Public policy and the provision of psychological services to older adults.

Public policy shapes who delivers health care, how care is delivered, and how much providers are paid. The impact of public policy will become even more important to psychologists who serve older adults as 76 million members of the so called “baby boom” generation enter their later years. Armed with basic public policy facts, psychologists can better maneuver the systems created by public policy and even change policy. This article reviews how Medicare works since it is the primary payer of mental health services for older adults. The article then turns to the question of how many health care professionals (including psychologists) will be required to meet the needs of a rapidly growing older population and concurrent challenges of training and building that work force. Finally, different policy visions for a better mental health care system for older adults are summarized since they may be roadmaps to what the future of mental health care will look like. The article closes with practical recommendations on how psychologists can influence mental health and aging public policy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Musings of a bureaucratic psychologist.

The value of having a background in both experimental and clinical psychology is evaluated from the perspective of an essentially administrative career. The opportunity to have a significant impact on major public policy issues is an important factor in choosing to become involved in a state bureaucracy. Some of the reasons why states have recently turned to managed care for mental health services are explored. The fact that psychologists have not taken an aggressive role in helping to define how public agencies should move into managed care is unfortunate, both from a public policy standpoint as well as for the future of the profession. The future role of psychologists in the changing mental health-managed care environment is also reviewed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Public and private responsibility for mental health services.

Relative to public services, private sector corporate mental health care has significantly increased since the late 1960s. The many tensions encountered in assigning public and private responsibility for mental health services give rise to significant value-laden questions for psychologists. These questions go to the heart of community mental health, deinstitutionalization, mental health policy development and evaluation, and many other areas in which psychologists are playing major roles. The public–private issue should be understood historically, from the twin vantage points of developments in general medicine and in mental health. Among the many public interest and public policy matters psychologists and others concerned with mental health should address are the emergence of corporate chains; the nature, cost, and quality of private sector services; the compatibility of profit motivation and the motivation to provide care; and patient selection issues (e.g., cream-skimming). Public and private cooperation and planning are certainly in order if the public interest is to be served in addressing the nation's mental health problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Envisioning and accessing new roles for professional psychology.

To support psychology's continued evolution as a profession, it is important to conceptualize roles that psychologists can play in the future and create pathways for developing and accessing them. This article considers a variety of roles that may become central to professional psychology in the future. Important opportunities appear to exist in the areas of psychological management of health and disease, serious mental illness, and public policy. Psychology faces both internal and external barriers to accessing these roles in larger numbers. Strategies related to public education, policy and advocacy, marketing, and training are recommended for overcoming them. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychologists as legislators: Results of the 1998 elections.

The November 1998 elections saw a significant increase in the number of psychologists elected to the U.S. Congress and to state legislatures. These psychologists bring health care expertise to their positions as legislators, which enhances their contributions to public policy. They are playing key roles in sponsoring health care reforms such as patient protection legislation and mental health parity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Opportunities in public policy to support infant and early childhood mental health: The role of psychologists and policymakers.

Infant and early childhood mental health practices can be supported by policies and professional standards of care that foster the healthy development of young children. Policies that support infants and toddlers include those that strengthen their families to provide a family environment that promotes mental wellness. Policy issues for infants, toddlers, and young children have come to the forefront of thinking as children need a “voice” to advocate for their support and care. This article (a) highlights several important policy areas that support the social–emotional development of very young children and (b) gives examples of current policy accomplishments and challenges. The article offers a policy agenda to promote the mental health of infants and young children and suggests ways that psychologists can engage with policymakers to promote policies that foster infant mental health, including contributing to the knowledge base that informs policy decisions, educating the public and policymakers about early childhood development and mental wellness, forming community partnerships to identify and address infant mental health risks, and participating in the development of policy recommendations that improve access to evidence-based practices in infant mental health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Public policy leadership opportunities for psychologists.

Despite the massive changes in the health care system affecting their practices, few psychologists become involved in public policy activities that can regulate this health care system. In addition to elected office, there are many opportunities for psychologists to work behind the scenes in public policy leadership positions. First-person accounts illustrating such opportunities are provided by a gubernatorial appointee, an American Psychological Association (APA) Congressional Science Fellow, and a United States Senate staff person. The opportunity to serve in such capacities is an important means by which psychology can contribute to society and fulfill its societal obligations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Public Health and Psychology: An Important, Expanding Interaction.

