Public Policy Update
Recent federal budget cuts to the Graduate Psychology Education (GPE) program, the only federally funded program dedicated solely to the education and training of psychologists, will hurt several programs that provide psychological services to Americans most in need of care.
Last year Congress reduced GPE funding from $4.5 million in fiscal year 2005 to $2 million for fiscal year 2006, resulting in the elimination in October of seven grants to support geropsychology programs. Moreover, the funding of the remaining 20 GPE grants was reduced by 44 percent. And the outlook for 2007 is equally concerning: Only $2 million is expected.
A gap unfilled
GPE supports the training of new psychologists, who through the program provide critical, culturally competent services to underserved populations, many of whom are racial and ethnic minorities. Many minorities are disproportionately represented in groups that are at higher risk for mental disorders, such as those that live in poverty, those that are incarcerated, or those that have experienced trauma.
According to the 2000 surgeon general's report on mental health, minorities have less access to mental health services, are less likely to receive needed mental health services, and often receive a poorer quality of mental health care. The report also found that the suicide rate among young African-American men has nearly doubled since 1980 and has increased at a much faster rate than that of young Caucasian men. African Americans are also 1.8 times as likely to be diagnosed with schizophrenia. American Indians have a suicide rate 1.5 times the national rate, with two-thirds of those suicides occurring in males between the ages of 15 and 24. Latino youth have higher rates of anxiety-related and delinquency problems, as well as drug use and depression, than do non-Hispanic white youth. Despite minorities' mental and behavioral health needs, the recent federal budget cuts are reducing the availability of services to minorities as well as decreasing support for the training of the next generation of culturally competent psychologists.
GPE, although small, is critically important to the training of new psychologists who will serve minorities in underserved or shortage areas throughout the country. According to the U.S. Health Resources and Services Administration, there are more than 900 mental health professional shortage areas across the United States (60 percent rural and 40 percent urban), many of which claim large minority populations. Moreover, according to 2004 Census Bureau data, of the 45.8 million people without health insurance, 19.7 percent are African American and 32.7 percent are Hispanic. African-American and Hispanic populations also have the two lowest median household incomes, further inhibiting their access to mental health care. Both minority groups are more likely to seek treatment from a primary-care provider or emergency facility than from a mental health professional. Fewer than one in 20 Hispanics will seek help from a mental health specialist, and less than one in 10 will turn to a primary-care provider.
The programs affected
Although all GPE grant recipients target underserved populations and work with other disciplines, often in integrated primary-care settings, many programs focus specifically on minority populations and their barriers to mental and behavioral health care. One such program is the Rosalind Franklin University (RFU) of Science and Medicine. The university's Clinical Psychology Training Program has dedicated itself to providing culturally competent mental and behavioral health-care services to the surrounding area, where 26 percent of county residents are uninsured and 60 percent of the school population is Latino. Thanks to GPE funds, RFU has created programs that specifically target two of the main problems facing Hispanics: lack of health insurance and a language barrier. The psychology trainees are taught Spanish and therefore able to better communicate with their clients. GPE funding has also allowed the program to create a school-based primary-care clinic that provides psychotherapy, free immunizations and parenting classes. In addition, the grant has provided for rotations at a free clinic specializing in behavioral health care for adults. Psychology trainees have even supported the local Head Start program by working on early identification and prevention strategies with low-income preschool children.
Yet successful culturally competent programs have suffered significant setbacks due to the recent cuts in GPE funds. RFU has had to close the behavioral health clinic and reduce the number of students in the school-based clinic.
Another GPE program at the University of North Dakota (UND), focuses on the needs of its surrounding American Indian population. American Indians often face greater incidence of physical and emotional abuse, post-traumatic stress disorder and substance abuse. The GPE grant has allowed the UND program to expand its services on reservation sites and provided for an expanded clinic with services in a county jail and juvenile correction center. UND also increased student stipends for minority recruitment and expanded its overall admissions. Of the 40 students enrolled in the psychology graduate program, one-third are of American Indian descent, making it one of the largest promoters of American Indian psychologists in the country. Unfortunately, current cuts in GPE funding will force the GPE program to terminate at the end of the year.
Another program losing its GPE funding is the Louis de la Parte Florida Mental Health Institute psychology internship program. The program had used GPE grant money to provide psychological services for a local charter school that focused on African-American youth at high risk for behavioral problems. The graduate interns offered individual and family therapy, teacher conferences, anger management, classroom management and monthly case evaluations for the school. The case evaluations were always supervised by a psychologist and nurse practitioner with extensive training in culturally competent care. However, because of the loss of funding, the services of the nurse practitioner are no longer available and only one intern serves the school for six months out of the year--as compared with previous years when multiple interns worked full time at the school.
"The cuts have not only hurt our program, they have hurt our community's capacity to improve our service delivery system," says Richard Weinberg, PhD, director of the internship program.
The GPE grant had also helped the Louis de la Parte Institute psychology internship program set up a conference that allowed psychologists and other health professionals, clergy and educators to collaborate on how to best serve the needs of African Americans in the community as well as provide culturally competent care. Even without GPE funding, the internship program maintains its work with the underserved Tampa
-area African-American youth, which was initiated with GPE funding, and continues to provide mental health services to the underserved populations in the area.
Increasing access to culturally competent mental and behavioral health care by psychologists is the best way to address the needs of minority populations throughout the United States. RFU, UND and the University of South Florida are just three of the 27 GPE programs that provided better and more comprehensive behavioral health care for minorities. With the minority population in the United States expected to reach more than 50 percent by 2060, now, more than ever, we need to increase--not decrease--funding for the GPE grant to better serve growing minority populations.
Kathryn Bosse is a former intern in APA's Education Public Policy Office.