IV. Board of Directors (Part 2)

This is Chapter 4 (Part 2) of the Council Policy Manual, which contains the current policies of the American Psychological Association. The organization of the manual follows the same major subject headings and sequence that is used in the agenda books of the Council of Representatives. Council actions are listed in chronological order with the earliest dated policies coming first. The table of contents of the Council Policy Manual, including all the chapter headings and all the items of the Council Policy Manual, can be found here.

Resolution on Terrorism

WHEREAS on September 11, 2001, terrorists hijacked four commercial airplanes and attacked the World Trade Center in New York City and the Pentagon in the Washington, DC, area and crashed the fourth plane in rural Pennsylvania;

WHEREAS those attacks caused the deaths of thousands and great destruction of property;

WHEREAS the physical impact of terrorism is death and destruction; its behavioral effects include disorganization, fear, anger, a sense of helplessness, loss of confidence, and problems in coping;

WHEREAS the fear of anthrax contamination has heightened these psychological states;

WHEREAS different segments of our diverse society use different methods of coping with and managing stress, some being more comfortable with individually-focussed methods like behavioral, affective and cognitive self-management and relaxation techniques, while others are more comfortable receiving support from their extended families, communities and places of worship.

WHEREAS psychology as a discipline and a profession has much that it can contribute through application of psychological knowledge and expertise;

WHEREAS the events of September 11 have led to a dramatic increase in the incidence of hate crimes based on ethnicity, ranging from harassment at work to murder;

THEREFORE BE IT RESOLVED that the American Psychological Association, an organization devoted to the promotion of health and well being, calls upon the psychology community to work toward an end to terrorism in all its manifestations;

BE IT FURTHER RESOLVED that the American Psychological Association:

Encourages its members to use their knowledge and expertise to help alleviate the public’s high levels of stress, anxiety, fear and insecurity and to mobilize the public’s strength and resilience to cope with terrorism and its aftermaths;

Provides relevant information to its members which will enable them to reduce the public’s high levels of anxiety, fear, stress and insecurity;

Advocates at the congressional and executive levels for increased use of behavioral experts and behavioral knowledge in dealing with both the threat and impact of terrorism;

Encourages increased support for behavioral research that will produce greater understanding of the roots of terrorism and the methods to defeat it, including earlier identification of terrorists and the prevention of the development of terrorism and its related activities;

Encourages increased research, treatment and prevention of trauma-related and disaster-induced problems among children, adolescents and adults;

Encourages ways to develop stress management, fear management and support programs specifically designed to help citizens deal with the continuing threat of terrorism;

Condemns prejudice leading to harassment, violence and hate crimes.

Council may "adopt," "support," or "endorse" documents of other organizations in principle. Endorsement of a statement, resolution, or policy of another organization does not mean that such a document has been adopted as APA policy, unless expressly so voted after appropriate review. APA policy takes precedent over endorsements of other organization's policy documents.

Council shall review and update its list of priorities at least every 3 years; 2) the Committee on Structure and Function of Council will recommend to Council a process for developing, reviewing and updating these priorities; 4) the latest list of the top priorities shall be included in each year’s Council agenda book; 5) new business item forms will include the list of these priorities so that the maker of a motion may identify the applicable priority/priorities to which the item is addressed or specify other issues to which it is speaking.

Psychological Needs of our Troops, Veterans, and Their Families

WHEREAS APA has already recognized the psychological impact on our non-military citizens affected by the war in Iraq and Afghanistan, as exemplified in APA's Task Force on Promoting Resilience to Terrorism, and the public education campaign on Resilience in a Time of War; and

WHEREAS APA constitutes a leading body of professionals and scientists whose expertise can best identify the behavioral and mental health needs of this nation, which will be essential in meeting the needs of our service men and women and their families; and

WHEREAS the health care systems of the Departments of Defense and Veterans Affairs are the usual resource access points through which the troops, veterans and their families receive psychological services; but the resources of these Departments may be unable to match the demands of the military personnel, veterans and their families; and,

WHEREAS access to mental health services must be maximized to insure optimal adjustment; and, WHEREAS, efforts should be made to minimize barriers to care and services (such as those associated with stigma or fears of adverse impact on career advancement); and,

WHEREAS, many of the deployed military personnel are our "citizen soldiers" of the National Guard and Reserve units, who are more likely to access services in the private sector and may encounter barriers due to lack of health insurance and other reasons; and