The authors opine that the behavioral sciences and the field of psychology are absolutely vital in meeting the nation's needs regarding health and health policy. Psychologists have become increasingly involved in health psychology, as reflected by the establishment and rapid growth of Division 38 (Health Psychology). This expansion of psychologists' involvement in physical health research and intervention has led to increased contact between psychologists and nurses, public health experts, and nonpsychiatric physicians. With such contact, psychologists are being recruited into the faculties of schools of nursing, schools of public health, and schools of medicine. This article examines aspects of psychology's role in, involvement with, and contribution to one sector of this arena--public health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Beneficiary choice and interprofessional participation in CHAMPUS mental health services: 1980–1987.

As a major health plan with freedom of choice of provider, the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) yields natural experiments in fee-for-service practice that are relevant to mental health policy. This is seen in the extent to which (1) beneficiaries use multiple mental health providers or a single (exclusive) provider, (2) psychiatrists have been replaced as the major provider, (3) general physicians are increasingly involved, and (4) psychologists have penetrated this market over the years 1980–1987, including some inpatient practice and the emergence of a general physician/psychologist alliance. The cost and public policy aspects are discussed against an empirical background. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Public policy and public service: Our professional duty.

Psychology is a steadily maturing profession, and we psychologists are finally beginning to accept our societal responsibility to be involved in the public policy and political process. Although psychologists have shown increased involvement in the recent past, there are still many areas in which psychologists could become markedly more involved—especially in the area of programs that affect the quality of life of our nation's elderly, disabled, and poor citizens. As our profession seeks to become more active in the overall health care arena, we will, of necessity, begin to define the parameters of "quality of care" for other professions. In doing so, we must closely explore the "outer limits" of our own practice. We must ensure that all state and federal legislative (and administrative) policies do not impose arbitrary limitations on the scope of practice. To accomplish this objective, we must seek to influence our subset of our nation's health policy priorities and policies that we have traditionally shunned—the subset that affects "the public good." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychologists as legislators: Results of the 2000 elections.

The elections of November 2000 saw the reelection of 2 psychologists to Congress, boding well for their continuing positive influence on national mental health and health policy. A recent example of this positive influence includes successful legislation creating mental health courts as a humane alternative to the criminalization of mental illness. In addition, 8 psychologist legislators were reelected to state legislatures, and 2 psychologists were newly elected to state legislatures, ensuring similar championing of mental health priorities in many Statehouses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A primer for advancing psychology in the public sector.

Psychologists working in the public sector should, in addition to providing direct services, advocate for systems change. Although many consumers treated in the public sector face a constellation of severe life problems, working to improve the system of care is more difficult than providing treatment. Improving the quality of life of consumers of publicly funded mental health services requires that psychologists become advocates. Four prerequisites to systems change, plus coalition building, legislative advocacy, the work of state psychological associations, and forming alliances between psychologists and nonpsychological community organizations such as Rotary International, are described. In conclusion, 12 orienting ideas are listed for psychologists who want to advocate for social, institutional, and political change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Insurance reimbursement: A mixed blessing.

Discusses possible undesirable effects of expanded 3rd-party insurance coverage for mental health services. It is suggested that in the absence of uniform qualification standards, the number of unqualified persons offering mental health services will increase. The distribution of services may become more and more unbalanced as practitioners seek lucrative urban locations. Services will tend to be made available to the less troubled but more affluent, and the type of treatment chosen by the practitioner will tend to be the most extensive and expensive. Fewer practitioners will want to work in public institutions, where pressure is greater and remuneration smaller than in the public sector. Suggestions for needed self-regulation in the mental health field are made. The article is followed by comments from 3 psychologists and a psychiatrist. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Professional associations' strategies for revitalizing professional psychology.

The professional associations of psychologists are working to revitalize professional psychology. In response to recent challenges, these associations have attempted to (a) remove barriers to quality services within the mental care health delivery system; (b) help psychologists become better integrated within the overall health care system, as opposed to being narrowly defined as mental health professionals; and (c) help more psychologists move into services outside of the health care delivery system. These 3 strategies are motivated by a vision of psychology as a broad problem-solving discipline that can contribute to human welfare in a varied range of domains. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The New Federalism and state mental health agencies: Roles for psychologists.

