It is past time: Moving psychology into primary health care.

It is past time for psychologists to expand their services into primary health care. For too long, psychological work has been limited to mental health care. Psychology also has much to offer in primary health care. One of my major initiatives during my tenure as president of the American Psychological Association (APA) was to focus on psychologists' contributions to health care in general, particularly on what psychologists are doing to help cancer patients. A great need exists for professional psychologists to expand into these areas. To illustrate the value of psychological interventions in primary health care, I focus on two major health care problems: heart disease and cancer. Both are particularly important areas for health care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Strengthening mental health services in Head Start: A challenge for the 1990s.

Steps must be taken to strengthen mental health services by building on Head Start's philosophy and by translating innovations in mental health services for older children and adolescents into improved services for young children and their families. Recommendations for strengthening Head Start's mental health program include creating a unified vision that reaffirms a holistic, family-focused, and comprehensive services approach; ensuring that mental health services are responsive to the diversity in families served; increasing coordination of mental health services and linkages with new initiatives; increasing resources and providing assistance in gaining access to new sources of funding; supporting innovation; and integrating the new paradigm for children's mental health services into more traditional approaches to intervention within Head Start. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychologists: The Backbone of the VA Health Care System.

Veterans returning from Iraq and Afghanistan are presenting in large numbers with serious mental health needs. Chairman Akaka addresses this concern and the role of the Department of Veterans Affairs in caring for those in need of mental health services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prevention of work-related psychological disorders: A national strategy proposed by the National Institute for Occupational Safety and Health (NIOSH).

NIOSH recognizes psychological disorders as a leading occupational health problem. This document, developed by a NIOSH working group led by the present authors, represents a first attempt to fashion a comprehensive national strategy to protect and promote the psychological health of workers. Roles are identified for industry, labor, government, and academia. Key initiatives include (a) steps to improve working conditions and employee mental health services and (b) increased research and surveillance to advance understanding of the problem. Because work-related psychological disorders appear to be a rapidly developing problem lacking complete definition in terms of scope and etiology, this strategy is not to be considered a final statement of NIOSH policy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of psychologists in the care of Iraq and Afghanistan veterans in primary care settings.

Although military personnel serving in Iraq and Afghanistan are at high risk of developing mental health problems, many report significant barriers to care and few seek help. Integrated primary care is a comprehensive model of health care that aims to improve access to care and provides a framework to assess and meet the complex psychiatric needs of newly returning veterans by embedding mental health specialists within primary care. We describe the role of psychologists in a Department of Veterans Affairs (VA) integrated primary care clinic that serves veterans of Iraq and Afghanistan. Psychologists based in primary care can assist veterans with reintegration to civilian life by providing rapid mental health assessment, normalizing re-adjustment concerns, planning for veterans’ safety, implementing brief interventions within primary care, facilitating transition to additional mental health care, and informing veterans of other available psychosocial services. A case example demonstrating the psychologist’s role highlights the benefits of an integrated care model. Implications of employing this model include reduction of symptoms and impairment by reducing stigma and barriers to seeking mental health care, increased motivation to engage in treatment, and implementation of early interventions. This model may also be beneficial in the civilian health care sector with groups that are at high risk for mental health problems, yet experience barriers to care, particularly stigma. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Does the use of telemental health alter the treatment experience? Inmates' perceptions of telemental health versus face-to-face treatment modalities.

In corrections, where staffing limitations tax an overburdened mental health system, telemental health is an increasingly common mode of mental health service delivery. Although telemental health presents an efficient treatment modality for a spectrum of mental health services, it is imperative to study how this modality influences key elements of the treatment experience. In this study, the authors compared inmates' perceptions of the working alliance, postsession mood, and satisfaction with psychiatric and psychological mental health services delivered through 2 different modalities: telemental health and face-to-face. Participants consisted of 186 inmates who received mental health services (36 via telepsychology, 50 via face-to-face psychology, 50 via telepsychiatry, and 50 via face-to-face psychiatry). Results indicate no significant differences in inmates' perceptions of the work alliance with the mental health professional, postsession mood, or overall satisfaction with services when telemental health and face-to-face modalities were compared within each type of mental health service. Implications of these findings are presented. (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)     

Cultural competence and evidence-based practice in mental health services: A complementary perspective.