WHEREAS, the psychological needs of those who have been deployed and their families are likely to be great, far exceeding all collective resources; and,

WHEREAS, prevention and early intervention models for treatment, including outreach to personnel and families, are preferred for treatment of what could become chronic; and,

WHEREAS, Post Traumatic Stress Disorder (PTSD) and related psychological conditions often emerge years after the deployment ends, requiring increased services over time to match the demand as it becomes evident,

THEREFORE BE IT RESOLVED that the American Psychological Association acknowledges we have a responsibility to inform the nation and our policy makers in identifying the psychological needs, resources, and gaps in services which are the consequences of the current war;

BE IT FURTHER RESOLVED that all segments of APA and its affiliated groups inform and support the federal government's pursuit of its responsibility to proactively support our troops, veterans, and their families, and that actions be taken to coordinate and harness the resources available across all psychological constituencies and communities to serve these veterans and their families.

Health Care for the Whole Person: Vision and Principles We, the undersigned health, public health, consumer, and health care groups consider the following to be important characteristics of health, public health, and health care as each currently exists in the United States:

The dominant conceptual model of health in the United States, and as a result, the U.S. health care system, artificially separates the mind and the body. This separation has a negative impact on health care access, health care costs, and quality of care with a disproportionate share of the burden falling on women, racial and ethnic minorities, and immigrant populations. Furthermore, this separation has a negative impact on public health as opportunities for prevention, education, and early intervention are denied.

The structure of the U.S. health care system diverges from the types of symptoms and problems patients and their families bring to their providers. Stigma and reimbursement issues are frequent barriers to appropriate health care.

A strong, integrated health care system and approach to public health in both urban and rural areas are the central (and missing) pieces of the health care puzzle.

There is abundant scientific evidence that behavioral, psychological, spiritual, and psychosocial factors are significant determinants of health status, healing, and health care utilization for all ages, including older adults.

Healthy People 2010 selected Leading Health Indicators “on the basis of their ability to motivate action, the availability of data to measure progress, and their importance as public health issues” across the life span. These indicators are:

“Physical Activity
Overweight and Obesity
Tobacco Use
Substance Abuse
Responsible Sexual Behavior
Mental Health
Injury and Violence
Environmental Quality
Immunization
Access to Health Care” (U.S. Department of Health and Human Services, 2000).

The ten most common problems adult patients bring to primary care--chest pain, fatigue, dizziness, headaches, swelling, back pain, shortness of breath, insomnia, abdominal pain, and numbness-- together account for 40% of all primary care visits, but only 26% of these have a confirmed biological cause;

Childhood psychosocial dysfunction, viewed 25 years ago as a “new morbidity” is now recognized as the most common, chronic condition of children and adolescents... 50% of these children are identified by their primary care physicians.

Primary health care providers treat 75% of all mental health problems of which depression, anxiety, trauma sequelae, and family stress are the most prevalent;

Seventy percent of patients coming to primary care bring one or more family members, thus presenting an opportunity for family-focused care and for providers to work in partnership with patients;

U.S. expenditures on health care are now 14.9% of GDP. Total health care expenditures per capita have almost doubled since 1990 to $5,440 in 2002; overall health care costs increased at a rate of 7.3 % in 2003; and HMO rate increases were 17% in 2004.

We note that many of the nation’s leading health and health care entities have strongly endorsed new, integrated approaches to health and health care:

Institute of Medicine

“Ensuring cooperation among clinicians is a priority” (Committee on Quality of Health Care in America, 2001)

“A fundamental shift in the national perspective of the value and importance of psychological health...” (p. 117, Goldfrank et al., 2003)

National Institutes of Health

“...behavioral scientists, molecular biologists and mathematicians might combine their research tools, approaches and technologies to more powerfully solve the puzzles of complex health problems such as pain and obesity...with roadblocks to potential collaboration removed, a true meeting of the minds can take place...” (National Institutes of Health, 2004)

President’s New Freedom Commission on Mental Health

“The integration of mental health and physical health is a crucial next step...” “bridge the differences between the mental and physical health communities...” (Mental Health Commission, 2003)

The Future of Family Medicine

“recognizing fundamental flaws in the fragmented US health care systems and the potential of an integrative, generalist approach...the project identified...a New Model of practice [with the] following characteristics: a patient-centered team approach...patient care in the new Model will be...multidisciplinary team approach...will include behavioral scientists...” (Kahn, 2004)

