Antonette M. Zeiss, PhD
Antonette M. Zeiss, PhD, retired at the end of 2012 after serving since May 2010 as the chief consultant for mental health services at the Department of Veterans Affairs Central Office (VACO), first as the acting lead in that role and then as the selected official. She completed her PhD in clinical psychology at the University of Oregon in 1977 and worked in VA from 1982 to 2012, after working as a faculty member at Arizona State University and Stanford University. Her previous VA positions were at the VA Palo Alto Health Care System, until coming to VACO in September 2005 as the deputy chief consultant for the Office of Mental Health Services.
One her major VACO responsibilities was to support effective implementation of the Mental Health Strategic Plan, which ultimately led to the VA Uniform Mental Health Services in VA Medical Centers and Clinics Handbook, thus enhancing and transforming VA mental health services. She has published extensively, particularly on mental health policy and training, on interprofessional teams and health care service delivery and on depression treatment and risk factors.
She has received numerous awards throughout her career. Most recently, these have included a United States Presidential Rank Award, Meritorious, for her service as a government senior executive; a lifetime achievement award from the Association for Behavioral and Cognitive Therapies; and a lifetime achievement award from the American Psychological Association in July 2013.
Q: You are retired now and so what have you been up to lately?
A: Well, I remain professionally active, I am a member of the Board of Professional Affairs for APA and have written a number of chapters and other articles, but I'm also retired and enjoying it. We are living in Santa Cruz, California, and spending a lot of time doing things of great interest to us, hiking, gardening, the beach.
Q: Who mentored you?
A: I had many mentors. My first mentor would have been Walter Mischel, when I was an undergraduate at Stanford. I started doing research with him as an undergraduate and went to his graduate psychology meetings weekly and then worked for him for six years after I graduated. And then when I started graduate school at the University of Oregon, Peter Lewinson, was my mentor. I did my dissertation with him and have published many things with Pete.
In VA, it is harder to say exactly who a mentor would have been. I was at the Palo Alto VA for most of my career and was the director of interdisciplinary team training in geriatrics — which over time developed into the interprofessional team training and development program, not just focused on geriatrics — and I had various mentors from the Office of Academic Affiliations at central office. I also had some brief mentoring from Donald Lim, who was the director of training at Palo Alto when I first arrived there, before he retired. I did ultimately become the director of training and associate chief of psychology service there before I left for Central Office in 2005, where I was initially the deputy chief consultant and later became the chief consultant.In Central Office, my main mentor was Madhu Agarwal — she had been the lead for patient care services and now has an even higher position, as associate deputy under secretary for health for policy and programs. She is a really remarkable woman who helped me learn the ways of VA Central Office, including testifying to Congress, dealing with press all the things that go along with being there.
I would say that for most of my time at VA Palo Alto I really didn't have direct mentoring, but I had some splendid mentors early on and when I got to Central Office.
Q: What makes a good mentor?
A: I think that the mentors that I've had have been truly inspirational in their vision. My first two mentors, Drs. Mischel and Lewinson, had wonderful visions of what psychology can be and what it can accomplish. Dr. Agarwal offered a vision of health care more broadly and how mental health fits into overall healthcare. A mentor is someone I respect utmost and who shows me how their vision is can be something that can guide what I do and the work that I try to accomplish. And particularly with my first two mentors (Walter and Peter), they were both splendid mentors at balancing professional and personal life; that is really important and something I've tried to do with people that I've mentored.
Q: How can psychologists get more involved in public policy, in your opinion?
A: That is such a broad question, I am not sure where to even begin there. There are thousands of ways that psychologists can get involved …Let me start at it from a slightly different angle and perhaps we can find a path. The first thing that I would want to say is not so much about policy and how to incorporate policy, but a more overarching statement. That is that in your career it is important to do things that you love and that you are passionate about. So setting a goal to do public policy sort of makes no sense in some ways. What you have to know is what do you feel passionate about, and then see how that leads you toward issues where policy becomes important.
So for instance, when I received the lifetime career achievement award at the last APA meeting, I mentioned of course both Walter Mischel and Pete Lewinson. But Pete, in particular, always said, when we were doing research together in graduate school, that we aren't doing this to get more publications. We are doing it because it could really end up being helpful to real people. The knowledge that gets generated could really make a difference in peoples' lives. And for me that has been a real touchstone. What I've wanted to do in my career is to find ways to have an impact on systems that determine how knowledge from research, in particular, will be used to help peoples' lives; it is not just something that other psychologists use and cite, but that it really turns into action. And so that task obviously leads me to caring very much about policy and how a health care system works.
I think many people would try to answer the question you've asked by talking about advocacy in more political arenas and there are splendid psychologists who have been very active in advocacy with Congress, for instance. That is not what I chose to do. I certainly spent plenty of time with Congress, doing behind-the-scenes advocacy and briefings as well as testimony at hearings. However, what I have found even more helpful in terms of having an impact on policy is to learn about the level of the organization in which you work where policy is determined. For VA mental health, that is mental health services and inpatient services, as they are addressed in Central Office and at the Office of Academic Affiliations where policies are set about how resources will be used to support what kinds of training. I've had relationships with both of those systems since I've been in VA.
As you may probably know, my husband, Robert Zeiss, took a job at the Office of Academic Affiliations when I went to Central Office, and he became the director for associated health training. He really helped determine policies about, for instance, the importance of interprofessional training in any VA training program and also how resources will be used to fund psychology training. He and I worked very closely because I was trying to have an impact on policies in the system, too. My focus was not training, but rather on what services need to be delivered. But obviously how those services get delivered depends very much on whether people are properly trained and if there is a sufficient pool of people to hire, etc.
