National health insurance: Prospects for profound change.

Comments on M. L. Meltzer's (1975) article on 3rd-party reimbursement for psychological services and discusses the effects that the inevitable institution of national health insurance will bring. Such a program will bring the demise of public mental health services, and it seems likely to bring an end to private independent practice for psychologists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health Care, National Health Insurance, and Psychology.

The role of psychologists as health care providers and the parameters of reimbursement for health care services are timely and controversial issues. A landmark decision was reached in this controversy in the 1980 appeal of a Virginia suit by clinical psychologists in which the court ruled that Blue Shield's refusal to directly reimburse psychologists was a violation of antitrust law. Thus, the requirement that psychologists bill through physicians was not upheld. In recent years a specific aspect of this controversy involved psychologists' roles in potential national health insurance programs. A limited study (appearing in the "National Register of Health Services Providers in Psychology" 1976-1978) of clinical psychologists' attitudes toward national health insurance suggests that Congress and psychologists may have disparate views. In addition to favoring national health insurance, over 85% of psychologists surveyed responded that consumers would benefit from such a program with mental health coverage. Only 16% agreed that such a program would constitute a subsidy of the rich by the poor (Albee, 1977). Several areas of conflicting or confusing responses in this study may reflect legitimate reasons for concern by Congress regarding institution of national health insurance. Belief that providers would benefit from mental health coverage in a national health insurance program was shared by 80% of respondents. Ninety-five percent of respondents identified the inclusion or exclusion of clinical psychologists in such a national health insurance as affecting the future of the profession. Curiously, over 50% of respondents agreed that primary care physicians should be reimbursed for mental health services, although such physicians have received no formal training in psychological services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychology and national health care.

Presents the position of the American Psychological Association concerning the national movement toward a "comprehensive and coordinated system of health services which will be of high quality and equally accessible to all persons." Provisions for recognition and management of emotional and mental disorders and for the optimum use of all qualified health care professionals are urged. Guidelines for the development of a health care program are enumerated and include concern for accessibility of services, patient rights, adequate funding, consumer roles, grievance provisions, program evaluation, and research into the system itself. Criteria for evaluating the adequacy of proposed legislation for a health care system in terms of the mental health provisions and the utilization of psychological services are also presented. It is concluded that "psychologists, by training and experience, have the qualifications to provide independent mental health services and should be permitted to do so." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health status and the use of outpatient mental health services.

Investigated the effects of mental health status—self-reported psychological distress and psychological well-being—on the use of outpatient mental health services, based on mental health data from the Rand Corporation's Health Insurance Survey. Results reveal that probability of mental health care and intensity of treatment provided by mental health specialists increase significantly with increases in psychological distress, independent of insurance plan, physical health, and sociodemographic variables. Results support the validity of self-report mental health surveys. (42 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Improving Medicare coverage of psychological services for older Americans.

Professional psychology's ability to meet older Americans' psychological needs and to simultaneously thrive as a profession will be closely tied to the federal Medicare program over the coming decades. Despite legislative changes in the 1980s providing professional autonomy to psychologists and expanding coverage for mental health services, Medicare coverage policies, reimbursement mechanisms, and organizational traditions continue to limit older Americans' access to psychological services. This article describes how psychologists can influence Medicare coverage policy. Specifically, the authors examine widely unrecognized policy processes and recent political developments and analyze the recent creation of a new Medicare counseling benefit, applying J. W. Kingdon's (1995) well-known model of policy change. These recent developments offer new opportunities for expanding Medicare coverage of psychological services, particularly in the areas of prevention, screening, and early intervention. The article provides an analysis to guide psychologists in engaging in strategic advocacy and incorporating psychological prevention and early intervention services into Medicare. As Medicare policy entrepreneurs, psychologists can improve the well-being of millions of Americans who rely on the national health insurance program and, in so doing, can help shape the future practice of psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using community outreach to promote integrated health care: A pilot project.

Although research has demonstrated the efficacy of psychological services for ameliorating physical conditions, consumers are often uninformed of the advantages of integrated health care. To begin to address this knowledge gap, the authors developed, offered, and assessed a 2-hr community outreach program, which included lectures highlighting the benefits of providing psychological services within general health care, a demonstration of stress-reduction techniques, and first-person accounts of the benefits of psychological health care. The preliminary results of the evaluation were positive. It is recommended that similar programs be disseminated in diverse communities. Suggestions for planning and conducting these types of programs are offered. Furthermore, strategies for improving the goals and content of workshops are offered, with a focus on the distinction between promotion of attitudinal change versus practical activism. Finally, implications for community outreach that is intended to inform the public of the value of psychological health care services are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Who requests psychological services upon admission to prison?