U.S. Surgeon General

“mental health care should flow in the mainstream of health care …[to] mend the destructive split between mind and body....” (USDHHS, 1999)

“A balanced community health system balances health promotion, disease prevention, early detection… require(s) a partnership between primary care and mental health.” (USDHHS, 2001)

Therefore, the undersigned health and health care groups endorse the promise of an integrated primary health care system and multidimensional approach to public health that

Rests on a biopsychosocial model of health and health care;

Meets the definition of quality of care;

Reduces the burden of illness and injury by an evidence-based emphasis on healthy behavior and psychological health in addition to physical health;

Reduces the incidence of untreated mental health problems;

Contributes to more effective use of resources and helps reduce the cost of health care with targeted, focused psychological health services in addition to physical health services;

Improves provider-patient relationships and satisfaction with care, and encourages patient-centered care;

Promotes healthy lifestyles and disease prevention.

In addition, integrated health care and biopsychosocial public health will help address the adverse health and mental health impact of environmental and psychosocial factors such as prejudice, discrimination, poverty, racism, disability, heterosexism and homophobia, and minority group stress.

We, the undersigned health, public health, and health care groups, believing a healthier population and a more rational health care system will result, affirm our intention to work together toward the development and application of a fully integrated health care and public health system.

Definitions

Integrated care is health care that addresses physical, mental and behavioral health issues at the same time and is optimally provided by a multidisciplinary team of providers.

According to its author, George Engel, MD, the bioposychosocial model adds “the patient, the social context in which he lives, and the complementary system devised by society to deal with the disruptive effects of illness” to traditional medical issues (Engel, 1977; p.135).

REFERENCES

Brown, R. T., Freeman, W. S., Brown, R. A., Belar, C., Hersch, L., Hoynyak, L. M., et al. (2002). The role of psychology in health care delivery. Professional Psychology: Research and Practice, 6, 536–545.

Committee on Quality of Health Care in America. (2001). Crossing the quality chasm: A new health care system for the 21st century. Washington, DC: National Academies Press.

Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196, 129–136.

Goldfrank, L. R., Wong, M., Ursano, R. J., North, C. S., Quinlisk, P., Wallace, N., & Jacobs, G. A. (2003). Preparing for the psychological consequences of terrorism: A public health strategy. Washington, DC: National Academies Press.

Kahn, N. B. (2004). The future of family medicine: A collaborative project of the family medicine community. Annals of Family Medicine, 2(Suppl. 2), S3–S32.

McDaniel, S., Hepworth, J., & Doherty, W. (1992). Medical family therapy. New York: Basic Books. Mental Health Commission. (2003). President’s New Freedom Commission on Mental Health. Retrieved from www.mentalhealthcommission.gov

National Institutes of Health. (2004). NIH roadmap: Interdisciplinary research overview. Washington, DC: Author.

Rathore, S. S., Berger, A. K., Weinfurt, K. P., Feinleib, M., Oetgen, W. J., Gersh, B. J., & Schulman, K. A. (2000). Race, sex, poverty, and the medical treatment of acute myocardial infarction in the elderly. Circulation, 102, 642–648.

Stancin, T. (1999). Special issue on pediatric mental health services in primary care settings [Introduction]. Journal of Pediatric Psychology, 24, 367–368.

Travis, C. B. (2005). Heart disease and gender inequity. Psychology of Women Quarterly, 29, 15– 23.

U.S. Department of Health and Human Services. (2001). U.S. Surgeon General’s working meeting: Integration of mental health services and primary health care [Report]. Rockville, MD: Office of the Surgeon General.

U.S. Department of Health and Human Services. (2000). Healthy People 2010 [Report]. Rockville, MD: Office of the Surgeon General.

U.S. Department of Health and Human Services. (1999). Mental health: A report of the Surgeon General. Retrieved from http://www.surgeongeneral.gov/library/mentalhealth/home.html

The American Psychological Association affirms the doctorate as the minimum educational requirement for entry into professional practice as a psychologist.

The American Psychological Association recommends that for admission to licensure applicants demonstrate that they have completed a sequential, organized, supervised professional experience equivalent to two years of full-time training that can be completed prior or subsequent to the granting of the doctoral degree. For applicants prepared for practice in the health services domain of psychology, one of those two years of supervised professional experience shall be a predoctoral internship.

