This Land is Your Land, This Land is My Land

Pat DeLeon (former APA President) Column, March 2016

As the Administration and the private sector steadily implement provisions of President Obama’s Patient Protection and Affordable Care Act (ACA), its population-oriented public health perspective will, over time, significantly impact our nation’s health care practitioners of all disciplines. At our Uniformed Services Hand with globeUniversity of the Health Sciences (USUHS) health policy class, we strive to expose graduate students in psychology and nursing to the experiences of those who are actually shaping policy and their life-long journeys. Not surprisingly, a number of common themes keep reoccurring, one of which is the importance of having a long-term vision, while being responsive to unanticipated challenges and opportunities. Another is the extent to which health care “belongs to” no one discipline; instead, it is influenced by many complex factors, with the patient, not the provider, ultimately making any critical decisions.

Dr. Janet Heinrich, Senior Advisor at the Center for Medicaid and Medicare Innovation (CMMI) of the Centers for Medicaid and Medicare Services (CMS), visited our policy course at USUHS. The insights she provided about the mission of her organization to promote healthcare that is better and smarter, as well as healthcare that ultimately leads to healthier persons was not only insightful, but confirming. At USUHS, the mission of our graduate, nursing, and medical programs is to improve the health of the nation. In doing so, we are committed to developing healthcare systems and implementing practices that recognize and treat the person as a whole. Our former U.S. Army Surgeon General Patricia Horoho emphasized ‘the importance of transforming Army Medicine from a healthcare system to a System for Health. The patient healthcare encounter is an average interaction of 20 minutes, approximately five times a year. Therefore, the average amount of time spent with each patient is 100 minutes; this represents a very small fraction of one’s life. It is in between the appointments – in the Lifespace – where health really happens and where we desire a different relationship with Soldiers, Families and Retirees.

Dr. Heinrich discussed the various grants and programs funded by her organization that enable clinics across the country to implement infrastructures and technologies that are person-centered, sustainable, incentivize quality of care over quantity of services, and are coordinated across multiple disciplines and providers. One of the ways CMS is pursuing this goal (initiated by the ACA) is by developing, testing, and implementing new payment and delivery models that not only acknowledge disease symptoms, but also the ‘social determinants of health’ that place individuals at risk for specific diseases and serve to maintain symptomology. Social determinants of health have been highlighted as key factors in recognizing and treating diseases that lead to the most deaths in our nation, such as cardiovascular disease, stroke, and diabetes. In considering these, one is forced to recognize the person as a whole being – not one who sits in a vacuum, but as one who is affected by myriad socio-ecological factors, including race/ethnicity, socioeconomic status, and education. Leading public health organizations, like the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH), have recognized that treating the whole person means viewing said person as a product of where they ‘live, learn, work, and play’ and acknowledging such social factors as key influences of their health, and thus, their treatment. CMS’s commitment to facilitating healthcare’s transition from being provider-centered to person-centered (i.e., recognizing social determinants of health) is exploring systematic means of treating the whole person – efforts that are crucial to our healthcare system becoming better, smarter, and leading to healthier lives. Our speaker also made it clear that all healthcare is local. “CMMI’s collaborative efforts with private insurance payers foreshadows the magnitude of change providers will be experiencing, especially as the advances in information technology continue to shape healthcare delivery and provide objective measures of healthcare outcomes” (Omni Cassidy, USUHS).

One of the most impressive examples of psychologists “making a real difference” in the lives of our nation’s active duty military personnel, their families, and our Veterans, has been the continual efforts of Barbara Van Dahlen, Founder and President of Give an Hour. Indeed it was because of the work of Give an Hour – providing over 185,000 hours of free care to our military and Veteran communities – that Barbara was inspired to tackle the primary barrier to the delivery of mental health care in our nation, our culture. With a small group of trusted colleagues, she developed and launched a collective impact effort aimed at changing the culture of mental health in America. “Mental health concerns affect one in five Americans. And yet, we continue to struggle with how to think about, talk about, and address the emotional well-being of our citizens.” Culture change happens more rapidly when high-profile champions and celebrities get involved in the conversation. The Campaign to Change Direction has been fortunate to have several impressive champions adding their voices to this critical effort. First Lady Michelle Obama was the first to take up this cause. She spoke at the launch of the Campaign in March of 2015 and has frequently used her powerful voice to amplify the effort.

