Health and Prevention: New Horizons for Psychology
Laura Barbanel, Ed.D.
Not too long ago, I had the not-so-welcome opportunity to spend a night in the emergency room with a family member. Sitting in the waiting room, I listened to the nature of the problems with which people come in. Here is a partial list:
Clearly a number of these, if not the majority, are behavioral or life-style issues. Others that did not appear in that emergency room that night are AIDS, drug and alcohol addiction, and high blood pressure. What I saw and heard that night is not something new. It speaks to the need for psychologists involvement in the medical care of many patients. As psychologists we have the skills to work on these issues within a framework of both prevention and treatment compliance. Working with other health professionals supports our long-held belief of the integration of the mind and the body. This is currently referred to as integrated care. The November 2000 Monitor had several articles that speak to this. One of these articles describes a coalition of organizations, including APA and led by the Academy of Pediatrics, which was formed to address the issues pertaining to the problems of the delivery of mental health services to children. The point is that there is a collaboration of groups, namely psychology and pediatrics (Foxhall, 2000).
In the same Monitor there is a discussion of the new CPT codes that will recognize the work of psychologists in the form of behavioral interventions. This recognition comes after several years of advocacy by APAs Practice Directorate. The AMA committee in charge of CPT codes voted in favor of an APA proposal to institute codes that reflect psychosocial services to patients with physical health diagnosis, rather than just mental health diagnosis, as has been the case until now.
This confirmation of the function of psychosocial services in physical health care is something that we, as psychologists, have been talking about for years. A configuration of six new codes will be published for the first time in the 2002 manual; two codes for health and behavioral assessment services and four for health and behavioral intervention services.
In the proposal a note is made that seven of the nine leading causes of death are due to unhealthy or risky behaviors and that about half of the patients do not follow the regimen prescribed by physicians. That is powerful stuff! (Foxhall, 2000).
I would expand the concept of integrated care to encompass the various educational initiatives that we already engage in and would be broadly subsumed under the concept of prevention. We need to broaden our mission and role as psychologists under the umbrella concept of prevention. Too often we see ourselves as operating only when pathology is already established.
We do prevention work, both as individuals and as a profession APA now has a task force on early education and care, which I was involved in initiating (Best, April 2001). A large percentage of children under the age of 5 are currently in some kind of educational program or day care. Data indicates that when these programs are quality programs, high-risk children do better in the school years and in life. As psychologists we need to be both at the table when these programs are initiated and advocating for the quality of these programs. I am hopeful that this task force will help us find direction in this area.
The importance of mental health as health care has entered the national consciousness as well. Surgeon General David Satcher released a report on Mental Health, the first of its kind, and followed up with a conference on childrens mental health, at which psychology was well represented. A national action agenda was formulated from that conference. Among the recommendations were:
Psychology as a health profession.
The APA council, at the recommendation of the Board of Directors, voted to add the word health to the mission statement of APA in an effort to punctuate the expansion of psychologys role. This reflects the recognition of ourselves as a profession that deals with health issues, not only pathology. It allows us to see ourselves getting involved in health care, in early intervention with young children, in antiviolence programs, in parenting, in making work places healthier for adults. There is much work to do. As we expand our horizons in this way, we will expand our job descriptions and our profession.
Foxhall, K. (2000). Pediatricians lead a call for more child mental health resources, Monitor of Psychology, 31, 10, 42-43.
Foxhall, K. (2000). New CPT codes will recognize psychologists work with physical health problems, Monitor on Psychology, 31, 10, 46-47.
Smith, Deborah (2001). A new era for childhood education, Monitor on Psychology, 32, 4, 78-81.
U.S. Public Health Service, Report of the Surgeon Generals conference on childrens mental health: A national action agenda (2001). Washington, DC: Department of Health and Human Services.