Science and health care

Richard McCarty

A consensus has emerged that the health-care system is in need of surgical intervention. With respect to the delivery of mental health services, one could argue that this sector of the health-care system is in need of major emergency surgery.

Indeed, many managed-care companies have enacted policies that place extraordinary pressures on practicing psychologists as they seek to meet the needs of their clients with the best care that the profession has to offer.

The changes in the health-care system have also affected the psychological science community, which, in turn, can have an impact on improving the national crisis in the delivery of mental health services.

Can research inform business decisions?

The problems confronting the practice community have created new research opportunities that are among the most important confronting our discipline. These newly emerging research opportunities are by their nature interdisciplinary and involve many segments of the behavioral and social sciences. Most managed-care companies are in business to make money, not to lose it. No surprise there! However, while appreciating the motives of profit-driven companies, can we argue that they are being penny wise and pound foolish by limiting access to mental health services? Such an argument must be supported by empirical data from research on the effectiveness of current treatment protocols and the long-term consequences of restricting access to care. For example, do restrictions on access to psychotherapy lead to higher medical costs over the long haul?

This is a clear example of an interdisciplinary research opportunity that may affect business decisions that in turn will affect peoples' lives. I might add that one study will have little chance of changing business decisions, but several compelling studies might. Other audiences that would be receptive to such research findings include consumer groups and policy-makers at the state and federal levels.

Another issue that must be addressed is the need for partnerships between scientists, practitioners and health-care systems if research is to be conducted. One can imagine moving toward a system where all research on mental health outcomes of participants in health plans will be done by in-house research groups and governed by proprietary concerns. A more optimistic view is that quality of care can actually be improved and costs can be reduced through greater integration of medical and mental health services.

Can research findings create new practice opportunities?

Innovative research findings on psychosocial aspects of disease are opening up many new practice opportunities for clinical psychologists now and in the future. Basic research in psychoneuroimmunology over the past two decades has moved from the benchtop to the bedside and clinical psychologists have benefited in significant ways. Clinical psychologists are now members of oncology treatment teams at many academic medical centers. In addition, pharmacotherapy for HIV/AIDS has led to a surge in studies of patient compliance for taking medications.

Other research projects are addressing ways in which psychologists can play vital roles in primary care and pediatrics practices as well as in medical practices in treating patients with chronic diseases. Finally, the explosion of research in the neurosciences over the past decade has provided the scientific foundation for new and expanded practice opportunities in neuropsychology, including treatment of traumatic brain injuries.

The public conception of mental health

Like it or not, there remains among the general public a stigma associated with mental health services. There is hope in many quarters that the Report of the Surgeon General on Mental Health will tackle this issue head-on. This report, commissioned in September 1997 and scheduled for release later this year, will take a broad-brush approach to discussing issues of mental health and mental illness. It will cover scientific and clinical advances, prevention of mental illness and promotion of mental health. Attention will also be directed to issues of access to mental health care in the changing service environment. This report is sure to attract considerable media attention and if all goes according to plan, it will inform the public and policy-makers about the important contributions of the scientific and practice communities to the health of the nation.

We must continue to make the connection between behavior and mental as well as physical health. If the many groups within APA can come together and work on health care and other major issues from a multidisciplinary perspective, our discipline and our nation will benefit from the effort.



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