Professional Point

Despite the time that has passed since the terrorist attacks, the past year has continued being influenced by the events of 9/11. Growing problems with this nation's health-care system have hardly been priorities in a Congress whose agenda understandably has been preoccupied with national security, terrorism, enemies abroad and the possibility of war. Add to that an economic climate marked by corporate scandal, a persistently declining stock market, the increasing possibility of a "double-dip" recession, employee layoffs and a hiring slump described recently in The New York Times as the worst in 20 years. In turn, state governments are grappling with their own economic woes, a situation more likely to result in resources being taken away from health care than it is to produce creative solutions for an ailing health-care system.

In these challenging and uncertain times, it is natural to begin wondering what we as a profession need to do differently, or how we need to change to respond to current circumstances. Yet, in times like these, adopting strategies to change course may not be the best approach. It may actually be that staying the course we have charted in recent years is a far more effective strategy. The theme of this year's State Leadership Conference (SLC), "Leading psychology forward: staying the course in uncertain times," was chosen to reflect a stance of resolve and confidence for our profession. That is not to say we should be without self-reflection and self-evaluation. Psychology leaders must demonstrate both perseverance and resilience in the face of significant challenges.

What does staying the course mean for our profession? First, we must continue pressing for mental health parity. We certainly have seen this at the state level over the past year with New Hampshire, West Virginia, Alabama and South Carolina either creating or expanding parity laws. At the federal level, we must ensure that people with mental health disorders are no longer the target of insurance discrimination in either the public or private sectors, and irrespective of what form the health-care system begins to take over the next decade.

Second, we must continue educating decision-makers and the public about the important role of psychological services in preventive care. No small number of health problems can be influenced through preventive lifestyle and behavior change--cardiovascular disease, diabetes, obesity, HIV and some cancers are but a few examples.

Third, mental health and psychological services cannot continue to be kept so separate from physical health services in our health-care system. In our public opinion research from as early as 1995, people said they overwhelmingly recognize the link between psychological health and physical health. Yet with relatively few exceptions, our health-care delivery system refuses to recognize it. Although perhaps an ambitious goal, I can imagine a time when the public's current understanding that good psychological health is an important part of good physical health is replaced with the reverse--the recognition that good physical health is an important part of good psychological health.

Fourth, we must continue pressing to hold managed-care companies accountable for their actions, accountable for their decisions and accountable for their choice to put profits before patients. More to the point, any market-driven approach to health care must have accountability at its core or the system's concern for quality will not keep pace with its concern for cost.

Fifth, we must continue to assure that the value of psychological services is recognized by policy-makers and the public. Not only is this recognition necessary to be certain that psychological services are included in any health-care reform that occurs, it also is critical for preserving adequate reimbursement rates for psychological services of all types.

Finally, we must remain flexible in our ability to apply these objectives to whatever health-reform plans emerge as politically and practically viable proposals. While many reform proposals will be raised and some even debated by Congress, definitive action over the next two years is unlikely. Rather, a more likely scenario is that health reform will play a role in the upcoming presidential campaigns and election. During this process, we would be ill-advised to tie ourselves to any single version of reform. That is not to say we should be without voice as to what we believe is necessary for effective reform. But we must be prepared to ensure that psychological services are treated as an integral part of any reform plan.