’ mean from various disciplines.  Lastly, the role of the patient in developing and implementing integrated care remains relatively untapped; e.g., training patients and family in health communication, using their consumer choices to influence the market, etc. [Edwin Szeto].”

“The Summit was an incredibly rewarding experience.  While we often speak about the importance of integrated healthcare within the American healthcare system, it was eye-opening to hear from experts from around the globe who provided perspectives on the need for such efforts worldwide.  Not only did we discuss the importance of getting out of our healthcare AND national silos, the conference put this into action by bringing together physicians, economists, nurse practitioners, psychologists, and many others who were national experts in the U.S., the U.K., Latin America, and other countries around the world.  It was spectacular.… Absolutely amazing [Omni Cassidy].”  Psychology’s future will remain very bright, as long as today’s leaders actively engage the next generation in their efforts and thereby share their vision.

Give an Hour:  Also this Fall, Give an Hour celebrated its tenth anniversary having provided over 175,000 hours of free mental health care to our nation’s veterans, service members, and their families.  The four day Celebration of Service included a fireside chat at the Embassy of Canada, as well as a special benefit concert performed by Brian Wilson of the Beach Boys and Paul Dano who played Brian in the outstanding film Love and Mercy – in which a California psychologist was “less than ethical.”  USUHS students and faculty were invited to attend the ceremonies.   If one stays to the very end of the film, long after many in the audience have unfortunately departed, it becomes clear that director Bill Pohlad and Barbara are on a mission to Change the Direction of how our nation views mental health.  Does each of us know “The Five Signs”?  President and Michelle Obama have publicly talked about their importance.

As Barbara has often stated: “We must change our culture if we are to succeed in saving lives and ending suffering.  We must come to accept that mental health and mental illness are elements of the human condition – just as physical health and disease are.”  Today less than half of the veterans (23% to 40%) who are experiencing mental health problems are likely to seek professional mental health care for fear of stigma or other related barriers to care.  Listening to those who have made a difference at the national level, it also becomes quite clear that sustainable change requires commitment at the local, individual-to-individual, level.  At the fireside chat, it was noted that those who serve our nation develop a deep appreciation for the importance of building a community of effort and of seeking to contribute beyond oneself.  It was opined that our nation needs our veterans to once again share their spirit of comradery and to bring home their “lessons learned” to our nation’s cities and rural communities.  As these complex issues are being contemplated, it is particularly timely that Give an Hour announced that they are actively bringing research expertise into their ever-expanding community of partners.  Changing a culture takes time and personal dedication.

Military Construction, Veterans Affairs, and Related Agencies (MilCon):  The day before Veterans Day, the U.S. Senate passed the Fiscal Year 2016 MilCon/VA appropriations bill, recommending $1.0 billion above the President’s budget request, by a vote of 93 to 0.  Addressing the special needs of certain veterans; e.g., the Veterans Justice Outreach (VJO) program, the Senate: “(C)ommends the Department for its efforts to support justice-involved veterans.  According to the Bureau of Justice Statistics, 9.3 percent of people incarcerated in the United States are veterans; 70 percent of these veterans are incarcerated for a nonviolent offense.  The Department reports that 60 percent of incarcerated veterans suffer from substance abuse, 30 percent from a serious mental illness, and 60 percent from a major medical condition.  Almost 50 percent of homeless veterans have interacted with the criminal justice system.  The Department’s VJO specialists provide outreach and case management services to justice-involved veterans to help avoid unnecessary criminalization of mental illness and substance abuse.  VJOs also work directly with local law enforcement and court officials to help identify veteran-specific issues, including Post-Traumatic Stress Disorder [PTSD] and Traumatic Brain Injury [TBI], and they connect eligible veterans with VA treatment programs.”

“Women Veterans – The Committee believes VA must make better progress in addressing the needs of women veterans….  Access to and utilization of VA benefits and services by women veterans remain low, with women often encountering cultural roadblocks in a system that was largely designed to meet the needs of male veterans.  The Committee anticipates the results of an ongoing system-wide review intended to determine what type and number of healthcare workers the system should have to address current and future demand of gender-specific care.”  Changing a culture requires vision and dedication.  “Wouldn’t it be nice?”  Aloha,

Pat DeLeon, former APA President – HPA – December, 2015

 

“WOULDN’T IT BE NICE”

 One of the most satisfying aspects of serving at the Uniformed Services University of the Health Sciences (USUHS) is realizing the extent to which APA, APS, various national nursing organizations, and individual psychology and nursing leaders have been willing to go "that extra mile" for those who are serving our nation and oftentimes putting themselves in "harm's way."  Former APA Presidents Don Bersoff and Ron Fox have participated in our health policy seminar, as has APA President Barry Anton.  Nadine Kaslow has addressed a larger psychology colloquium; while Give an Hour Founder and President Barbara Van Dahlen has graciously participated in both venues.