Brian and Melinda Wilson – along with the director, writer, and actors from the film Love & Mercy about Brian’s life – joined the campaign last fall and have done much to help drop the movement into the cultural stream. And Richard Gere recently agreed to share his perspective, and his image, for a PSA promoting the importance of recognizing the Five Signs of emotional suffering – the hallmark of the campaign – as a critical step in preventing homelessness. We are honored by the support of all these champions. Their time and their brands are in great demand, and they have chosen to lend both to help us change the culture of mental health.  They recognize the need for change, and they are willing to do their part to make it happen. The most recent artist to add his voice to this effort is country music star and Grammy Award winner, Chris Stapleton, who just released a powerful music video, ‘Fire Away.’ His video will allow us to reach and engage a huge number of people – some we might not have been able to reach otherwise. The video is artistically beautiful and emotionally painful. Some who see ‘Fire Away’ will be reminded of their own struggles; some will most certainly be reminded of loved ones lost to suicide. All will be touched [www.changedirection.org].

Those who are passionate about RxP should embrace the vision of Elaine Foster, one of the first USAF prescribing psychologists. “After graduating from the DoD Psychopharmacology Demonstration Project (PDP) I served as a prescribing psychologist in the Air Force for over 20 years. I continued to serve our active duty military after retiring, again as a prescribing psychologist under contract with the Air Force. During that time, I prescribed for our veterans when we had space available at our military clinic…. If I walked across the hospital parking lot to our annexed VA clinic, I could no longer prescribe to that same patient I’d been prescribing to while he or she was active duty. The current VA restrictions are illogical…. Because New Mexico recognizes prescribing psychologists, I can now prescribe to our veterans, but only in New Mexico and only through a third party contractor…. This just does not make sense.”

Beth Rom-Rymer’s Illinois RxP trainees understand the importance of personal involvement. “I was born in Chicago and I am a first generation American.  My parents immigrated from the former Soviet Union as teenagers. My grandfather practiced biological psychiatry while my father, an American trained psychiatrist, embraced psychotherapy, in addition to treating patients with medication. I became interested in psychology after taking a psychology-literature class in high school. I would like to be able to offer my future patients a more comprehensive treatment by being able to prescribe medication, when necessary, and to offer psychotherapy.”

It Seems Like Only Yesterday: 2016 marks the 25th anniversary of The National Psychologist (TNP) newspaper which has become a staple for practitioners. TNP was founded in 1991 by a wonderful person and former reporter, Henry Saeman, former Executive Director of the Ohio Psychological Association. In its very first issue Henry wrote: “The National Psychologist will grant the opportunity for conflicting views, and will avoid serving as a mouthpiece for any individual or cause, realizing there are two or more sides to most stories, relying on experience and good sense to decide what constitutes news and information. We will seek to flush out important issues affecting practitioners, and if articles contradict their convictions, readers will find a publication which is receptive, subject to space limitations, to present opposing, legitimate viewpoints with civility.” In 1996, TNP was a first-place winner in a national editorial competition of the American Society of Business Press Editors. This award was presented to Henry for the article he wrote, “Behavioral Health and the Managed Care Dilemma.” Upon his death in 2003, his son, Marty, has been at the helm. The circulation remains between 28-30,000 practicing psychologists nationwide. Do subscribe to be current on the ever-evolving health care environment [www.nationalpsychologist.com].

At this year’s impressive State Leadership Conference (SLC) Expanding the Practice Spectrum, Katherine Nordal urged those present to forge their own destiny. “SLC is a major training ground for leadership and advocacy for students, Early Career Psychologists, and our diversity delegates. You are our future leaders!”

“This land was made for you and me.”

Aloha,

Pat DeLeon, former APA President – Division 55 – March, 2016