Building a world-class mental health care system for America.

This article examines our current mental health care system, and what can be done to expand this current system. It focuses on the mental health needs of our children, and makes some suggestions to improve their care. Some things discussed are putting more mental health professionals in schools, affordable and convenient treatment options for parents, and flexible treatment arrangements. (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)     

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)     

Practice, policy and parity: The politics of persistence.

The road to comprehensive mental health parity legislation at the state level often reaches a dead end when mental health advocates are forced to compromise by accepting partial parity for "severe mental illness" (SMI) only. In 1999 Connecticut became the first state to modify a biologically based or SMI mental health parity law into comprehensive mental health and substance abuse parity legislation. In this article we chronicle the fight for mental health parity in Connecticut and discuss subtleties of legislative advocacy. This information should prove useful to psychologists who are pursuing parity in other states. (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)     

The tragedy of Native American youth suicide.

High rates of suicide among American Indian and Alaska Native populations call for significant efforts by lawmakers and public sector psychologists to develop, implement, and evaluate policy and programs that increase our understanding of factors that contribute to these high rates, and lead to effective resources that reduce the suicide crisis among these groups. The author describes how the federal government has responded to this crisis, what the barriers have been, and what is needed in the future from multiple sectors to ensure our nation's health care system is responsive to the tremendous health care needs that have long been evident in American Indian and Alaska Native communities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changing concepts in the training of therapists.

Many professionals in the mental health field recognize the ability of nontraditional workers with relatively little training to produce good therapeutic results. The question is raised and discussed as to why the guardians of our present system are slow to use fully new resources, the effectiveness of which has been demonstrated. The suggestion is made that professionals with long traditional training should identify themselves with the advancement of knowledge and leave more of the practice of crafts to new categories of workers. (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)     

The Psychologist Connection: Service Linkage and Role Definition.

The mental health field is not always perceived in terms of benevolent experiences, and Gothic attitudes can still prevail. Although the stigma attached to mental illness has diminished, some lay and professional people, including physicians, still have difficulty recognizing mental health problems and/or if recognized, knowing where to refer patients for proper treatment. In addition, many people lack awareness of the range and role of mental health professionals who are available to deal with the complex issues of treatment and prevention surrounding mental illness. This commentary highlights some of the shortcomings that exist when professional roles are not clearly understood and how such a lack of understanding adds to the separation that already exists between professionals when attempting to provide appropriate service linkages. (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)     

The Evolution of Behavioral Primary Care.

The financing, organization, and delivery of behavioral health care services has undergone dramatic change in the past 25 to 30 years. The authors trace the evolution of behavioral health care delivery in the United States over the past several decades and find (a) that the value of mental health "carve-outs" has diminished greatly and that they are being replaced by "carve-ins," (b) that primary care physicians (PCPs) are becoming a primary source of mental health care secondary to the introduction of new medications, and (c) that PCP treatment of mental health disorders is suboptimal. The authors conclude that the behavioral health care system is entering an era of flux as it experiments with ways of integrating behavioral and primary care. Opportunities for psychologists are explored. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to the special issue on long-term care.

There are over 1.3 million American residents in long-term care (LTC) facilities of one type or another. We have a considerably greater number of patients in LTC facilities than in general hospitals. Because of the projections that in the next several decades millions more will become residents of LTC institutions, it is remarkable that so little attention has been directed to the psychological issues that involve elderly residents in these settings. In recognition of the variety of recent changes in the relationship between acute care settings and LTC institutions, because of an emerging body of research being developed about the nursing home, and in view of the large number and projected growth of the LTC institutional population, our focus in this special issue is largely upon the institutional setting. Individual articles in this issue focus upon aspects of a range of subjects. These include broad issues of health policy in the United States as they relate to LTC; the future of nursing homes; staff-patient relationships in LTC institutions; and the clinical and social-psychological issues that must be addressed by rehabilitation psychology in LTC settings. The hope is that this issue of Rehabilitation Psychology will stimulate greater interest among psychologists and allied professionals in the field of LTC and in addressing the needs of the millions of persons who could profit from help. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interdisciplinary collaboration in outpatient practice.

