Psychotherapy Bulletin

Psychotherapy Bulletin

“We’ve Been Standing on Your Shoulders, Pete, for Oh, So Many Years… There’s a Banjo Ringing Somewhere and a Yodel in the Air”

“Blue Sky” Thinking – Emerging Trends, Priorities, and Opportunities: The National Academy of Medicine (NAM) released its Special Publication Priorities on the Health Horizon: Informing PCORI’s Strategic Plan in 2021. The Patient-Centered Outcomes Research Institute (PCORI) was established as a component of President Obama’s Patient Protection and Affordable Care Act with the mission of identifying national priorities for health care research, taking into account factors of disease, gaps in evidence, practice variations, health disparities, and the potential for new evidence.

Four cross-cutting themes surfaced that were deemed especially important over the next decade. Foremost was the imperative for strategies that will advance health equity and dismantle the structural racism that contributes so greatly to health inequities. Untangling how clinical factors and social determinants of health work alone or in combination to reduce or exacerbate inequities was viewed as an essential area. A second theme was the apparent value disconnect – that is, the gap between perceptions of value in the economic sense and values in the moral, cultural, or personal sense. The disconnect between the current structure, financing, and organization of health care, and what patients, families, and communities need and value is increasingly acknowledged as a key driver to this disconnect. Timely access to responsive, affordable, high-quality, person-centered health care is essential, yet the experience for many is a health system that is fragmented, uncoordinated, expensive, inequitable, and of uneven quality.

The third theme related to the need for an agile learning health system – one in which the alignment of evidence, informatics, incentives, and culture naturally improves and accelerates advances in health system effectiveness, efficiency, equity, and continuous learning. The final theme related to the need for a better understanding of the heterogeneous impacts of emerging technologies on patients, families, and communities. The impact of technology (telehealth, virtual care, remote patient monitoring, and the integration of devices/wearables to support prevention, diagnosis, treatment, and rehabilitation, etc.) during the COVID pandemic was clearly noted.

The participants expressed their awareness that health is influenced by numerous biological, behavioral, social, cultural, environmental, geographic, economic, health system, and public policy factors, most of which are interdependent at some level. Mental health and psychology were only tangentially mentioned. And yet, Barbara Van Dahlen and her husband Randy Phelps have now built a tech company (WeBeLife.com) and launched a free App to improve emotional health and well-being. WeBe is the first App that teaches users how to rate and track 6 key elements that affect well-being – to help them better care for themselves and their loved ones. WeBe provides a simple mechanism that allows users to share daily ratings with those they trust – to ensure that we all take better care of each other.

It was clearly noted that the United States spends twice as much per capita on medical services as any other developed nation – and 50% more than the second highest spending nation. Nevertheless, its health performance ranks below the top 24 among the community of all nations. This is broadly attributed to financial incentives and system fragmentation that promote volume over value, resulting in unneeded services, inefficient care delivery, high prices, administrative waste, and missed prevention opportunities. “In every discussion of the meeting series, anchoring focus and design on patients, families, and communities was emphasized as fundamental to reorienting the business of health care.”

The National Alliance on Mental Health (NAMI):

Beth Rom-Rymer – “NAMI, the nation’s largest grassroots mental health organization, serves families who are living with a serious mental illness. It was started by families talking together at home, around a kitchen table, in 1979 and has grown into a national network of 600 affiliates. The healthcare profession with whom NAMI has been most closely associated has been psychiatry. Because of that close association, psychologists have often been sidelined. As the President of the Illinois Psychological Association, 2011-2012, I worked very hard, as had many of my IPA predecessors, to create a collaborative relationship with NAMI. It had seemed to be a system that was closed to us psychologists. Then a breakthrough. On October 22, 2012, the Illinois Psychological Association, for the first time, was given an opportunity to present a panel at the State NAMI Convention. The focus of our panel was psychologists’ Prescriptive Authority. Two Illinois psychologists, who were prescribers in other states– a Latina psychologist, who was the Director of Behavioral Health at a Chicago FQHC and in training to become an Illinois prescribing psychologist and a pro-RxP psychiatrist– spoke on the panel, and I chaired. The audience was wildly enthusiastic and various audience members were standing on their seats, as they cheered the possibility of prescribing psychologists’ providing much needed care to NAMI families.

“National NAMI was not as enthusiastic. The institutional history of antipathy toward psychologists had not dissipated and psychiatry’s aversion to psychologists’ Prescriptive Authority had not diminished. Despite the chilly institutional response, however, I was determined to cultivate relationships with state chapter Directors as well as with the State Executive Director. I told the Executive Director that when our bill passed and was signed by the Governor into law, I would call her immediately and sit down with her to talk about how prescribing psychologists could begin to provide services to NAMI families.

“Governor Pat Quinn signed our Prescriptive Authority bill into law on June 25, 2014. I called Lora, the Executive Director, on June 26th. Ever since, I have been working steadfastly with Illinois NAMI to support and fundraise and facilitate access to Illinois prescribing psychologists. And, now, in October 2022, 10 years since that first panel presentation, I have been elected to the Illinois NAMI State Board! How thrilling! I am so excited to serve with my NAMI State colleagues in providing resources to all Illinois families who are looking for comprehensive, integrative mental health treatment.”

