Many of the nation's urban and rural areas lack adequate health services for populations that are often indigent and under-insured. To help fill the need, the federal government has stepped in with a number of community health programs. Behavioral health services, including those psychologists provide, are critical to these programs, said Tanya Pagan Raggio, MD, a senior adviser in the Bureaus of Health Professions and Primary Health Care in the Health Resources and Services Administration, which administers the programs.
Speaking at the Education Directorate's Advocacy Breakfast at APA's 2006 Annual Convention, Raggio said mental health services are an important component of overall health and primary care in underserved areas. For example, she said, psychologists' help is needed managing behavioral aspects of chronic illnesses such as cardiovascular disease, diabetes, hypertension, AIDS, alcoholism and Alzheimer's disease, and with combating high rates of depression, and aiding with medication adherence.
Psychologists can provide those services alongside other health providers in federally subsidized health centers catering to areas with health profession shortages. Other such sites include migrant health centers, rural health centers and public housing and homeless programs, which serve underserved groups.
The federally subsidized sites total 3,745, serve about 14 million patients and use various models of mental health and substance abuse services, including an integrated medical model, co-location of services and referral to specialty care, said Raggio.
"Psychologists and other mental health professionals are part of the primary-care team," she said. "When we compare types of patient encounters, mental health has the largest number-3.7 million-and I suspect it may be far higher if we include all mental health services and not just those addressing mental illness and substance abuse."
Recognizing this, the Bureau of Primary Health Care has created the Depression Collaborative-which includes registration and tracking of patients diagnosed with depression to ensure proper treatment, follow-through and improved outcomes. The plan is to integrate aspects of the depression collaborative into other bureau collaboratives, such as diabetes, hypertension, asthma and cancer prevention.
Psychologists, said Raggio, can obtain training and provide such needed mental health services through several bureau-operated programs, including:
The Graduate Psychology Education (GPE) program. It supports training of psychology students to work with minorities, the elderly, people with disabilities and other underserved groups. The grants are competitive and go to APA-accredited psychology doctoral, internship and postdoctoral programs that train students for interdisciplinary care, especially primary care, in rural and urban areas. For more information, visit the GPE Program page.
The National Health Service Corps (NHSC) Student/Resident Experiences and Rotations in Community Health (SEARCH) program. It gives trainees opportunities to work on interdisciplinary health-care teams and to learn about providing culturally competent care in rural and urban settings. Other possible activities include community health promotion projects and routine health screenings. To be eligible, students must have started their training as a health service provider. For more information, go to http://nhsc.bhpr.hrsa.gov/join_us/search.asp.
The NHSC Loan Repayment Program. It repays health-care professionals' education loans for two years' service in areas with provider shortages; providers can also apply for extensions of service and repayment.
At last count there were over 4,000 health professionals in the program. Of those, 772 were mental health providers, but many vacancies for psychologists go unfilled: Last year, only one of every three vacancies was filled, said Raggio. In addition, she noted that psychologists can sometimes carve out their own positions in communities of greatest need-called "Health Profession Shortage Areas."
In closing, the breakfast spotlighted one effort to train psychologists for integrated primary care. In an ongoing collaboration, the Forest Institute of Professional Psychology sends psychologists and psychology graduate students to Jordan Valley Community Health Center in Springfield, Mo., to aid physicians in treating the center's low-income clientele (see "Making integrated health care a reality," July/August Monitor).
The teaming of psychologists with physicians at Jordan Valley counteracts stigma sometimes associated with mental health services, said Forest Institute President Mark Skrade, PsyD. "The warm handoff is particularly effective at knocking down those barriers to care," Skrade said.Y
For more information on NHSC loan repayment, go to http://nhsc.bhpr.hrsa.gov/join_us/lrp.cfm.
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