I often receive e-mails noting that APA devotes too much attention and resources to one "special interest" (e.g., clinical practice, science) over another. As you might predict, that special interest area varies among different e-mails. Perhaps the concept in need of greatest scrutiny is the notion of special interest. APA's work on clinical practice illustrates the point. Within APA, considerable efforts are devoted to educating the public, the work force and legislators about mental health, the relation of mental and physical health, and what psychology can do to help. The Public Interest, Education, Science and Practice Directorates are involved in critical ways, but let me draw attention to the Practice Directorate, in particular. The very name suggests a narrowly focused agenda of interest to those in professional practice; it would not be bad if that were true, but it is not a fair characterization.
Consider the mental health of our nation. One in five children, adolescents and adults meets criteria for at least one psychiatric disorder, a very conservative estimate that includes arbitrary cutoffs and omits many social, emotional and behavioral woes and deleterious psychological concomitants of poor physical health. Juxtapose that to the finding that approximately 70 percent of the people in need of psychological services do not receive them. The percentage climbs for people of color, those who are not proficient in English and those who live in rural areas. It is very likely that our lives are touched directly or indirectly by the mismatch of need and services. Moreover, we are all paying a high financial price as the lack of psychological services translates to expensive alternatives (e.g., emergency-room visits, prison time for mentally ill individuals, care of homeless, lost work days). It is in all of our personal and professional interests to reduce the burden of psychological dysfunction in all its forms. A daunting array of obstacles impedes delivering clinical services to the public and contributes to the lack of treatment: Federal and state regulations, challenges to psychology's scope of practice, reimbursement rates that do not cover treatment costs, the absence of insurance for psychological impairment and postdoctoral training licensure requirements without enough salary to earn a living are merely the tip of the fast-melting iceberg.
We have succeeded in overcoming or managing obstacles through the Practice Directorate and its companion organization, the APA Practice Organization, which permits advocacy in ways that a nonprofit 501c(3) tax-exempt organization such as APA is not permitted to do. Improving the health care of our nation is achieved through legislative advocacy, legal and regulatory work, and public education (e.g., including pro bono services to disaster victims). Here are some examples of successes and ongoing advocacy:
APA has advocated to delay further cuts in Medicare payments for services that deter providing treatment.
APA has given assistance to practitioners so they diversify and manage their work in a way that helps ensure the availability of high-quality psychological services.
APA continues to work on prescriptive authority for qualified psychologists to increase access and treatment options for individuals in need of care, allowing psychologists the ability not only to prescribe, but to unprescribe drug treatment. (Most medication for psychological disorders is given by general practitioners and nurse practitioners.)
APA is participating in a nationwide class action lawsuit against several managed-care companies that allegedly reduced or delayed payment of claims for psychological services.
APA is continuing efforts to train and support practitioners who are interested in providing services in health professional shortage areas and having their graduate school loans repaid in the process.
The APA Practice Organization helped gain unanimous Senate passage of the Mental Health Parity Act of 2007 (legislative action shifts to the House this year) that would provide insurance coverage for mental health care.
Mental illness and the full continuum of psychological impairment exert huge burdens on individual families and on society. Services are for the very few, and constraints on practice place a chokehold on providing care or entering the field to provide care. The public is not being served; it could be by ensuring that highly trained professionals are allowed to provide high-quality services. The health-care gestalt is not working: We are altering "some of the parts." Mental health, clinical care and allowing those in practice to provide services perhaps are special interests, special not because of their restricted relevance, but because they affect the lives of millions, often one at time.
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