APA’s Visionary Icons

A decade and a half ago, at the 2007 State Leadership Conference, Positioning for Change: Expanding Psychology’s Roles, Influence and Value, Russ Newman, Executive Director of the APA Practice Organization, presented an inspirational future for psychology that is highly relevant today. Russ: “Welcome to the ‘new’ Washington, where the Democrats have taken control of Congress for the first time in twelve years, a woman has been elected Speaker of the House for the first time in the history of the United States’ Congress and health care reform is back in the news and back on the agenda. Change does, indeed, appear to be in the air.

“We have underscored the central and unique role psychology can play at the intersection of psychological and physical health, sometimes referred to as ‘mind-body health.’ We highlighted our belief that integrating mind and body, behavior and health, and the psychological and the physical, all hold a credible promise of helping to achieve the long sought-after goal of improved health with controlled, if not lowered, costs. We emphasized that health promotion and the prevention of illness are critical to healing an ailing health care system all too preoccupied with simply responding to symptoms or chasing after diseases. We concluded that in the absence of any comprehensive health reform plan for the country, a focus on health promotion, prevention, lifestyle and behavior may be just what the doctor ordered. There is now growing evidence that this tipping point may have occurred, or at least be close by.”

Before the nearly 700 attendees, Russ opined: “Simultaneous to this transformation in health that is just beginning is a transformation in technology that is well underway. The two will eventually intersect as an efficient health system built around an informed consumer will require accessibility, easily shared, secure health information, as well as transparency of information when it comes to cost and quality. Towards this end, our profession will need to continue to work diligently to assure that privacy is protected, and that evidence-based practice, outcomes measurers and pay-for-performance programs are not hijacked in the service of economic interests and profit motives.

“I also believe there will be an important role for psychologists within the massive information technology transformation underway. Irrespective of your view of the benefits and liabilities of technology, its role in transforming the way we live is inescapable. We are now challenged to step up our role as experts in behavior to help guide this technology-driven shift. The point is, important shifts are occurring – in health care, in technology and in our culture. It is incumbent upon us as psychologists to use our research, our knowledge base and our technologies in the service of those shifts. Our expertise in behavior– both for solving problems and enhancing performance– makes our profession well suited to help manage these changes around us. We must continue to be curious and creative, walking around keeping our eyes and minds open, looking for good solutions to our profession’s problems, and looking for solutions to society’s most pressing problems. We must continue to build our relationships with communities beyond our walls.”

Mike Sullivan: Reflections on Volunteering for Meals on Wheels:

“This summer marked my 14th year as a volunteer for Meals on Wheels. I began this rewarding part-time job after fully retiring from my first ‘retirement’ job as a licensed community association manager in the Tampa/St. Petersburg area. That had followed my retirement from 13 years of state advocacy work in psychology at APA, and 12 years of clinical work prior. My retirement employment adventures are more fully described in a chapter in Retirement Experiences of Psychologists, a wonderful compendium edited by Rod Baker and Pat DeLeon (Cambridge Scholars Publishing, 2021).

“After my wife and I moved to Columbia, SC, delivering meals to homebound seniors became the organizing part of my weekly schedule. It has been a source of great meaning and service in my life. So many older Americans are isolated and lonely, and subject to food insecurity. Volunteers for local Meals on Wheels programs provide healthy food, social contact, and a watchful eye. It is a great way to give back.

“My deliveries of hot meals take only an hour or two a day at lunchtime yet always leave me believing I am doing something helpful and constructive. In my experience, aging tends to bring heightened attention to eternal questions like the meaning of life. Feeling a sense of purpose in life has been priceless compensation for my small investment of time volunteering.

“This year marks the 50th anniversary of President Richard Nixon’s signing the Older Americans Act Nutrition Program that supported the rapid growth of the nationwide nutrition programs known as Means on Wheels. These programs have been a hugely successful public/private partnership, relying as they do on government and private funding as well as thousands of individual volunteers. I heartily recommend them as a way of giving back.” 

“You can see the world, Pete, no matter where you are.” -Pete’s Shoulders (The Power of Song), by Tom Paxton, Cathy Fink & Marcy Marxer

Aloha,

Pat DeLeon, former APA President – Division 29 – October, 2022

Pat DeLeon is the Distinguished Professor at the Uniformed Services University of the Health Sciences (DoD) in the School of Nursing and School of Medicine. He was elected to the Institute of Medicine of the National Academies of Science in 2008 and served as President of the American Psychological Association (APA) in 2000. For over 38 years he was on the staff of U.S. Senator Daniel K. Inouye (D-Hawaii) retiring as his Chief of Staff. He has received numerous national awards including the Order of Military Medical Merit; Distinguished Service Medal, USUHS; National League for Nursing Council for Nursing Centers, First Public Policy Award; Sigma Theta Tau, Inc., International Honor Society of Nursing, First Public Service Award; Ruth Knee/Milton Wittman Award for Outstanding Achievement in Health/Mental Health Policy, NASW; Delta Omega Honor Society Award for Outstanding Alumnus from a School of Public Health; APA Outstanding Lifetime Contributions to Psychology Award; American Psychological Foundation Gold Medal for Lifetime Achievement in the Practice of Psychology; and Distinguished Alumni Award, University of Hawaii. He has been awarded three honorary degrees. He is currently the editor of Psychological Services. He has over 200 publications.

Cite This Article

Leon, P. (2022). “We’ve Been Standing on Your Shoulders, Pete, for Oh, So Many Years… There’s a Banjo Ringing Somewhere and a Yodel in the Air”. Psychotherapy Bulletin, 57(4),

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