Running Commentary

Last month, I had the privilege of giving the commencement address at a large school of professional psychology. I was happy to tell the newly minted psychologists that they are entering the field at a time of unprecedented opportunity as the need for our expertise is more fully recognized in public health, education and business.

The career paths of these new psychologists are sure to be varied, but many will undoubtedly work in a health-care system that is sure to change in the coming years. As noted in an APA Annual Convention address by Dr. Michael Follick, the drivers of this change include the continued and dramatic increases in health-care costs; weak consumerism, where among other things, patients know little about the actual cost of health care; and deficits in the quality of care, where thousands of people die each year from medical mistakes.

Because of these and other pressures, the managed-care era is likely sunsetting, but what will replace it remains an open question. As psychologists we, better than any other health profession, know the degree to which behavior will impact the success of any new health-delivery system.

I told the graduating class that a few of the key elements that must be features of any new health-care system--and that psychology has a critical role in furthering--are the following:

  • Integrated care. Mental and behavioral health services have to be part of an overall health-care delivery system, not separate from it. No health-care system will work if behavior--the key factor in seven out of 10 of the country's leading causes of death--is dealt with as an afterthought or not at all.

  • Prevention and health promotion. I believe that one of the biggest shortcomings of our current health-care system is that it fails to emphasize, teach and reward prevention. Psychologists must take the lead in changing this. Prevention is all about behavior.

  • Self-management. The concept of self-management is taking hold in medicine. In the future, to control costs, patients will be asked to assume greater responsibility for managing their illnesses and reducing symptoms, and psychology has a key role to play in this. We've developed techniques for controlling pain, adhering to medication regimens, maintaining an exercise routine, reducing negative emotions and eating a proper diet.

  • Evidence-based practice. The concept of evidence-based practice has been adopted by the rest of the health-care community and so it makes sense for psychology to embrace it. In embracing it, though, we must ensure that "evidence" includes research evidence, clinical experience and patient values.

  • Cultural competence. Former Surgeon General Dr. David Satcher reported to the nation that many minority Americans were suffering disproportionately from health and mental health problems in part because of their limited access to quality health care. That is, when they enter the health-care system, they sometimes receive inferior or inappropriate care, regardless of insurance coverage or ability to pay. Cultural barriers have been cited as a possible reason. This is a human and financial crisis for America. As psychologists, we must ensure that our own profession is ready to deliver culturally sensitive services to all residents of the United States, and we must help other health professionals to ready themselves to do the same.

Finally, I told the graduates that they would have two other responsibilities during their careers. They would need to be ambassadors of psychology to the public, and they would be well advised to pay attention to their own wellness.

In order for psychology to play the expanded role it should play in solving national problems, policy-makers, leaders in allied fields, corporate America and the public need to understand and appreciate what psychology can do for them. Every psychologist has a role to play--whether on the national stage or in the local community or hospital or academic department--in communicating the value of psychological research and practice.

More generally, I advised my new colleagues to pursue their passions regardless of what others might say (see page 5); to not be bashful about what they, as psychologists, have to offer; to be results-oriented in their work and produce, produce, produce; to find activities outside of work that provide a sense of joy, meaning or connectedness to others; to not be afraid of change and to pursue new career options as their passions and interests evolve, since where they start is unlikely to be their last career stop.