Structuring a system of psychological services for offenders and releasees requires an understanding of the offenders who voluntarily seek psychological services upon admission. To begin to develop such an understanding, a sample set of responses to the Psychological Services Inmate Questionnaire (PSIQ) from 2,674 newly committed male and female federal offenders were examined. About one-tenth of the sample made a request for psychological services upon admission to prison without a mandate or referral, and confirm that a combination of prior mental health treatment and current symptoms are among the factors associated with making the request. Logistic regression analysis indicated male gender, receipt of mental health treatment prior to current incarceration, history of a head injury, current symptoms of depression, hopelessness, nervousness, sleeping problems, and racing thoughts, were independent and significant predictors of service request. Implications for future corrections research, clinical training and practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of medical referral on outpatient psychological services.

Demonstrates a positive relation between the formal recognition of psychologists for outpatient mental health services under the Civilian Health and Medical Program of the Uniformed Service (CHAMPUS), Hawaii Medical Service Association, and Medicaid programs and the extent of services that they provide. Utilization data for 1983 outpatient mental health services by Hawaii residents show that the imposition of a medical referral condition under the Hawaii Medicaid program curtailed the use of psychological services relative to psychiatric services and restrained patients' freedom of choice. (6 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Service providers in psychology: Results of the 1982 APA Human Resources Survey.

Obtained information on psychological service provision from a 1982 survey with a stratified random sample of 6584 members of the American Psychological Association. 65.5% of the respondents indicated that they provided either health services of educational services; 57% of these providers were health service providers (HSPs). 89.2% of HSPs held doctoral degrees. About two–thirds of all psychological service providers were men. 1.3% of the HSPs were Black, 0.9% were Hispanic, 1% were Asian, and 0.2% were Native American. Organized care settings, independent practice, and academic settings were the most frequent primary employment settings. About half of the psychological service providers delivered services in secondary settings, usually in independent practice. Median number of weekly visits was 20; median number of clinical service hours was 30. Distribution of the ethnicity of clients was similar to the ethnicity of the general US population. Clients presented with a wide range of problems and from all age ranges (the most underserved population was the elderly). Referrals to psychologists were made by a variety of professionals. Patterns of reimbursement are described. The median hourly fee in 1982, for doctoral HSPs, was $54.74 per hour. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological services designed for men: A psychoeducational approach.

Examines the male sex role and (1) its effects on men's physical and mental health and (2) the associated obstacles for men in seeking and using psychological services. A psychoeducational structured-group program for men illustrates how psychological services might be designed to make them more accessible and useful to men. R. F. Levant and G. F. Doyle's (see record 1983-28490-001) empirical evaluation of the group (The Fatherhood Course) is briefly discussed. (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)     

Medicaid: Direct provider recognition.

Half of the states of the US recognize psychologists as service providers under Medicaid, although there is great variation in the services covered and methods of reimbursement. The present author describes the administrative and legislative avenues taken by Virginia psychologists to obtain independent provider status. A model bill is presented that would give consumers of any Medicaid program direct and unobstructed access to all psychological services provided within the scope of the clinician's license. (5 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Who uses psychological services in Canada?

This paper used data collected in the 1994–95 National Population Health Survey to provide a profile of consumers of psychological services. The survey was designed to assess the health status of Canadians by collecting data from a representative sample of 12+ yr olds in Canadian households. Approximately 515,000 Canadians indicated that they had consulted a psychologist in the 12 mo prior to the survey. The demographic profile of consumers of psychological services is consistent with patterns of utilization of mental health services found in other studies. Consumers were more likely to be female, to be middle-aged and to be separated, divorced or widowed. Those with higher education and higher income were more likely to receive psychological services. Consumers of psychological services reported poorer health status than the general population, a higher number of past and recent stressors, higher levels of distress, and were more likely to have received psychotropic medication. The majority of those likely to meet criteria for a diagnosis of depression did not receive psychological services. Another important theme was the apparent underutilization of psychological services, especially by people with the greatest mental health needs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The metamorphosis of clinical psychology: Toward a new charter as human services psychology.

