La psychologie et la santé.

This article traces the historical development of Canadian medicare and its significant influence on shaping not only the clinical services provided within Canada's public health care system but also its major impact on the nation's overall health research agenda. Particular emphasis is placed on how this has influenced the development and role of psychology in the public health care system. It is argued that all psychologists, whether their work is focused on the applied or experimental areas of the discipline, have much to offer Canadians across the entire health care spectrum. Nevertheless, psychological services in the public health care system, and particularly in hospitals, have mainly developed within and continue to be primarily focused around mental health. Services in nonmental health areas of health have been more limited, although their importance is well recognized. The current situation partly reflects the limited training in general health issues that clinical psychologists-in-training generally receive in many graduate school programs in Canada. However, it also reflects the overall influence of medicare on the development of Canada's health care system. Medicare has tended to focus the activities of Canada's health care system primarily on treating illness rather than on preventing it and/or maintaining health. Also, medicare has oriented Canada's health care system mainly toward delivering medical services rather than providing more comprehensive health services (e.g., the "medically necessary" criterion for funding). However, times are changing. The growing emphasis among health policymakers in Canada on illness prevention and health promotion (e.g., the creation of the federal government Public Health Agency of Canada in 2004) will significantly expand psychology's role across all areas of health. Psychology education and training programs are urged to seriously examine whether psychology practitioners and researchers are being adequately prepared at present for the much broader array of future interdisciplinary professional, research, and educational activities and responsibilities that will emerge. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health Services and Health Care Economics: The Health Psychology Marketplace.

In an effort toward cost containment, the health care system in the United States has undergone radical changes in the last decade. These changes have influenced the delivery of clinical health psychology services. This article reviews several economic and marketing factors salient to the clinical health psychology marketplace. For example, these economic changes have placed greater emphasis on the need for cost-effectiveness and accountability in the health psychology field. Implications for education and training, collaboration with other health care specialties, new practice initiatives, and public relations are reviewed. Future challenges and opportunities for clinical health psychology are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reconceptualizing Health: A Response to Romanow and Marchildon (2003).

The Commission on the Future of Health Care in Canada (CFHCC) is to be congratulated for addressing the tension among various levels of government regarding health-care funding. The CFHCC also took the progressive step of creating the National Health Council, a body charged with ensuring greater accountability in health care. Psychologists have argued for decades that treatment decisions should be guided by a consideration of what works for whom and under what conditions. In our response to Romanow and Marchildon (see record 2003-09748-001), we argue that funding of health services in Canada has failed to heed this recommendation and the scientific evidence in support of the efficacy of psychological interventions for a wide range of health conditions. Despite remarkable advances in healthcare delivery, Canada's health-care system continues to be funded based on an outdated model of disease and illness. Romanow and Marchildon are to be applauded for their broad conceptualization of health and the role of various health professionals in advancing the health of Canadians. Unfortunately, this recognition did not make its way into the report of the CFHCC to the extent needed to make Canada's health system truly progressive. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Shaping the Future of Psychological Services in the Canadian Health-Care System: A Response to Romanow and Marchildon (2003).

Our response to Romanow and Marchildon's article (see record 2003-09748-001) on the role of psychology in the Canadian health-care system focuses on two challenges that emerge from the article, namely the continuing marginalization of mental health services and the dominance of political considerations over compelling scientific evidence for the impact of psychological services on health and recovery from illness. We conclude our comment with calls for (a) continuing efforts to educate policymakers, the media, and Canadians about the value of psychological services and (b) active involvement from psychologists in efforts to develop new models of primary health care in Canada. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Survey of Hospital Psychology in Canada.

Despite the major advances in health psychology over the past decade and the changes that have taken place in the Canadian health sector, there remains a paucity of information available about the structure of psychological services in Canadian health-care settings. The most current information about psychology in Canada's hospitals was gathered in 1982 - almost 20 years ago (Arnett, Martin, Steiner, & Goodman, 1987). This article updates the previous information, as it presents the results of a survey that was sent to 975 acute, psychiatric and continuing care health facilities with a minimum patient bed count of 100. Detailed information about the number of psychologists and administrative organizations of psychological services in Canada are reported. The range of services provided by psychologists in health-care settings has expanded, and professional autonomy, as shown by the existence of independent departments of psychology, has changed. The implications of these results for the organization and delivery of psychological services in Canadian healthcare, and for advocacy on the part of psychology, are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

L'accessibilité à des traitements pour les troubles anxieux au Canada: Un commentaire.