Psychology has had a long history of collaboration with the medical profession. This collaboration has been greatly enhanced over the past decade or more as an increasing number of psychologists have become successful in applying the science and practice of psychology to the problems of health and illness. This article reviews and summarizes salient aspects of professional issues in practice that contribute to successful collaboration with physicians in primary and tertiary ambulatory health care settings. Practical strategies to enhance collaboration in independent practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Good psychologists must also be good citizens.

In the United States, the wealthiest nation in history, our nation, 43 million of our fellow citizens, including more than 6 million children, have no health insurance. Of those who do have insurance, the vast majority do not have mental health benefits. Among those who have insurance, increasing numbers are insured by for-profit HMO and managed care plans that limit provider selection, dictate patient care, and seem far more interested in the profits of shareholders and the compensation of CEOs than the well-being of patients. The average citizen, and, for that matter, the average professional acting individually, probably feels he or she has little direct ability to affect these and other issues facing our country. I want to dispel that notion and insist that individual psychologists, and psychology as a profession, are, in fact, influencing policy every day in Congress and in state legislatures. But there is much more to be done. The message of this article is that good psychologists, for their own benefit and for the benefit of their patients and their nation also must be good citizens. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

CMA-sponsored Task Force on the Allocation of Health Care Resources.

Hurray for the Canadian Medical Association! They have just released Health: A Need for Redirection, the report of a Task Force on the Allocation of Health Care Resources. The task force, headed by Joan Watson, the former hostess of CBC's "Marketplace," included the Honourable Pauline McGibbon, former lieutenant-governor of Ontario, Roy Romanow, former NDP attorney general of Saskatchewan, and two physicians, John O'Brien-Bell and Leon Richard. The purpose of the task force was to examine the allocation of health care resources in the face of an increasing elderly population and the explosion of new technology. The report could help shape the future of the health care system. The report makes it clear that the health system is in crisis and the reform of the health system needs us all, as both active professionals and critical consumers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Research survey: State mental health programs.

"In preparation for the 1959 meeting of chief psychologists in state mental health programs a questionnaire on research was prepared and sent to 77 psychologists who were either functioning as chief psychologists in state programs" or in similar positions. Replies were received from 39 individuals, representing 30 states. "Evaluation of treatment was listed most frequently as an area in need of research." At least 45 different types of ongoing research projects were listed. "Three factors were emphasized as the main obstacles to research in the state programs: lack of personnel… lack of funds… emphasis on service, with subsequent lack of time for research." Psychologists were "seen as the individuals most involved in mental health research in state programs." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Mental health law in Canada.

Reviews the book, Mental health law in Canada by Harvey Savage and Carla McKague (1987). Mental health professionals who come into contact with the law in the course of their work generally have an interest in the well-being of the client. However, they often feel dismayed and confused because of their lack of understanding of mental law and the legal system in general. Until recently, mental health professionals in Canada could not turn to a single volume which would help explain mental health law, including their clients' rights. However, Harvey Savage and Carla McKague's book, Mental health law in Canada, will help alleviate some of the concern and confusion Canadian mental health professionals have come to know. Although some authors have written about Canadian mental health law in specific contexts (e.g., criminal responsibility or fitness to stand trial), Savage and McKague's contribution is the only available comprehensive source directed to the law affecting psychiatric patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

HIV infection and health policy.

The epidemic of human immunodeficiency virus (HIV) infection has given an urgency to health policy dilemmas that have long been brewing. By exacerbating long-standing problems, the epidemic has surpassed what we find tolerable and has pressured politicians and health officials to find solutions. Whether the approaches they take will substantially contribute to solving the underlying problems is unclear. Many persons engaged in health policy believe that in responding to the AIDS crisis we may be defining our society for future historians. Judgment may be passed on how compassionately we care for those who are sick, how effectively we choose our public health measures, and how creatively we apply our scientific knowledge. This paper addresses six challenges that face policymakers: (a) protecting people from discrimination, (b) designing testing and screening programs, (c) developing safe and effective antiviral drugs, (d) planning for future vaccine trials, (e) organizing and delivering health care to sufferers of HIV infection, and (f) financing such health care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)