As I write this column America is at war. The nightly news is full of war reports, terrorism threats and economic troubles. The same news sources also carry stories about anxiety and post-traumatic stress disorder (PTSD). Never before has there been so much open discussion of the psychological impact of national events. While the loss of life that war brings is tragic, I am hopeful that this will help to call attention to such critical causes as reducing stigma and promoting mental health parity. However, I am also mindful that we as a field must be ready to handle the increased demand for services that these events portend with interventions based on good science and accumulated clinical experience, and with mechanisms for delivering them.
For several years, APA members have been building a knowledge base related to terrorism and related events. A decade ago, APA's Section on Clinical Child Psychology (now Div. 53--Society of Clinical Child and Adolescent Psychology) developed the Task Force on Children and Disasters, which led to the publication last year by APA of "Helping Children Cope with Disasters and Terrorism." In 1997, the APA Task Force on the Mental Health Response to the Oklahoma City bombing issued a final report summarizing the lessons learned from that tragedy and providing a useful framework for thinking about current and future response activities. More recently, the Practice Directorate has collaborated with the Discovery Channel's Health Network to develop a cable special on resilience and has created public information materials designed to help people cope during a time of war at APA Help Web site. APA members have also been at the forefront of studying both short- and long-term effects of 9/11 on residents of New York, Washington, D.C., and the nation as a whole.
This vital work is part of a much larger effort involving psychologists from around the globe who have worked for years in veterans' hospitals, nations at war, university laboratories and other settings studying PTSD, trauma, stress and other anxiety disorders. Their cumulative expertise is an essential foundation for the work that must now be done.
While psychologists clearly have something to offer in response to our current situation, we still must ask if our nation's mental health infrastructure can handle the challenge. Last year, the Interim Report of President Bush's New Freedom Commission on Mental Health raised serious concerns about the nation's mental health infrastructure. Many APA members would undoubtedly concur with testimonies heard by the commission lamenting the scattered service-delivery systems and financing mechanisms that have developed through the years.
As economic troubles continue in our nation, this situation may grow worse. Facing serious budget deficits, many states are altering the health-care coverage they provide to their residents. Many states have changed the eligibility criteria for Medicaid benefits and have reduced benefits in various ways, including increased cost-sharing for patients. Medicaid is the single largest provider of mental health coverage for children and one of the largest providers for adults as well, constituting about 50 percent of state and local spending on mental health services. Obviously, changes in Medicaid have a significant impact on mental health services at the local level.
So, where does this leave us? The work of APA divisions and individual members has resulted in a wealth of information about best practices for helping people in troubled times. Nevertheless, the same problems we have faced for years in the area of service delivery continue. Mental health services consistently absorb a disproportionate share of budget cuts during lean economic times. Mental health parity is not yet fully realized. As the open discussion of anxiety and emotional reactions in our post-9/11 world helps to reduce the stigma of talking about psychological problems, we must seize this opportunity to talk about what we have to offer and why we need to ensure all Americans have access to adequate mental health care. May is Mental Health month--a perfect opportunity to advance this discussion in our local communities and in the nation.
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