Responds to Gauthier (see record 2004-17185-003) who commented on the two articles by Koerner et al (see record 2004-17185-001) and by Roberge et al (see record 2004-17185-002. The purpose of this response is to discuss the issue of limited availability of mental health services for anxiety disorders in Canada. From a public health perspective, the authors emphasize the importance of gathering Canadian empirical data on the organization of mental health services for anxiety disorders. Specifically more research is needed on care requirements, and the financial and structural barriers that restrict access to mental health services at the regional, provincial and national levels. The authors also discuss the role of psychologists in improving mental health care in Canada. Cost-effectiveness studies conducted in interdisciplinary practice environments could demonstrate the value added by psychology in the organization of mental health care for anxiety disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Le régime d'assurance-maladie du Canada--Arrive-t-il à un tournant?

Canadians' support for the underlying values and structures of medicare still remains extremely high, according to all recent public opinion studies. However, their confidence is being tested by the persistent advocacy that increased private-for-profit payment and delivery be introduced in order to guarantee medicare's future sustainability. Patience is further being challenged as the public eagerly awaits (but does not yet sees) productive reforms actually being implemented into the system. Delay erodes public support. Alternative "solutions" gain currency. Thus, the public-private debate must be engaged fully and emerge from the shadows of public policy so that Canadians can determine its efficacy and its compatibility with our society's values. Therefore, the long overdue reforms also need to be advanced. One of the most urgent reforms to medicare should address mental health needs and concerns, which I have described as being "an orphan of medicare." An essential first step would be to construct a basic platform of care and research on issues of mental health. This platform would provide necessary, immediate services for those in need and, at another level, would provide the impetus for further solutions to the wide-ranging needs in this field. Overall, the snail's pace of reforms has caused many Canadians to speculate that the future of medicare is at the crossroads on mental health policies and other issues, like accountability, quality, adequate reporting and health outcomes. The time to act is now. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Investing in our future: Unrealized opportunities for funding graduate psychology training.

Purpose: Changes in the health care environment have brought challenges and opportunities to the field of psychology. Practitioners have been successful in modifying service models to absorb losses of financial support for behavioral health care, due to managed care and public policy changes, while simultaneously managing the growing need for these services. However, in this reactive mode of responding to evolutions in the health care system, the field of psychology has at times lost sight of the long-term vision required to promote psychology's inclusion in the health care system of the future. In particular, a focus on training psychologists and ensuring the availability of funding to support these activities must be a priority in planning for the future. This article provides an overview of federal programs that currently offer funding for psychology training, as well as other opportunities for federal funding that have been unrealized. Details regarding advocacy efforts that were required to secure available sources of funding are given, followed by consideration of strategies for taking advantage of existing resources and prioritizing advocacy for additional funding. Conclusion: Funding for psychology training provides an avenue for increasing the number of well-trained psychologists who can serve patients' mental and behavioral health needs and thereby improve health outcomes. Moreover, capitalizing on available funding opportunities for psychology training and promoting efforts to expand these opportunities will help ensure that the field of psychology is positioned to remain an important contributor to the health care system of the future. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Canada's Medicare--At the crossroads?

