Feature

While visiting a federally funded maternal health program in Philadelphia last year, Mary Wakefield, PhD, RN, was struck by the magnitude of problems facing the women she met.

“These young women were dealing with multiple stressors, from poverty to violence to depression — stressors that would be overwhelming to me,” said Wakefield, administrator of the Health Resources and Services Administration (HRSA), the agency that oversees care for the nation’s uninsured, isolated or medically vulnerable.

The women Wakefield encountered that day embody what she sees as an urgent need for federal programs to treat people’s physical as well as mental health challenges. “We can’t just be dealing with the physical issues or we will lose the battle,” she said.

Providing for more mental health care in federal programs for the underserved is a top priority for Wakefield, whom President Barack Obama appointed in March 2009. In an address at the Annual APA Education Advocacy Breakfast during APA’s 2010 Annual Convention, Wakefield gave an overview of HRSA’s reach and the many ways psychology is needed to improve its services.

“Mental health is a very integral part of virtually all of our programs and is a focus that … I’m trying to strengthen markedly as we go forward,” she said.

HRSA, a division of the U.S. Department of Health and Human Services, is a $7.8 billion agency that administers more than 80 programs. For example, HRSA runs the Maternal and Child Health Bureau, the federal government’s effort to improve the health of women and children, which reaches six of 10 women who give birth in the United States. HRSA also directs the nation’s Ryan White HIV/AIDS program, which delivers high-quality care to more than 500,000 low-income and uninsured people living with HIV/AIDS.

Among HRSA’s largest programs is its grant program for community health centers, which serve 19 million people a year in facilities ranging from large medical complexes to neighborhood clinics and mobile vans. That patient total is expected to nearly double, said Wakefield, thanks to an $11 billion investment over the next five years from the Patient Protection and Affordable Care Act. With such a substantial infusion of money, Wakefield said, HRSA will be able to “embrace a much fuller and robust set of strategies to ensure that people have access to care that will keep them healthy” — including psychological care.

Wakefield emphasized that she sees “definite room” for growth in psychologists’ services, particularly in the wake of the economic downturn. “It’s no surprise [that] when people lose their jobs and lose their health insurance, there’s increased cases of depression [and] family violence.” Two-thirds of all HRSA-funded health centers provide mental health treatment or counseling services, and one-third provide substance abuse treatment and counseling, she said.

Also of particular importance to psychologists is the National Health Service Corps, which provides scholarships and student loan repayments of $50,000 in exchange for two or more years of working in a service shortage area. That HRSA-administered program has also expanded under her watch, enabling qualified participants to receive up to $145,000 in loan repayment for five years of service in underserved areas. In addition, the corps is now recruiting about 4,000 new members, she said.

“Five years ago, people had to fight and scratch over a very few clinician slots,” said Wakefield. “That’s not the case anymore. We now have resources unlike anything we’ve had and we’re looking for partners to help us get the word out to the next generation of health-care providers.”

Such endeavors to develop the nation’s health-care work force are a priority for President Obama, she said. “There’s a real recognition that we’ve got to have a work force in place in order to meet expected increases in demand for health care. So we’re looking at psychologists and other care providers across all of our programs.”

All of these efforts — and many more — to integrate more psychological services into federal health-care programs have great promise, but they cannot be done alone, Wakefield said. They require collaborative networking between public and private partners.

“Our collaboration with APA and other providers is going to be particularly relevant for us as we do the very tough work, the challenging work,” she said. “That requires heavy lifting from all of us working together to ensure that we do in fact have access to high-quality health-care services for all Americans.”