The need for cultural competence and the need for evidence-based practice in mental health services are major issues in contemporary discourse, especially in the psychological treatment of people of color. Although these 2 paradigms are complementary in nature, there is little cross-fertilization in the psychological literature. The present article illustrates the complementary nature of these 2 paradigms. A main point of convergence is related to the development of culturally adapted interventions in the move from efficacy research to effectiveness studies. The implications of cultural adaptations of empirically supported treatments for mental health services in terms of research and practice with ethnic/racial minority populations are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Timing of postcombat mental health assessments.

When soldiers return from combat and peacekeeping operations, the United States and many NATO and Partnership for Peace countries conduct some form of postdeployment mental health assessment. To date, however, no research has been published examining changes in prevalence rates of mental health problems in the first several months after returning from combat duty. In this study, the authors examined the degree to which timing was related to reported prevalence rates of mental health problems in a matched sample of 509 US Army soldiers returning from combat in Iraq. Results showed significant increases in mental health problems at 120 days postdeployment relative to immediate reintegration. The findings are discussed in terms of providing mental health services to soldiers returning from combat. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Developing community capacity to treat post-deployment mental health problems: A public health initiative.

Meeting the mental health needs of Veterans returning from recent deployment requires the coordinated effort of partnerships across Department of Defense (DoD), Department of Veterans Affairs (VA), and state and local communities. Although the proportion of Veterans of Iraq and Afghanistan who have accessed VA health care has grown, the majority of these new combat Veterans have yet to present for VA care. The stigma associated with reporting a deployment-related mental health problem may be one factor in this, but access to treatment may also be an important concern among the one third of American Veterans who live in rural or highly rural areas. As these Veterans are more likely to present to a primary care, faith-based or mental health provider in their own community, partnerships between community providers, DoD, and VA are of critical importance in ensuring appropriate care, regardless of treatment setting. In an effort to improve services and access to services, especially to rural Veterans, an educational public health initiative was created to educate community providers about military culture, deployment-related mental health issues, VA resources, and evidence-based treatments. We describe the development, dissemination and evaluation of this initiative, as well as lessons learned for future similar endeavors. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Mental health services for homeless mentally ill persons: Federal initiatives and current service trends.

Recent research suggests that approximately one third of the population of homeless single adults suffer from severe mental illnesses. Despite multiple health, mental health, and social welfare needs, this population is often unable to obtain necessary housing and community-based services. For this reason, since 1982, the National Institute of Mental Health (NIMH) has undertaken a number of federal initiatives to encourage research and assist states and localities in improving services focused on this vulnerable subgroup of the homeless population. This article describes the target population, NIMH research findings, and current mental health programs—with particular emphasis on two mental health programs established under the Stewart B. McKinney Homeless Assistance Act. Proposed future directions for federal research and evaluation efforts in this area are also discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reaching out to the families of those who serve: The SOFAR project.

Families of those in the U.S. Army Reserves represent a population at risk for mental health problems. Strategic Outreach to Families of All Reservists (SOFAR) is a pro bono outreach program serving families with soldiers deployed in Afghanistan, Iraq, and Kuwait. Program components include prevention, intervention, and the production of educational materials. SOFAR negotiated with the reserves (a hierarchical system wary of mental health), recruited pro bono therapists, and oriented them to the needs of reservists' families. During the pilot phase, SOFAR participated in support services, direct services, and psychoeducation. The project is a pilot for a national program. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender differences in combat-related stressors and their association with postdeployment mental health in a nationally representative sample of U.S. OEF/OIF veterans.

