August 1, 2009

Five Questions on Health Care Reform For James H. Bray, PhD, President of the American Psychological Association

APA believes that every American should have access to quality health care that includes mental and behavioral health promotion, screening and referral, prevention, early intervention, treatment and wellness services across the lifespan.

What is APA’s position on health care reform?

APA believes that every American should have access to quality health care that includes mental and behavioral health promotion, screening and referral, prevention, early intervention, treatment and wellness services across the lifespan. Health care reform should be much more than covering the uninsured. Our overarching goal is to transform the way that health care is delivered by integrating psychological care into primary care and being full partners in the health care system.

Why is the inclusion of psychological care in primary care important?

Combining physical and psychological or behavioral treatment makes sense on multiple levels. First, mental and behavioral health are integral to overall health and well-being -- the leading causes of death in the United States are behavior-related. Second, if you treat physical symptoms but not psychological or behavioral ones, you are only treating half the client – whole person treatment requires integrated care. In short, for many illnesses, treatment outcomes will not improve if the role of behavior is not addressed. Mental and behavioral health care must be integrated into primary care and other health care services across the lifespan, with psychologists recognized as vital members of interdisciplinary health care teams. Increasingly, primary care physicians rely on the unique mental and behavioral health services that psychologists provide to patients in a variety of primary care settings. Psychologists often take a lead role on multidisciplinary treatment teams when a patient has a primary mental health or substance abuse diagnosis. Our chief priority is to see the inclusion of comprehensive mental health and substance use services on parity with physical health services in every benefit package created through health care reform.

Does APA have other health care reform priorities?

Yes. We would like to see a reform plan that develops and maintains a diverse psychology work force that is competent to develop and apply evidence-based behavioral and psychosocial assessments and interventions to address the current needs and changing demographics of our nation's population. Any new plan must also ensure that quality mental and behavioral health care and access to psychologists are included in the benefits. Additionally, we would like to see a plan that eliminates disparities in care across socioeconomic groups, increases research funding, ensures privacy of health records and enhances consumer involvement.

Can the health care system be made more efficient while leaving psychological care as a separate delivery system? Would it be less expensive to do so?

No, I don’t believe so. In fact, in the long run, leaving psychological and behavior care out of primary care will cost health care dollars, not save them. We already have a lot of data that show that behavior plays a huge role in many illnesses – diabetes for example. We also know that asking a patient who is having a difficult time controlling their diabetes to see another provider outside of their primary visits often falls on deaf ears; the patient will often not make the referral to see an outside psychologist or doesn’t have insurance coverage for such services.

Can you explain what APA means when it talks about the mind-body health connection?

Research continues to show that mental health and physical health are inextricably linked, and that the majority of Americans believe that they can’t have good physical health without good mental health. But even though we know this, people are still more likely to seek help for the mind only in cases of depression or suicidal thoughts. People turn to yo-yo dieting rather than deal with the emotional issues that lead them to overeat. They'll treat the physical ailment that may have been forestalled if they'd sought help for the stress that preceded the illness.

By integrating mental health care into overall health care, practitioners are better able to treat the whole person and increase the likelihood of positive outcomes. Particularly in these stressful times, it’s important to gauge patients’ emotional state and well-being as part of comprehensive care. Psychologists are specially trained to meet these needs. And the improved outcomes have been documented.

To give just a few examples:

  • Brief psychological counseling for heart patients before medical procedures produces shorter stays in the critical-care unit, less emotional distress and shorter hospital stays. And group therapy for recovering heart patients improves psychological well-being and cuts the death rate in the first three years of recovery. In addition, research has shown that two hours of psychological counseling per week for seven weeks reduces by 60 percent the rate of rehospitalization for heart patients.

  • Cancer patients who have psychological interventions have shown an improved quality of life as well as improved their physical health. Targeted group therapy and relaxation training have been shown to improve patients' moods, lower their emotional distress and improve their ability to cope with their illnesses.

  • Effectively treating people’s depression when they also have diabetes helps to improve their diabetic control and health.

The American Psychological Association, in Washington, D.C., is the largest scientific and professional organization representing psychology in the United States and is the world’s largest association of psychologists. APA’s membership includes more than 150,000 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting health, education and human welfare.