The American Psychological Association affirms that postdoctoral education and training remains an important part of the continuing professional development and credentialing process for professional psychologists. Postdoctoral education and training is a foundation for practice improvement, advanced competence, and inter-jurisdictional mobility.

In adopting the preceding policy statements, the Council supports further development of competency goals and assessment methods in the professional education and training of psychologists.

Mental Disability and the Death Penalty

The American Psychological Association urges jurisdictions that impose capital punishment not to execute certain persons with mental disabilities under the following circumstances:

1. Persistent Mental Disability: Defendants should not be executed or sentenced to death if, at the time of the offense, they had significant limitations in both their intellectual functioning and adaptive behavior, as expressed in conceptual, social, and practical adaptive skills, resulting from mental retardation, dementia, or a traumatic brain injury.

2. Mental Disorder or Disability at the Time of the Offense: Defendants should not be [sentenced to death or] executed or sentenced to death if, at the time of the offense, they had a severe mental disorder or disability that significantly impaired their capacity (a) to appreciate the nature, consequences, or wrongfulness of their conduct, (b) to exercise rational judgment in relation to conduct; or (c) to conform their conduct to the requirements of the law. A disorder manifested primarily by repeated criminal conduct or attributable solely to the acute effects of voluntary use of alcohol or other drugs does not, standing alone, constitute a mental disorder or disability for purposes of this provision.

3. Mental Disorder or Disability After Imposition of Death Sentence:

(a) Grounds for Precluding Execution. A sentence of death should not be carried out if the prisoner has a mental disorder or disability that significantly impairs his or her capacity (i) to make a rational decision to forgo or terminate post-conviction proceedings available to challenge the validity of the conviction or sentence; (ii) to understand or communicate pertinent information, or otherwise assist counsel, in relation to specific claims bearing on the validity of the conviction or sentence that cannot be fairly resolved without the prisoner's participation; or (iii) to understand the nature and purpose of the punishment, or to appreciate the reason for its imposition in the prisoner's own case. Procedures to be followed in each of these categories of cases are specified in (b) through (d) below.

(b) Procedure in Cases Involving Prisoners Seeking to Forgo or Terminate Post-Conviction Proceedings. If a court finds that a prisoner under sentence of death who wishes to forgo or terminate post-conviction proceedings has a mental disorder or disability that significantly impairs his or her capacity to make a rational decision, the court should permit a next friend acting on the prisoner's behalf to initiate or pursue available remedies to set aside the conviction or death sentence.

(c) Procedure in Cases Involving Prisoners Unable to Assist Counsel in Post-Conviction Proceedings. If a court finds at any time that a prisoner under sentence of death has a mental disorder or disability that significantly impairs his or her capacity to understand or communicate pertinent information, or otherwise to assist counsel, in connection with post-conviction proceedings, and that the prisoner's participation is necessary for a fair resolution of specific claims bearing on the validity of the conviction or death sentence, the court should suspend the proceedings. If the court finds that there is no significant likelihood of restoring the prisoner's capacity to participate in post-conviction proceedings in the foreseeable future, it should reduce the prisoner's sentence to a lesser punishment.

(d) Procedure in Cases Involving Prisoners Unable to Understand the Punishment or its Purpose. If, after challenges to the validity of the conviction and death sentence have been exhausted and execution has been scheduled, a court finds that a prisoner has a mental disorder or disability that significantly impairs his or her capacity to understand the nature and purpose of the punishment, or to appreciate the reason for its imposition in the prisoner's own case, the sentence of death should be reduced to a lesser punishment.

Council notes that adoption of the recommendations above is not intended to supersede or alter existing APA policy on the death penalty (e.g., Resolution on the Death Penalty in the United States. Adopted August 2001).

Impact of Elementary and Secondary Zero Tolerance Policies

At least on an annual basis, each Directorate include within their report to Council an account of their activities and actions for each of the current top 10 APA priorities, as identified from the current priority list developed by Council with the assistance of CSFC and relevant divisions.

Workforce Analysis

To achieve its mission in advancing psychology as a science and a profession, and as a means of promoting health, education, and human welfare, the APA is committed to the development and maintenance of an ongoing workforce analysis and research capability to assess relationships among the supply, demand, and need for psychologists in society.

Workforce Analysis Report 1

Workforce Analysis Report 2

Workforce Analysis Report 3

Workforce Analysis Report 4

The Psychological Needs of U.S. Military Service Members and Their Families:A Preliminary Report

Integrated Health Care for an Aging Population