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Psychology needs to continue to keep track of the nation's evolving health-care system by considering innovative practice environments, keeping training current and, overall, moving toward a model of psychological services as health care, not just mental health care, said an APA Board of Professional Affairs-sponsored panel at APA's 2004 Annual Convention in Honolulu.

Psychology has already changed tremendously over the last 100 years, said psychologist Keith Humphreys, PhD, of the Stanford University Medical School, who presented a historical perspective on psychology. After the field established confidence in empirical mental health principles, like the effectiveness of psychotherapy, from 1900 to 1950, psychotherapy took hold, he said. The next 50 years saw the expansion of public and private health insurance, the Boulder conference that tied psychology directly to science and an effort to distinguish psychology from psychiatry.

Now, in the third half-century of psychology, the field faces the current rise in managed care and a surge in behavior-related health problems that demand creative public health and behavioral solutions, Humphreys said. Doctoral-level psychologists need to redefine their role in the field, he said, and, in a way, go back to the role of early psychologists who were creative innovators in the science and application of psychological knowledge.

"We need to reopen the universe of alternatives for psychology," said Humphreys.

Large-scale behavior change

One of the ways that psychology can take on a new role is through emphasizing the role of behavior change in health-care cost containment, panelists suggested. Seven out of 10 deaths in the United States are caused by a chronic disease, and there's a growing recognition of the role of patient behavior in both disease treatment and prevention, said psychologist Suzanne Bennett Johnson, PhD, of the Florida State University College of Medicine.

Chronic diseases require long-term complex medical regimens that often include lifestyle changes, she said.

"But people aren't good at lifestyle changes," Johnson continued. "Fifty percent of people fail to adhere to long-term regimens, especially if there are lifestyle changes and especially if their diseases, like heart disease, are asymptomatic. Psychologists can step in and help people with these behavior modifications."

Johnson predicted there will be a serious move toward psychological services as health care rather than mental health care. For psychologists, this means:

  • The identities of psychologists will change from being "just" mental health-care workers to being essential parts of multidisciplinary health-care systems.

  • Practice foci and settings will change. For example, more psychologists will work with hospitalized cardiac patients on behavioral interventions.

  • Psychologists will do more interdisciplinary work.

  • Psychologists will need new clinical, research and policy skills, such as abilities to demonstrate cost-effectiveness of psychological services to policy-makers.

  • Graduate training programs will increase their emphases on health psychology, public health and other such health-care areas.

Education as 'the' change agent

In fact, all the panelists agreed that serious transformations in psychology have to be supported by academic programs. Psychologist Beverly Thorn, PhD, of the University of Alabama, said academic programs may struggle to change established training models that they've spent years honing, but adapting is key to producing students who'll fit well into the marketplace.

For example, she said, they will have to ensure students are well-rounded in research and clinical preparation for leadership roles and new health applications.

"We're at the cusp of talking about innovative solutions; people are waking up to these training realities," she said. "Academic training programs need to continue to train students on a broad range of skills so that these psychologists can be leaders in redefining the field."

Echoing Thorn's point was the panel's discussant, psychologist Ronald Fox, PhD, of Chapel Hill, N.C.

"The key really is education," said Fox. "And the question is do we train graduates to deliver services in the traditional health-care system? Or do we prepare them for new and emerging types of care settings? Or do we prepare students to create innovative delivery systems that incorporate the very best psychological care that we can foresee? The answer to all of the above is 'Yes.'"