Canadians' support for the underlying values and structures of medicare still remains extremely high, according to all recent public opinion studies. However, their confidence is being tested by the persistent advocacy that increased private-for-profit payment and delivery be introduced in order to guarantee medicare's future sustainability. Patience is further being challenged as the public eagerly awaits (but does not yet sees) productive reforms actually being implemented into the system. Delay erodes public support. Alternative "solutions" gain currency. Thus, the public-private debate must be engaged fully and emerge from the shadows of public policy so that Canadians can determine its efficacy and its compatibility with our society's values. Therefore, the long overdue reforms also need to be advanced. One of the most urgent reforms to medicare should address mental health needs and concerns, which I have described as being "an orphan of medicare." An essential first step would be to construct a basic platform of care and research on issues of mental health. This platform would provide necessary, immediate services for those in need and, at another level, would provide the impetus for further solutions to the wide-ranging needs in this field. Overall, the snail's pace of reforms has caused many Canadians to speculate that the future of medicare is at the crossroads on mental health policies and other issues, like accountability, quality, adequate reporting and health outcomes. The time to act is now. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction.

The three articles presented in this issue reflect different problems encountered by psychologists as each attempted to pursue a career. All three psychologists were trail blazers, developing new applications of psychological knowledge, and each faced different challenges. Stanley Moldawsky, a pioneer in the development of professional psychology, reflects on the establishment of a private practice in the 1950s. He shares how politics had to become an important concern in order to survive, gives us a glimpse of some of the hurdles that had to be crossed to establish a professional school in New Jersey, and impresses on us that professional psychology will grow only if we advocate for it. In contrast to Moldawsky, Jonathan Cummings' career was devoted to the application of clinical and counseling psychology to the medical-surgical areas of the health field. His career was focused on working in the Veterans Administration Hospital system, where he was the first psychologist who was assigned to work outside of the mental health area. Cummings' work was instrumental in the development of the field of health psychology and of the need to focus on the whole person when treating people in these settings. John Jackson, in his poignant essay, reflects on the upward climb of minorities into professional psychology. An African American, Jackson did not have the benefit of more recent civil rights legislation to assist his career. He reflects on his involvements with the American Psychological Association and how he perceives the role of minority psychologists within organized psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emerging trends in mental health policy and practice

The continuing deinstitutionalization of patients in public mental hospitals and the growth of managed care are fundamentally altering mental health practice. Managed care provides opportunities for achieving parity of insurance coverage between mental and physical illness, but serious problems persist in integrating mental health, substance abuse, and general medical care and assuring an appropriate range of services and programs for persons with serious mental illness residing in community settings. Hospital and community care are poorly coordinated, and hospital care needs to be integrated into a more balanced system of services. Important new roles are emerging for purchasers, patient advocates, and mental health authorities.     

The Public Health Psychologist: An Ounce of Prevention Is Not Enough.

An increasing number of health service providers in psychology are working in non-mental-health areas in behavioral health and in community health programs. Much of the psychological work in prevention, wellness, and health promotion has ignored the contributions of public health. This article describes a joint MPH/PhD program recently established on two campuses of the University of Alabama system. The value of the dual perspectives is illustrated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cost offset: Past, present, and future.

The health of the U.S. health care system is precarious. Calls for reform in areas such as cost, quality, and equal access to health care are widespread and growing louder each day. Action is required on each of these issues, yet the lack of progress is cause for serious concern. A central problem is the reluctance to acknowledge the roles that the mind and behavior play in health and illness. One solution is the integration of psychological health care into the general health care system. A major vehicle for advancing the integration of health care is the "cost-offset" effect, a concept that involves paying systematic attention to psychological factors in order to reduce overuse of medical services and thereby decrease costs. Despite data demonstrating that the cost-offset hypothesis is quite robust, little has been done to implement integrated health care. This article reviews the literature on cost offset, discusses the policy implications, and considers its application to the public sector. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Community psychology: Impressions of the Boston conference on the education of psychologists for community mental health.

Mental health "is shifting from the amelioration of illness to preventive intervention at the community level… community psychology is more than a by-product of clinical… it depends upon and interacts with all the basic areas of psychological knowledge. Particular emphasis [is] given to the contributions of social psychology, group dynamics, and child development." The Conference recommended that "some permanent organizational medium be established… to facilitate communication among psychologists with vital interest in community psychology." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychology's Role in Health in Canada: Reaction to Romanow and Marchildon.