Though the broader literature suggests that women may be more vulnerable to the effects of trauma exposure, most available studies on combat trauma have relied on samples in which women's combat exposure is limited and analyses that do not directly address gender differences in associations between combat exposure and postdeployment mental health. Female service members' increased exposure to combat in Afghanistan and Iraq provides a unique opportunity to evaluate gender differences in different dimensions of combat-related stress and associated consequence for postdeployment mental health. The current study addressed these research questions in a representative sample of female and male U.S. veterans who had returned from deployment to Afghanistan or Iraq within the previous year. As expected, women reported slightly less exposure than men to most combat-related stressors, but higher exposure to other stressors (i.e., prior life stress, deployment sexual harassment). No gender differences were observed in reports of perceived threat in the war zone. Though it was hypothesized that combat-related stressors would demonstrate stronger negative associations with postdeployment mental health for women, only one of 16 stressor × gender interactions achieved statistical significance and an evaluation of the clinical significance of these interactions revealed that effects were trivial. Results suggest that female Operation Enduring Freedom/Operation Iraqi Freedom service members may be as resilient to combat-related stress as men. Future research is needed to evaluate gender differences in the longer-term effects of combat exposure. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Relationship adjustment, PTSD symptoms, and treatment utilization among coupled National Guard soldiers deployed to Iraq.

Although combat-related posttraumatic stress disorder (PTSD) is associated with considerable impairment in relationship adjustment, research has yet to investigate how PTSD symptoms and relationship distress uniquely and jointly predict utilization of a range of mental health services. The present study sought to examine these issues utilizing a longitudinal sample of National Guard soldiers surveyed 2–3 months following return from deployment to Iraq and again 12 months later (N = 223). Results indicated that PTSD symptom severity, but not relationship adjustment, uniquely predicted greater odds of utilizing individual-oriented mental health services. A significant interaction was found indicating associations between PTSD symptoms and the odds of using services were increased when soldiers reported greater relationship adjustment. For utilization of family-oriented care, greater relationship distress was significantly correlated with greater odds of using services, but associations with PTSD symptoms were nonsignificant. The association between relationship distress and utilization of family-oriented services did not vary significantly with severity of PTSD symptoms. Results suggest supportive intimate relationships facilitate mental health treatment utilization for soldiers with PTSD symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Award for Distinguished Early Career Contributions to Psychology in the Public Interest: Keith Humphreys.

Keith Humphreys, recipient of the Award for Distinguished Early Career Contributions to Psychology in the Public Interest, is cited for creatively combining a scientist’s commitment to rigor, a clinician’s emphasis on high-quality mental health care, and a policy analyst’s understanding of how to address and resolve social problems. His work as a program evaluator and policy analyst has informed important legislation that has enhanced access to and quality of mental health services for U.S. veterans within the Department of Veterans Affairs. Moreover, he has been a prime mover in shaping the Iraqi Ministry of Health’s effort to create a modern and equitable system of mental health care for the Iraqi community. A biography and selected bibliography of Humphreys' works are provided. In addition, Humphreys' paper, entitled "Responding to the psychological impact of war on the Iraqi people and U.S. veterans: Mixing icing, praying for cake," a version of which Hymphreys delivered at the American Psychological Association's annual convention, is presented. (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)     

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)     

Leading Psychology Forward: Staying the Course in Uncertain Times.

Like everyone in the country, those in organized psychology have functioned recently in a climate marked by threats of terrorism, uncertainty, and a declining economy. In such challenging times, it might seem logical for the profession to wonder how it needs to change to respond to current circumstances. Yet at such times, staying the course already charted is likely a far more effective strategy. For psychology, this means continuing to press for mental health parity, educating decision makers about the important role of psychological services in preventive care, helping to integrate psychological and physical health services, continuing to hold managed care companies accountable, and increasing the profession's political giving. Psychologists must also be prepared to ensure that psychological services are treated as an integral part of any health reform plan that emerges. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Roles of perceived sexist events and perceived social support in the mental health of women seeking counseling.

The authors of the present study contribute to research on the role of sexist events in women's mental health by examining the sexism-distress relation (a) with a sample of women who are seeking mental health services and (b) in the context of the additional roles of perceived social support in positive self-appraisal (i.e., empowerment and self-esteem) and psychological distress. A path analysis was conducted with data from 157 women who were seeking counseling services. Results supported the generalizability of previously observed links between the frequency of perceived sexist events and psychological distress. Results also indicated that the sexism-distress link was significant in the context of an additional significant indirect relation of perceived social support with psychological distress, which was mediated through empowerment but not through self-esteem. Implications for future research and practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)