By Patrick H. DeLeon, PhD
Finding our way
Former APA President Nick Cummings frequently called for organized psychology to develop “homes of their own” where they would be administratively and clinically responsible for providing quality, integrated behavioral healthcare. Finding psychology generally unresponsive at that time, Nick ultimately established the managed care behavioral health organization Biodyne, which covered 37 million Americans, with 10,000 employees in all 50 states and the District of Columbia. Those with an historical perspective will appreciate that Nick’s vision was shared by David Rogers at the Cleveland Clinic, whom the Ohio Psychological Association honored in 2000 with their Lifetime Achievement Award. Similarly, over the years, Dennis Freeman has also taken this message to heart, administering cutting-edge behavioral healthcare at Cherokee Health Systems in Tennessee. Those fortunate to attend our exciting 125th annual convention earlier this year, under the leadership of President Tony Puente, were exposed to a wide range of programmatic initiatives demonstrating that psychology has finally come to appreciate Nick’s wisdom in conceptualizing psychology as one of the bona fide health professions and the importance of providing proactive leadership.
In 2005, psychologist Barbara Van Dahlen founded Give an Hour, which provides free mental health care to those who serve in the military, our veterans and their families. Collectively, generous volunteer mental health professionals of all disciplines have donated over 124,000 hours of free care and support, valued at nearly $23 million. Barbara appreciates that those whom the VA ultimately serve come from the military. Accordingly, she has been extremely supportive of including students and faculty from the Uniformed Services University (USU) in her programmatic efforts, and personally participating in USU seminars. This fall, she extended invitations to attend “The Department of Veterans Affairs’ Role in Changing the Culture of Mental Health,” her special SiriusXM radio broadcast with VA Secretary David Shulkin in recognition of National Suicide Prevention Month.
During their fascinating one-hour discussion, the secretary covered a number of topics that are highly relevant to public service colleagues. On a personal level, several members of his immediate family possess psychology and pharmacy backgrounds, thus enhancing his appreciation for how important interdisciplinary, integrated care can be. He reiterated his commitment to providing timely access to behavioral health care, including his support for utilizing telemental health services. Both of these efforts are also high priorities for the current U.S. Army Surgeon General Nadja West. Having recently watched the moving film documentary “Served Like a Girl,” which highlighted the plight of an estimated 50,000 female veterans with children who experience minimum support from the VA, we were particularly pleased with the secretary’s commitment to serving this unique population in response to Barbara’s question about female veterans. He was also quite candid about the need to appreciate how a mental health crisis can adversely impact one’s discharge status and that necessary behavioral healthcare must be provided.
“I appreciated Secretary Shulkin’s sincerity, and his background as an internal medicine physician was evident in how he prioritized his objectives for the VA. He recognizes that some crises require immediate attention to mitigate further deterioration — just like in his former patients. He shared one statistic that was particularly shocking. From 2001 to 2014, the suicide rate among female veterans who were not being treated by the VA went up 85 percent. Conversely, the suicide rate among female veterans who were being treated by the VA went down 2 percent. It follows that access to care is a major roadblock that must be addressed immediately. He further recognizes that all of our veterans need timely, effective and compassionate care — this is a priority. One innovative solution may be auto-enrollment, whereby if a veteran doesn’t choose an alternative healthcare plan, he or she will be auto-enrolled in the VA system. Then, if a health crisis arises, the veteran doesn’t have to worry about the administrative delay of getting enrolled. Likewise, he enacted VA coverage for emergency mental health services for all Veterans (not just those with honorable discharges) as of July 1, 2017. This is a critical step in decreasing the suicide rate among veterans, especially those who were dishonorably discharged due to a behavior that stemmed from unresolved mental health conditions. I believe Secretary Shulkin is steering the VA down the right path — towards timely, effective care and wellness for all Veterans.”
USAF Capt. Michelle Binder, USU Doctor of Nursing Practice (DNP) student
APA’s new director of military and veterans health policy, Heather O’Beirne Kelly, was delighted to sit in the studio audience for Barbara’s Sirius XM conversation with Secretary Shulkin.
“Barbara’s interview was wonderful, and has the power to reach so many veterans and mental health providers through Sirius XM. APA shares the secretary’s priority for decreasing the troubling rates of suicide among veterans, and subgroups of veterans like older cohorts, women and those with other than honorable discharges. We applaud his moves to open up emergent care to veterans with so-called "bad paper," and to focus on getting evidence-based treatments to veterans far upstream, before they’re in crisis, while also strengthening the VA’s capacity to effectively reach and work with veterans in crisis through the crisis line, same-day service in VA medical centers, and integrated primary care. We are proud of APA’s collaboration with Barbara and Give an Hour, and our advocacy to garner congressional support for a strong, well-resourced VA.
That same evening, Give an Hour and their Campaign to Change Direction hosted a packed movie screening of the new film, "Rebel in the Rye," about the life of J.D. Salinger, the author of "Catcher in the Rye." The film particularly highlighted Salinger’s post-traumatic stress reactions from fighting in World War II and surviving the D-Day invasion. After returning from the war and following his remarkable success at a writer, Salinger was portrayed as struggling with trusting others, leading him to isolate himself from the world. This isolation, combined with his fixation on healing himself through various religious and meditative practices, negatively impacted his relationship with his family and friends.
"'Rebel in the Rye' strives to contribute to increasing public awareness of how war affects the mental health of veterans. Public awareness of post-traumatic stress disorder is particularly important as we see the effects of war on an influx of veterans from the wars in Iraq and Afghanistan, while continuing to care for Vietnam veterans.”
Joanna Sells, USU Medical and Clinical Psychology graduate student
Give an Hour’s successful model is being expanded to address the mental health concerns of other populations who are also clearly in need — including at risk teens, at risk seniors, survivors of gun violence, and victims of human trafficking. They have opened their network in response to the trauma in Charlottesville and most recently are partnering with the Red Cross to respond to the unprecedented devastation due to Hurricanes Harvey and Irma.
Labor, Health and Human Services, and Education FY 2018 Appropriations Bill
The U.S. Senate Appropriations Committee recommended the U.S. Department of Health and Human Services continue to provide support for the Graduate Psychology Education Program (GPE). “The Committee recognizes the growing need for highly trained behavioral health professionals to deliver evidence-based services to vulnerable populations, including the elderly, returning military veterans and those suffering from trauma. The GPE program is the main Federal initiative dedicated to the education and training of psychologists. The committee urges the Health Resources & Services Administration to explore evidence-based approaches to leverage workforce capacity through this program, to invest in geropsychology training programs, and to help integrate health service psychology trainees at Federally Qualified Health Centers.” Our special thanks to former Interim APA CEO Cynthia Belar, who, in her earlier capacity as director of the education directorate, made the GPE initiative a high personal priority.
Public service colleagues work in a fascinating variety of positions. Under the leadership of editors Femina Varghese and Gary VandenBos, the division’s journal will be highlighting several of these during the coming months. We expect, for example, to hear from those serving on a U.S. Navy aircraft carrier and/or submarine, responding to the extraordinary trauma resulting from national disasters, and the unique opportunities evolving from the APA Congressional and Administration Fellowship program. “We celebrate the past to awaken the future.”
Cummings, N.A., & VandenBos, G.R. (1979). The general practice of psychology. Professional Psychology, 10(4), 430-440.