Reorganization mobilizes VA psychologists

They are exploring the leadership skills needed to excel amid the rapid changes at veterans hospitals.

By Scott Sleek
Monitor staff

Psychologists are working to expand their power and influence in the veterans health-care system and to sustain a key role for the profession as the system reorganizes.

The psychologists also are looking for ways to promote their special skills that may be unrecognized, but could be useful, in the U.S. Department of Veterans Affairs (VA) health-care system. They say they could, for example, teach stress-management skills to VA hospital staff or set up patient-education programs on healthy lifestyles and behavior.

The psychologists? efforts, spearheaded by the Association of Veterans Affairs Psychologist Leaders (AVAPL), are a response to an ongoing reorganization of the U.S. Department of Veterans Affairs? (VA) health-care operations, which has eliminated many psychologists? jobs, taxed their caseloads and allowed psychiatry to assume too much authority over mental health services, according to those employed by the VA. Such trends, they say, could leave veterans receiving inadequate psychological services and limit psychology positions within the VA, which now is the nation?s largest single employer of psychologists.

About 100 AVAPL members from all over the country convened in Dallas Jan. 23?24 to develop plans for addressing these issues. They agreed that psychologists can restore their stature in the VA by promoting the vital services they provide to veterans and capturing more leadership positions within the Veterans Health Administration (VHA).

A prime purpose of the conference was to bring VA psychologists together to network, strategize and provide each other with moral support at a time when the reorganization is leaving them feeling isolated and uncertain about their futures. The goal was to share ideas on how to advance psychology?s role in VA health care and to develop plans to implement those ideas, said Russell Lemle, PhD, chief psychologist at the San Francisco VA Medical Center (VAMC). Lemle devised the idea for the conference and was integrally involved in shaping its agenda.

The goals

Practice Directorate staff, led by Randy Phelps, PhD, assistant executive director for professional issues, sponsored and helped coordinate the Dallas conference as part of their efforts to ensure that psychologists? services remain a crucial part of VA health care. Other APA officials who participated in the meeting included Norm Abeles, PhD, APA past-president and a leading advocate for VA psychologists; Kathleen McNamara, PhD, staff psychologist and training director at Honolulu?s VA Medical and Regional Office Center and a member of APA?s Board of Directors; Russ Newman, PhD, JD, APA?s executive director for practice; and Paul Nelson, PhD, APA?s deputy executive director for education. With APA?s help, AVAPL seeks to:

? Identify new leadership or management skills that psychologists will need to excel in the rapidly changing VHA system.

? Incorporate relevant business and management curricula into psychology training programs.

? Explore the possibility of establishing special management or business credentials for psychologists, much like an MBA or MHA.

? Promote psychology?s contributions in clinical research, human resources, community outreach and staff team-building.

? Develop models for collaboration between psychologists and other VA health professionals, including primary care.

? Preserve and expand internship and postdoctoral training opportunities in the VA. (New training allocation procedures in the reorganization will affect the way VA distributes training funds among the disciplines.)

AVAPL has assigned various task groups to investigate these strategies, and plans to discuss the groups? progress during APA?s Annual Convention in San Francisco, Aug. 14?18.

AVAPL also wanted the conference to highlight success stories?the experiences of psychologists who have garnered top managerial positions at the VA. AVAPL President Robert Gresen, PhD, said his job as manager of the Milwaukee VAMC?s mental health division?and his adjustment to the reorganization?has taught him that quality care can be delivered in a variety of ways, not just the way it was in the old VA system. And Matthew Blusewicz, PhD, who is AVAPL president-elect , discussed the challenges he faced?including resistance from psychiatrists?when he became associate chief of staff for mental health at the VA Northern California Health System.

The ?product?

The overhaul, which began three years ago, shifts oversight of the VA?s 172 medical centers from VA headquarters to 22 geographically distinct Veterans Integrated Service Networks. The decentralization has allowed many hospitals to consolidate psychology, psychiatry and social work departments into a single department or ?product line.? Mental health care is the product they provide.

The consolidations have resulted in staff cuts and the elimination of chief psychologists? positions, AVAPL members report. In many hospitals, psychologists who used to be supervised by a chief psychologist are now reporting to psychiatrists. Many psychologists say their roles are being largely diminished in VA hospitals, as psychiatrists assume more power and opt for pharmacological interventions as the choice treatments for veterans struggling with mental disorders.

Those trends mirror the changes occurring in the private health-care market, Newman told AVAPL members at the Dallas conference. The swift changes challenge VA psychologists to revamp their services, while preserving their core values as caregivers, he said.

Officials in VHA?s Washington, D.C., headquarters also took interest in AVAPL?s efforts. Among the participants at the meeting was psychologist Mary Jansen, PhD, the new deputy chief consultant in the Mental Health Strategic Healthcare Group at VA headquarters in Washington, D.C. She said she and other officials at the Health-care Group wanted to work with AVAPL to address the problems that psychologists encounter in the restructuring. She encouraged AVAPL to provide her with an agenda that she and other VA officials can work on.

Psychologists have been encouraged by Jansen?s selection as the new deputy chief consultant. In fact, for the past three and a half years, officials in APA?s Practice Directorate advocated for the appointment of a psychologist to permanently fill that position. (Jansen served as administrative officer for special projects at APA from 1981?83.)

Promotional ideas

In addition to discussing the possibility of higher-level positions, AVAPL members shared ideas on promoting psychology?s unique, essential functions within the VA system. Among those contributions are psychological assessment and behavioral interventions to improve patients? treatment compliance.

?We have to build the perception that we?re indispensable?that there are things that only we can do,? said Blusewicz. ?Then the recognition and compensation will follow.?

AVAPL and APA should advocate for legislative or regulatory changes that would designate psychologists as primary-care providers, not just mental health providers, added McNamara.

Conference participants added that VA psychologists should be encouraged to:

? Redesign existing programs to help the VA move more patients into outpatient care and other lower-cost services?a stated goal of the reorganization.

? Evaluate the effectiveness of the existing VHA.

? Run employee-assistance programs for VA staff.

? Evaluate VA security officers for fitness for duty.

? Develop strategies to curtail the level of patient violence in VA hospitals.

? Help management analyze and interpret various data.

? Develop treatment guidelines for VA mental health professionals.