Front-line psychologists working alongside primary-care physicians often aid the underserved, many of them insured through Medicaid and Medicare. However, due to budgetary pressure to cut these programs' costs, psychologists must increasingly demonstrate that their behavioral-health services are good for public health and its bottom line, notes Garret Evans, PsyD, director of the University of Florida's National Rural Behavioral Health Center, which administers the university's training program in primary-care psychology.
To this end, and also to learn more about the inner workings of public health care, Evans joined with 28 other primary-care professionals in March to begin a six-month Primary Health Care Fellowship run by the U.S. Department of Health and Human Services (HHS).
APA's Practice Directorate nominated Evans for the slot, making this the seventh year in a row that APA's nominee has been selected for the primary-care fellowship. The directorate, in fact, was instrumental in winning psychology eligibility for the HHS fellowship program, notes APA Practice Directorate Deputy Executive Director Randy Phelps, PhD, who spearheaded the eligibility drive.
According to Phelps, the field's being granted fellowship access "reflects a clear recognition by governmental health policy officials that psychologists play a critical role in delivering primary-care services."
As did the other fellows before him, Evans will join with physicians, pharmacists and dentists and seek opportunities for change within the health-care system through direct work with government officials--conducted during monthly trips to Washington, D.C. over long weekends. In particular he'll focus on advocacy for mental health primary care, pushing, for example, to improve care for people with chronic illnesses.
Evans acknowledges that infusing more behavioral health into the nation's public health-care system will take time, patience and the collaborative efforts of everyone from physicians to government agencies to hospital administrators.
"In policy issues there are many issues that intersect, and different disciplines will try to protect their own turf," he says. "This [fellowship] is about getting professionals from all corners of the health-care system to sit down, improve care and reduce cost--it's so darn exciting!"
Through the fellowship program, Evans and seven other fellows will work to increase equality in care for people managing or coping with disabilities and chronic disorders. Currently, Medicare funds dramatic efforts to save lives at the end stages of chronic illnesses, such as through heart transplants, but it does less to help people cope with and fight those illnesses up to that point, says Evans.
He argues that a better approach--one that involves psychologists, improves people's physical health and eases strain on public health--is helping people with heart disease change their lifestyles after initial diagnosis and treating any concurrent mental disorders, such as depression.
"Depression is a more powerful predictor that someone will have a second heart attack than 'ejection fraction,'" a measure of the pumping power of the heart, Evans explains.
While he cautions that large changes will come in small steps, Evans predicts pressure on Medicaid and Medicare as a result of the recession and an aging population will eventually spark reforms. And psychologists can help bring about those reforms, and benefit from them, through political involvement, he notes.
"Psychologists need to be ready for these changes," he says. "We need to demonstrate that what we do is effective--that there is real value and quality to our outcomes--and we need to tie it to the economics of health care."