Global Approaches to Integrated Health Care: Translating Science and Best Practices into Patient-Centered Healthcare Delivery:  This Fall, APA President Barry Anton graciously extended invitations to the USUHS community to participate in his two and one-half day working Summit.  Over 400 viewers, representing 36 countries, "streamed live" into the conference; which was held at the APA Capitol View Conference Center.  Video recordings of the summit sessions will soon be made available on the APA web.  Barry's goal was to facilitate the sharing of best practices and innovations across disciplines, health care professions, health care settings, and countries.  Through the shared understanding of "patient-centered care" he envisions enhanced public expectations (and, in all candor given his long-time interest in the field, appetite) for the integration of health services, bringing together un-likeminded people and shareholders across the health care domain.  On his visionary planning committee was former APA Congressional Science Fellow Brian Smedley and Toni Zeiss, former head of mental health for the Department of Veterans Affairs (VA), both of whom have participated in our health policy seminar.  Two of the noteworthy keynote speakers were Ronalso Holer, MD, from the Pan American Health Organization (PAHO) and Sue Dopson, Ph.D. from the United Kingdom.  APA President-elect Susan McDaniel also actively participated, moderating panels on special populations and international perspectives.

USUHS student-participant views:  "The Summit brought together the pressing issues in healthcare integration.  The attendees demonstrated well-rounded ideas and approaches to healthcare and service delivery.  I learned about many new topics and ways to communicate.  For example, the role of entrepreneurship and business management is becoming increasingly indispensable for any clinician.  The experts expressed the pressing need of updating professional education with integrative science on what exactly 'health,' 'wellness,' 'illness,' and 'patient-centered care' mean from various disciplines.  Lastly, the role of the patient in developing and implementing integrated care remains relatively untapped; e.g., training patients and family in health communication, using their consumer choices to influence the market, etc. [Edwin Szeto]."

"The Summit was an incredibly rewarding experience.  While we often speak about the importance of integrated healthcare within the American healthcare system, it was eye-opening to hear from experts from around the globe who provided perspectives on the need for such efforts worldwide.  Not only did we discuss the importance of getting out of our healthcare AND national silos, the conference put this into action by bringing together physicians, economists, nurse practitioners, psychologists, and many others who were national experts in the U.S., the U.K., Latin America, and other countries around the world.  It was spectacular.… Absolutely amazing [Omni Cassidy]."  Psychology's future will remain very bright, as long as today's leaders actively engage the next generation in their efforts and thereby share their vision.

Give an Hour:  Also this Fall, Give an Hour celebrated its tenth anniversary having provided over 175,000 hours of free mental health care to our nation's veterans, service members, and their families.  The four day Celebration of Service included a fireside chat at the Embassy of Canada, as well as a special benefit concert performed by Brian Wilson of the Beach Boys and Paul Dano who played Brian in the outstanding film Love and Mercy– in which a California psychologist was "less than ethical."  USUHS students and faculty were invited to attend the ceremonies.   If one stays to the very end of the film, long after many in the audience have unfortunately departed, it becomes clear that director Bill Pohlad and Barbara are on a mission to Change the Direction of how our nation views mental health.  Does each of us know "The Five Signs"?  President and Michelle Obama have publicly talked about their importance.

As Barbara has often stated: "We must change our culture if we are to succeed in saving lives and ending suffering.  We must come to accept that mental health and mental illness are elements of the human condition – just as physical health and disease are."  Today less than half of the veterans (23% to 40%) who are experiencing mental health problems are likely to seek professional mental health care for fear of stigma or other related barriers to care.  Listening to those who have made a difference at the national level, it also becomes quite clear that sustainable change requires commitment at the local, individual-to-individual, level.  At the fireside chat, it was noted that those who serve our nation develop a deep appreciation for the importance of building a community of effort and of seeking to contribute beyond oneself.  It was opined that our nation needs our veterans to once again share their spirit of comradery and to bring home their "lessons learned" to our nation's cities and rural communities.  As these complex issues are being contemplated, it is particularly timely that Give an Hour announced that they are actively bringing research expertise into their ever-expanding community of partners.  Changing a culture takes time and personal dedication.

Military Construction, Veterans Affairs, and Related Agencies (MilCon):  The day before Veterans Day, the U.S. Senate passed the Fiscal Year 2016 MilCon/VA appropriations bill, recommending $1.0 billion above the President's budget request, by a vote of 93 to 0.  Addressing the special needs of certain veterans; e.g., the Veterans Justice Outreach (VJO) program, the Senate: "(C)ommends the Department for its efforts to support justice-involved veterans.  According to the Bureau of Justice Statistics, 9.3 percent of people incarcerated in the United States are veterans; 70 percent of these veterans are incarcerated for a nonviolent offense.  The Department reports that 60 percent of incarcerated veterans suffer from substance abuse, 30 percent from a serious mental illness, and 60 percent from a major medical condition.  Almost 50 percent of homeless veterans have interacted with the criminal justice system.  The Department's VJO specialists provide outreach and case management services to justice-involved veterans to help avoid unnecessary criminalization of mental illness and substance abuse.  VJOs also work directly with local law enforcement and court officials to help identify veteran-specific issues, including Post-Traumatic Stress Disorder [PTSD] and Traumatic Brain Injury [TBI], and they connect eligible veterans with VA treatment programs."

"Women Veterans – The Committee believes VA must make better progress in addressing the needs of women veterans….  Access to and utilization of VA benefits and services by women veterans remain low, with women often encountering cultural roadblocks in a system that was largely designed to meet the needs of male veterans.  The Committee anticipates the results of an ongoing system-wide review intended to determine what type and number of healthcare workers the system should have to address current and future demand of gender-specific care."  Changing a culture requires vision and dedication.  "Wouldn't it be nice?"  Aloha,

Pat DeLeon, former APA President – HPA – December, 2015

 

Sent from my iPhone