The article reacts to Romanow and Marchildon's article (see record 2003-09748-001). Notwithstanding its high cost, the current Canadian health-care system provides Canadians with minimal access to publicly funded psychological services in spite of their demonstrated efficacy, comparative cost advantages, minimal risk of adverse treatment effects, and the public's preference for these services. Psychological services are now available not only for mental health problems but also for a wide range of physical health problems. A great deal of illness is preventable; population health research has illuminated the links between illness and risky individual behaviours, which are amenable to psychological intervention. These approaches have been shown to be effective in promoting health-enhancing behaviours that reduce morbidity and mortality. Nevertheless, the primary focus of the present health-care system is on the increasingly expensive detection and treatment of disease, often with expensive equipment and pharmaceuticals, rather than on the prevention of illness and health promotion. We believe that the current Canadian health-care system is not sustainable in the long run in its present form. We urge governments to act to provide Canadians with greater access to psychological services and we urge psychology education and training programs to ensure that students are adequately prepared to assume a larger role in a reformed health-care system. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

History, Politics, and Transformational Change in Canadian Health Care: A Rejoinder.

Our rejoinder addresses two common themes raised in the responses by Arnett et al (see record 2004-17185-005), by Hunsley and Crabb (see record 2004-17185-006) and by Mikail and Tasca (see record 2004-17185-007) to our article (see record 2003-09748-001) concerning the potential role of psychological services in the future of public health care in Canada. The first concerns the current system's capacity to evolve beyond the medical-hospital illness model of the 1960s to incorporate psychological treatments aimed at illness prevention and health promotion. This would be more likely if psychologists were to participate directly in primary-care and home-based mental health-care reform. The second theme is the presumed negative role of "politics" rather than scientific evidence in decisions concerning public coverage or subsidy. We argue that democratic decision-making is the proper basis upon which decisions concerning public coverage are made, but it need not be in opposition to evidence-based decision-making. As recommended in the final report of the Commission on the Future of Health Care in Canada, the Health Council of Canada along with applied research institutes can make politicians and policy-makers more aware of the growing body of evidence supporting the efficacy of psychological treatments relative to the alternatives. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health promotion in the community: Development of a curriculum for predoctoral clinical psychologists.

There is increasing evidence that life-style choices play a major role in premature illness and death from cardiovascular disease and cancer. Skyrocketing health care costs have promoted interest in health promotion activities. Although clinical psychologists appear to be in a unique position to contribute to health promotion activities, predoctoral training programs in clinical psychology have not generally included health promotion as a significant component. My colleagues and I are developing a curriculum for predoctoral clinical psychologists in the area of health promotion. Our emphasis on community interventions, rather than office- or hospital-based interventions, is consistent with the National Institutes of Health's funding of cardiovascular disease prevention programs at Stanford, Pawtucket, and Minnesota and appears valid from both a public health perspective and a psychological perspective. Our curriculum currently includes didactic and research components, as well as two community health promotion projects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of public/private health care insurance parameters for independent psychological practice.

Managed care cost-cutting strategies are more prevalent in the private (employer provided) than public (Medicare/Medicaid) health care sectors. The main organizational managed care strategy pertaining to the independent practice of psychology has been the separation of the administration of mental from medical health care though behavioral health carve-outs. These organizations typically offer lower reimbursement rates and have greater preauthorization requirements than non-managed care public plans for the same psychological service. Dispute resolution in the private sector involves lawsuits and state consumer protection programs while public plans utilize internal review and are subject to investigations of provider billing fraud and abuse. Behavioral health carve-outs have reduced mental health care utilization rates with unknown effects upon outcome. There is some evidence that psychologists have chosen to limit practice within the private sector, but national data on the overall effect is lacking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to the Special Section on the Future of Health Psychology.

Following 25 years of landmark progress, health psychology faces even greater change in the foreseeable future. Evolving patterns of health and illness and developments in medicine and related fields will shape the future of health psychology. The articles in this special section discuss these future issues in several areas: the biopsychosocial model, changes in demographics, prevention, clinical health psychology interventions, health care financing, and new technologies. In every case, the future holds a variety of important challenges and opportunities in research, practice, training, and policy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)