In This Issue

Community and state hospital section

Members surveyed agree that working in the public sector is a rewarding yet challenging mission

By Jon Marrelli, PsyD

As acting chair of the Community and State Hospitals section I have an interest in learning about our membership and understanding how to enhance our section to serve our members better. As an Early Career Psychologist (ECP), I have a more personally vested interest in learning about the concerns, satisfaction and the challenges facing psychologists in the public sector as I begin to embark upon my own career. In developing my understanding of psychologists in the public sector, I have tried to learn about what my colleagues enjoy or dislike about their work, and what trajectory they feel their profession is heading. I was particularly interested in how one thinks about their identity as psychologists as we begin to enter a new era of health care — one that continues to evolve but which will seem to require additional skills as well as adaptation to new concerns and new demands.

Survey of psychologists in public sector hospitals 

You may recall that in April/May, I sent out a brief, anonymous survey to our membership to start to investigate some of these issues. Although I had many questions that I would have liked to ask members in that initial survey, I limited myself to 20 questions (plus one optional question). The survey sought to give me a general overview of a) the age of our members, b) primary work functions, c) what members liked best/least about their work, d) members opinions of why the public sector psychology workforce has been diminishing, and e) the most important tools public sector psychologists should possess. The remainder of this column will focus on the results of this survey.

Although fewer than expected responded to the survey, the answers were very instructive and, I think, can be extrapolated to give a sense of the current mindset of psychologists in public sector hospitals.

The majority of respondents were greater than 50 years old, worked full time, identified primarily as administrators or consultants (and secondarily as practitioners). A robust 93 percent of the sample found their work meaningful, while 84 percent reported that they were moderately or extremely satisfied with their job. Additionally, 100 percent of the respondents would recommend working in the public sector to incoming psychologists. This seems to indicate that, of those section members that responded, the majority are late career psychologists who are satisfied with their work, find the work very personally meaningful and would very much recommend public sector hospital work to new psychologists entering the field.

In response to what aspects of the job were liked least, the high volume of patients, lack of time to manage job responsibilities, lack of resources, poor pay, and bureaucratic politics and inefficiency, were among the top responses.

Probing the data more deeply

A portion of the survey asked more in-depth questions which required a narrative response such as "What are the most important tools, skills, treatments that you feel public sector psychologists should possess?", "What do you think is the most pressing professional concern for members of this section?," " What do you like least about your job?" and "What do you think is the Number 1 thing psychology can do to ensure it's livelihood in the future?" Here members were able to give more personal and detailed answers.

Far and away, the majority of respondents felt that psychologists in the public sector should be skilled in evidence based practices, especially for those with serious mental illness (SMI). Aside from this, other frequent responses included having a strong research background, consultation skills, managerial skills and strong diagnostic/assessment skills. Besides possessing these skills, other members commented on the importance of being able to work well with others in multidisciplinary settings, becoming better at mental health advocacy and having a strong sense of self and self-confidence.

In discussing the diminishing workforce of psychologists in the public sector, members primarily attributed this to the rise of other mental health professionals who are able to perform the same work but for less pay, tremendous federal and state pressures to contain costs, lack of recognition by MD's, lack of being perceived as 'critical' by administrators, and not being focused on learning treatments with a strong evidence base.

The survey concluded with an opportunity for members to discuss the 'Number 1 thing that psychology can do to ensure its livelihood in the future.' Here, members again gave detailed responses. Chief among them is that, for psychology to thrive in the future, psychologists must embrace the integrated healthcare model and promote ourselves as providing an essential component of health, become better at marketing ourselves and our unique contributions to the field of mental health, improve our advocacy skills, focus more on assessment skills and do more for early career psychologists (e.g., the internship imbalance, prohibitive costs of attending school, improved loan repayment options).

Summary

Although fewer members responded to this survey than I had expected, the survey was helpful in understanding the current thinking among our membership, especially for new and early career psychologists who are just entering the field and have an interest in public sector mental health. The central theme across many of the responses was that working in the public sector is a rewarding yet challenging mission. For many members, it seems that serving to help those with more serious mental illness is very rewarding and personally meaningful. However, the sense seems to be that there are threats to psychologists in these settings that must be addressed. How to address these continues to be debated and should be debated. However, there is a strong sense from senior psychologists on the front-lines that we must embrace the changing winds of healthcare and position ourselves as central figures in the provision of integrated behavioral healthcare, that we must educate ourselves in more empirically sound treatments, that it is essential to develop managerial skills, and that we must dedicate/organize ourselves towards more professional advocacy. My hope is that our schools will increasingly come to teach the skills identified here, either within doctoral programs or through post-doctoral certification courses, such as in various evidence based practices as well as in mental health leadership and administration. And that those who are more senior in the field will help mentor and teach these skills to those entering who share similar interests.

I am working on developing another survey dealing with leadership and your thoughts on health-care reform. But if you missed this original survey the first time around, the anonymous survey will be re-activated throughout the month of October.

I look forward to hearing from you, and urge you to share any comments, information or debate relevant to our section on our listserve. The email list is a wonderful place to engage our community and it can be a lively forum for discussion in you participate. Subscribe to the DIV18HOSPITAL-COMMUNITY list. Since there were so many thought provoking responses in the survey, I am hoping that we can continue the discussion there.

Thank you for your time and I look forward to hearing from you and seeing additional commentary on our community email list.