Contends that the traditional conceptions of clinical psychology (CP) as centering around the treatment of individuals suffering from mental health problems are no longer adequate. The concept of human services psychology, defined as a sector of professional psychology concerned with the promotion of human well-being through the acquisition and application of psychological knowledge about the treatment and prevention of psychological and physical disorders is proposed as an alternative capable of representing both training and practice in contemporary CP and related professional specialities. A biopsychosocial model of human behavior would be the basis for a generic professional program that would be functionally rather than categorically based at the doctoral level. Such a program, based on a systems orientation, has been established at the author's university. It is suggested that human services psychology graduates will be able to confront racism, sexism, delinquency, the effects of poverty, and other social ills in an effective and cost-efficient way. (41 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Costs of predoctoral clinical psychology internship training in a Canadian health care setting.

Financial pressures on institutional health care in Canada in recent years have led to substantial pressures on institutional psychological services. These pressures have resulted in the elimination or substantial diminution of psychological services in some of these institutions, including the discontinuation of many longstanding psychology internship programs. It is therefore important for psychologists to demonstrate their cost-efficiency in delivering services. However, evidence for this efficiency in the current Canadian context is lacking. This investigation examines the costs and clinical activities of the interns and staff at a major Canadian teaching hospital in order to determine the degree to which the internship is a cost-efficient method of delivering services. The results indicate that there is a small increased cost to having the services delivered through an internship program. The results are viewed as part of a balanced scorecard approach to the evaluation of an internship program. From such a perspective, other factors can be seen as balancing out the slightly increased cost. Also, a number of strategies are outlined for increasing internship cost-efficiency. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A program of psychologic service delivery in a multiple sclerosis center.

Describes a program of psychological services in which the services are built on a theoretical model of coping, directed at education in a broad sense and at peer contact and support. Also included is a program of group discussions for patients and family, conceptualized as reference groups for the learning of a new lifestyle with a different set of values. Factors of critical importance in the success of this model of care are discussed. It is suggested that psychologists must carefully consider political, financial, and organizational realities in their attempts to structure programs in the primary health care settings. (11 ref) (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)     

Providing mental health care services to Americans.

Summarizes legislation introduced or cosponsored by the author, a US Senator from Minnesota, to respond to Americans' need for mental health services. This legislation included the Medicare Ambulatory Mental Health Services Access Amendments of 1987; S.123, a bill that would amend Part B of the Medicare program to recognize and reimburse psychologists as independent mental health providers; S.763, the Services for Homeless Mentally Ill Individuals Act of 1987; S.809, the Urgent Relief for the Homeless Act; and S.1663, the Child Abuse Prevention Act of 1987. The author encourages mental health professionals to promote public policies that expand Americans' access to public health services through research, effective communication of this research, and preventive mental health efforts (such as programs aimed at preventing teen suicide). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Primary Care Psychology Training on Campus: Collaboration Within a Student Health Center.

Applied psychological services are being implemented into the primary care treatment milieu to improve patient treatment and reduce health care costs. Unfortunately, few psychologists have training specifically oriented to working in this setting. A predoctoral training program wherein psychology graduate students may obtain practicum experience working in a student health center on a university campus is described. The theoretical underpinnings of this training are based on the integrated primary care models of K. Strosahl (1997) and K. Strosahl, N. Baker, M. Braddick, M. Stuart, and M. Handley (1997), which emphasize integration of psychological and medical treatment, brief intervention, consultation, and expedited referral for longer term cases. Though many issues remain, integrated primary care offers promise for improved health care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Somatic symptoms, social support, and treatment seeking among sexual assault victims.

In an effort to clarify the relationship between the experience of sexual assault and physical health, rape victims and a matched comparison group were repeatedly assessed for somatic symptoms, psychological distress, health care use, and self-rated health perceptions during the year immediately after the assault. Women who experienced sexual assault reported more somatic complaints, poorer perceptions of physical health, greater psychological distress, and increased use of medical services. However, victims did not show a significantly higher use of mental health services and continued to seek medical attention at the end of the year after the assault, when health perceptions and somatic symptoms were no longer significantly elevated. The use of mental health services and social support as moderating variables are examined, and implications for the medical and psychological treatment of sexual assault victims are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)