As state governments expand and become more influential and as universities constrict employment opportunities for psychologists, psychologists should consider career possibilities in state mental health systems. Four key functions in the state mental health agency are described: administration, training, research, and evaluation. Changes in professional training that are needed to adequately prepare psychologists for these nontraditional career roles are discussed. (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rehabilitation: Psychology's greatest opportunity?

Rehabilitation (RHB) is one of the fastest growing areas in the health industry. Supported by several key pieces of legislation, psychologists have established themselves as integral health care providers in RHB. Although psychologists have benefited from legislated membership in RHB, most individual psychologists and the psychological associations have not recognized the importance of public policy for the practice of psychology. Escalating health care costs have resulted in major revisions in the manner in which health insurers reimburse treatment. Medicare, the major federal health insurance provider, increasingly has been viewed as a model for the provision of all health care. The historic exclusion of psychologists from Medicare has limited the scope of psychologists' practice and the growth of professional psychology. The recent inclusion of psychologists in Medicare improves but does not solve practice and policy issues confronting psychology. Knowledge of national health policy formulation and greater participation by psychologists in health policy are necessary to secure the scope of professional practice most psychologists expect. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychology and public policy.

Discusses ways to increase the involvement, awareness, knowledge, and education of psychologists in the public policy process. Psychologists have functioned effectively in a variety of roles that are relevant to the policy sector. For example, they are increasingly called upon as expert witnesses. There is a great need for people who can translate the findings of psychology and the behavioral sciences into language and recommendations easily comprehended by the public. Probably the most common role for a psychologist in public policy is that of researcher or evaluator, which uses the psychologist's methodological skill to help policymakers determine whether a program, intervention, or treatment was effective. Psychologists have also increasingly taken positions as administrators in education, health, mental health, welfare, correctional, and human service organizations, where they are directly responsible for the formation and implementation of social policies. Psychologists can also function as activist-collaborators by advocating solutions to social problems. It is concluded that greater involvement of psychology in the public policy process will facilitate the growth of psychological knowledge and the application of that knowledge to the world of which psychology becomes continually a larger part. (44 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental health services to children and adolescents: A national view of public policies.

Summarizes and discusses the implications of a national study conducted by the present author (1982) on public policies affecting the delivery of mental health services to disturbed children and adolescents. Relevant state officials and advocacy organizations were surveyed, state reports and child and adolescent mental health statutes were analyzed, federal programs and policies were reviewed, and responsive program models were identified. Findings suggest that there is more knowledge about how to help children and adolescents in need of mental health services than is reflected in the organization, funding, and delivery of these services. Three encouraging developments, policy recommendations, and implications for psychologists are discussed. (28 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A new role for psychologists—Hospital Ethics Committees.

Over the past decade psychology has begun to appreciate that it represents more than "merely mental health care" and has become increasingly involved in the generic health care arena. The participation of psychologists in Hospital Ethics Committees (HECs) is presented as a professional activity for which psychologists are particularly well suited. The clinical mission of HECs, the historical importance of ethical considerations to psychology, and the field's specific training and psycho-social expertise suggest valuable contributions that psychologists can make in this particular area. Further, as psychology actively increases its participation in HECs, other professional disciplines outside of the mental field will systematically have the opportunity to become more familiar with psychology and its clinical and research expertise. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Acute stress management with public safety personnel: Opportunities for clinical training and pro bono community service.

Public safety personnel are exposed to high levels of chronic stress, and at times they experience intense emotional reactions to critical incidents that can severely impair their ability to provide emergency services to the public. Critical incident stress management (CISM) involves directly intervening in these cases, using a team composed of both mental health professionals and peer support personnel. Involvement with a CISM team offers psychologists an opportunity to intervene in a substantial community health problem. Because services are provided free of charge, psychologists can offer pro bono work to their communities, which is consistent with their ethical obligations to the public. CISM teams also present an excellent in vivo setting for training psychology interns about psychological trauma, and the teams offer the interns a chance to become involved in community-based interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)