State Leadership Conference

Psychologists need to start seeing themselves as health-care professionals—with mental health as a subset of their expertise—and they must communicate that to the public and policymakers, said Katherine C. Nordal, PhD.

Nordal, APA's executive director for professional practice, called for this fundamental shift in psychology's focus at the opening session of the 2009 State Leadership Conference, held March 1–4 in Washington, D.C.

"It is foolhardy for us to focus narrowly on mental health issues when the real opportunities to make a difference in the quality of life for most of our citizens are in the broader domains of general health care," Nordal said.

Describing the U.S. health-care system as "broken and fragmented," Nordal cited some bleak statistics: The United States spends $2.3 trillion annually on health care, twice as much as any other industrialized nation, but 46 million Americans lack insurance. Even those with coverage face higher out-of-pocket costs and a higher rate of medical error than people in any other industrialized countries. Fundamentally, we're not getting what we pay for, she said.

"At the heart of this problem is the failure to coordinate care," said Nordal. "We need to pay more attention to wellness and preventive care and an integrated approach to health care."

Nordal said it's estimated that in five years, only about 7 percent of health spending will support mental health and substance abuse treatment and that by 2014, almost a third of all the money spent for mental health treatment will be spent on psychotropic medications.

Instead of limiting ourselves to the treatment of patients with mental health and substance abuse disorders, psychologists should focus more on treating chronic diseases, many of which are preventable or reversible with proper treatments focusing on lifestyle changes, she said. Psychologists can help people stop smoking, eat healthier foods, ease out of sedentary lifestyles and start exercising. Psychologists have an arsenal of treatment techniques, developed by psychologists, to prevent and manage chronic diseases, such as adherence protocols, cognitive behavioral therapy and prevention and wellness interventions, to name just a few.

"We have the skills to improve quality of life, and at the same time, dramatically reduce costs to the health-care system," she said.

One approach is to integrate psychologists into medical practices, said Nordal, observing that studies have long demonstrated that providing psychological interventions decreases patients' use of medical services. She noted that Parinda Khatri, PhD, Cherokee Health System's director of integrated care, has reported data from her health-care system in Tennessee showing that putting a psychologist on a patient's treatment team improved treatment adherence, increased patient satisfaction and reduced medical costs by around 30 percent.

Nordal added that by integrating into the wider world of health care, psychologists can reach a variety of underserved populations, including service members dealing with post-traumatic stress disorder and traumatic brain injury, the seriously mentally ill, people who are incarcerated, children with emotional problems and older adults.

Following her address, SLC participants heard from Susan Dentzer, editor-in-chief of the journal "Health Affairs," who emphasized that if job losses continue, about 3 million more Americans will likely lose their health-care coverage this year, with many ending up with publically funded coverage.

Even those with health insurance are having trouble paying for health care, as insurance premiums have doubled since 2000, she said.

Americans are responding to rising costs by taking drastic cost-saving measures, Dentzer said. A February survey by The Henry J. Kaiser Family Foundation found that more than half of those polled said they've relied on home remedies or over-the-counter drugs instead of going to see a physician, skipped dental care or didn't fill a prescription to cut medical costs.

However, real reform may finally be on the horizon, Dentzer said. The reauthorization of the Children's Health Insurance Program, signed by President Barack Obama in February, will expand coverage to 11 million children, up from the 7 million now enrolled. In addition, about 20 percent of the $787 billion economic stimulus package goes to health care in one form or another.

Obama has also proposed creating a $634 billion Health Reform Reserve Fund over 10 years, with the eventual goal of universal coverage, she said.

While there's reason to be optimistic, the immense fiscal challenge posed by the meltdown of the nation's financial system and big federal and state budget deficits may stymie the push for comprehensive reform, Dentzer said.

"This is really only going to happen if we the people, you in this room, everyone who has a stake in this keeps up the pressure and keeps the ball rolling," she said.