So he and I both have worked to understand how the system makes policy and what would it take to really have those policies work out. I've also really tried to learn about system change, theories and research on systems change, as well as specifically who, where and what in VA guides system change. I think I've been very satisfied with that. Again, not anything against those who choose to try to have an impact on policy in more political ways, but there's an incredible path you can follow in really trying to understand your system and teaching yourself how systems work and how you can have the most impact on that system.
Q: What has been your biggest professional challenge to navigate?
A: Let me talk about two things. One has really been the arch of my career in VA, focused on interprofessional care. I started in VA as director of Interdisciplinary team training in geriatrics ; there was a real vision of what is interdisciplinary, which has evolved into interprofessional, and the crucial need for such an approach in order to create more coordinated, holistic care planning with the veterans and their families who will receive that care. I've been trying to do that work since early in VA, initially with older veterans because geriatrics is a fabulous place for interprofessional care and really had a vision earlier than the rest of the system. It has been amazing over my lifetime in VA to see how that has become the basis for PACT as well as many kinds of specialty care and has now become the basis for the transformation of the general mental health outpatient clients in VA. It is really thrilling, but I think the biggest challenge has been being patient. I started in the VA in 1982 in that role, and here we are quite a few years later; if I had had to see immediate results, I would have probably despaired long ago. But I could see the power of the approach in certain teams, I could see the literature starting to accumulate, I could learn more increasingly about when and where those policies would get set. Then, with my move to my role in Central Office, I could become a part of the group that was formulating those policies and making decisions about the resources and how they would be used to support different kinds of care, and I could emphasize interprofessional care.
So a challenge [is] just watching that evolution, and figuring out at each point along my career how I can best use my energies to keep moving this forward to become the standard model of care. Issues have been similar at APA. Recently, there has been great interest in APA in interprofessional care and development and defining competencies for psychologists who work in interprofessional care. There also is thinking, in the revision of the guidelines for accreditation, about whether there is a place to expand expectations for interprofessional training as well. There are lots and lots of challenges, but I would say the main challenge, is finding something you're passionate about and then sticking with it. You need to be willing to handle frustrations, obstacles and slow progress sometimes, and look for the moments when things can really start to shift.
I think the other challenge that everyone in VA is going through right now, and that I experienced constantly in Central Office, is that both Congress and the press leap on transgressions or failures of the VA system while ignoring the incredible array of services — and the fact that VA provides the best, most extensive, most integrated care of any system in the US. So it's a real frustration and challenge to constantly be thinking about how to accept challenges while remaining passionate about VA service. VA is far from perfect, and I'm as angry as anyone about what has come out in the press recently about the wait list falsification. It has to change, but I have enormous respect for Secretary Shinseki, and I think he's doing everything he possibly can, and he doesn't do it just by punishing people (although people will be held responsible who need to be) but by pushing to make VA care better. I think that's in essence the challenge: How do you accept the challenges, not get defensive, work to fix problems when they are identified but not let that distract you from doing proactive things to keep moving the system toward being even stronger in ways that the press and Congress may not ever appreciate or pay attention to. These changes still will make a difference in the lives of veterans.
Q: What would be your advice to aspiring psychologists, or students/trainees, who are interested in careers within the VA?
A: Good choice. I started in academics and that was certainly where everyone expected my career to go, but I have loved the VA career. I certainly have done research and published, but in a context in [which] that could turn into making a difference in people's lives. At certain parts of my career, that was through the direct services that I've done. Later in my career, that has been through system change. I guess my advice is what I said early on: You can do things you love to do in VA.. If what you love is to be a part of a system and figure out how to work in a very collaborative way, interprofessionally, with the other components of the system, then you can develop a career where you move forward in using the skills that you have that best fits with what you want to do. You can do training, you can do research, you can do direct clinical care, you can do administration — there's so much that you can do. Nobody has to do all of it, but there are a lot of options.
Q: What do you think is next for you?
A: I will be on the APA Board of Professional Affairs (BPA) for three years. I just started with them in January, and I am finding that quite exhilarating, I am on the executive board for BPA, so that will be a main focus professionally in the foreseeable future.
I have been doing writing, largely on chapters for various psychology handbooks and encyclopedias that lay out the breadth of what psychologists do in VA, the tremendous way that psychology is involved and the positive impact psychologists have. Also, I just had an article in the American Psychologist with another psychologist, Lisa Kearney and two physicians, on mental health integration into PACT. I am trying to get information out about very positive changes in VA, and I will continue to try to do the best I can, even knowing that there are certain audiences that won't pay attention. At least getting the information out there feels important.
I also am going to spend a whole lot of time with my grandson. The balance of personal and professional life has been a huge theme in my life. My husband retired in September and I retired earlier. We're very much enjoying that, enjoying family along with the other things I mentioned.
Q: Were there any final things you wanted to say?
A: Just that I commend Div. 18 for wanting to offer some leadership models and to get information out there. I will say I've had people approach me seeking to become more active in APA, in particular. The way to develop relationships in APA and to get into positions with broader responsibilities and areas of oversight is to get involved in a division, take on a task that the division wants to have done, do a good job with it and look for the next opportunity. I commend you for stepping up and doing some interviews. It really puts you on a path where you can make decisions about next opportunities. You'll know more and more about the organizations as you do that. It was a pleasure to talk with you and I'm glad to see you involved and thinking about VA.