Psychology Is a Behavioral and Mental Health Profession

The focus of health care today is proactive – the emphasis is on illness prevention and wellness promotion. Health care delivery systems are oriented to preventing disease by promoting healthy lifestyle, rather than solving problems after they exist. This is not only due to the continuing rise in health care costs, but also the evolving global health problems that are primarily behaviorally-based.Consequently, health care delivery systems that recognize the physical and behavioral etiology of disease and focus on disease prevention and health promotion are becoming even more critical.

As a health profession, psychology has evolved from one with a concentration on mental health to one that includes behavioral health. By applying their knowledge and skills about behavior, psychologists play an integral role in helping people modify their behavior to prevent or reduce the risk of disease and illness. Because of their understanding of interrelationships between biological, social, emotional, and cognitive processes, psychologists play an important role in helping individuals recover from illness or related physical and mental dysfunction.

Psychologists work in primary, secondary, and tertiary health care settings as members of interprofessional health care teams, as well as independent practice. They provide inpatient and outpatient services, depending on the setting, to persons with acute and chronic health problems, emphasizing maintenance of health and prevention of illness. Psychologists work in varied settings including hospitals, correctional institutions, schools, and nursing homes. Across the roles or functions, some psychologists focus their practice in behavioral medicine, including rehabilitation, while others focus more on mental health services. Some of the problems addressed by psychologists in these different roles or emphases of practice are summarized below.

Psychological interventions have demonstrated efficacy in reducing high-risk health behaviors, improving clinical outcomes and providing net cost savings for a number of health problems including cancer, heart disease, hypertension, arthritis and chronic pain. Also, psychologists provide interventions to patients and their family members for conditions associated with illnesses such as cancer and diabetes. Intervention and treatments may include:

• Pain Management – providing pain management techniques for conditions such as back pain, cancer pain, severe burns, and migraine headaches.

• Symptom Management – providing interventions to control symptoms associated with medical treatment, such as nausea from chemotherapy, or desensitization to fears resulting from medical procedures such as MRI, needles/injections, and cardiac catheterization.

• Stress Management - stress management interventions for patients with illnesses exacerbated by stress, such as hypertension, cardiovascular disease, and ulcers.

• Urinary Incontinence - behavioral techniques and biofeedback for urinary incontinence.

• Pre-Surgical Patients – anxiety reduction interventions for pre-surgical patients.

• Treatment Compliance - behavioral interventions for dietary and medical regimen compliance for diseases such as diabetes and end-stage renal disease.

• Assessment - assessing a suspected dementia process such as Alzheimer’s disease and the development of interventions to manage behavioral and functional problems associated with this disease.

• Adjustment to Illness- individual and group psychological interventions for depression, anxiety, and adjustment issues surrounding chronic illness, all of which affect quality of life.

• Improving Patient Communication - interventions designed to improve the patient’s ability to communicate effectively with health care providers about medical procedures.

• Family Intervention/Problem Solving - supportive and problem-solving interventions for family members of patients suffering from chronic illness.

Behavior can be either a major cause or a contributing factor to the onset of illness. Psychologists develop, implement, and conduct outcome research on interventions to alter behaviors, which place the individual at high risk for both immediate and future health-related problems. These interventions are designed to reduce and/or prevent problem behavior such as:

• Smoking – development of smoking cessation programs, including cognitive-behavioral skill building programs and preventative interventions.

• High-risk Sexual Behavior – development of preventative and intervention programs aimed at high-risk sexual behavior associated with HIV and other sexually transmitted diseases.

• Substance Abuse – development of programs to address such problems as binge drinking.

• Diet and Lifestyle – development of programs to address poor diet and/or sedentary life style, which are often, associated with heart disease and other health problems.

• Accidents and Injuries - development of programs to prevent accidents and avoid post traumatic stress syndrome if serious injuries occur.

Nearly half (48%) of all Americans between the ages of 15 and 54 will experience a mental disorder in their lifetime. Psychologists in all 50 states are licensed to independently diagnose and treat these mental disorders. Psychologists provide services to individuals with mental disorders of varying severity, from moderate mental health disorders to severe and chronic mental illness. In treating these disorders, psychologists provide a continuum of care, including crisis intervention, comprehensive assessment and diagnosis, psychotherapy, psychosocial rehabilitation, and preventive interventions. Psychological treatments provided by psychologists in many cases are equally, if not more effective, than medication in successfully treating individuals with mental disorders (e.g., cognitive-behavioral therapies for anxiety disorders or depression). In short, psychologists provide a wide variety of mental health services, including treatment for:

• Severe and Chronic Mental Disorders - such as bipolar depression and schizophrenia;

• Situational Depression or Anxiety – such as grief and bereavement;

• Phobias - such as a fear of heights, or fear of open places;

• Neuroses - such as obsessive-compulsive behavior;

• Psychosomatic Illnesses- such as headaches due to stress;

• Alzheimer’s Disease – such as related cognitive and psychosocial problems.

The primary care setting is an increasingly crucial arena of the health care delivery system in which assessment and treatment determinations for patients with a wide variety of health complaints occur. Psychological services need to be an integral part of primary health care and integrated services for the most cost-effective outcomes. The problems presented in primary care have significant behavioral and mental health components or implications, and there is substantial evidence on the effectiveness of psychological interventions in the treatment of a wide range of physical illnesses, mental disorders and psychosocial problems.

In the Department of Veterans Affairs (VA), for example, psychologists and other health care professionals function as members of a coordinated interdisciplinary team. This primary care team has responsibility of monitoring the health of patients and providing access to a continuum of health care services, including: health promotion, disease prevention, comprehensive management of acute and chronic medical and mental conditions, and patient education.

Thus, as members of interdisciplinary primary health care teams, psychologists serve a critical function in the diagnosis and treatment decision-making process. Some examples include:

• Presenting Problems - As many as 60% of patients’ physical complaints are a result of psychological problems. Psychologists in primary health care diagnose and treat those psychological problems (e.g., depression, anxiety) that patients may experience as physical symptoms.

• Attention-Deficit/Hyperactivity Disorder - Psychologists working in pediatricians’ offices offer assessment and behavioral treatment for conditions such as attention-deficit/ hyperactivity disorder and learning disabilities.

• Domestic Violence - Victims of domestic violence are often treated and frequently seek help in primary health care settings. Psychologists working in primary health care provide supportive interventions for these individuals.

• Gerontology – Psychologists are working with other providers to meet the complex needs of older persons with multiple psychological, social and medical problems. An example of this is the Veteran Affairs Interdisciplinary Team Training Program (ITTP).

The growing emphasis on the behavioral aspects of health promotion and illness prevention coincides with the increasing use of an interdisciplinary approach to health care delivery; one that maximizes the use of both medical and behavioral interventions and provides the most cost effective, quality health care possible. Indeed, the key to realizing a healthy American society will be to find the right balance between medical and behavioral interventions. Psychologists, as mental and behavioral health professionals, will continue to play an increasingly vital role in the provision of health care as we embark on the 21st Century.