Psychotherapy Articles

Psychotherapy Articles

“WHEN THE NIGHT HAS COME.  AND THE LAND IS DARK”

Enhancing Psychology’s Public Policy/ Political Presence

Reflecting upon the APA/APA Services’ Grassroots Fly-In, Katherine McGuire, APA’s Chief Advocacy Officer, noted: “We were thrilled to host 70 psychologists representing over 40 states during our June Fly-In, Advancing Health Equity Across the Lifespan in Washington, D.C.  Participants included Federal Advocacy Coordinators (FACs) and Directors of Professional Affairs (DPAs) from State, Provincial and Territorial Associations (SPTAs); Federal Education Coordinators Advocacy (FEDACs); leadership and members of the APA Board of Directors; and members of the Advocacy Coordinating Committee (ACC).

“Participants led over 175 meetings on Capitol Hill to advocate for policies to strengthen access to Medicare mental and behavioral health services, including telehealth services and services furnished via integrated care models.  They advocated for three key pieces of legislation: 1). The Telemental Health Care Access Act (H.R. 3432/ S. 3651) which would repeal a Medicare requirement that patients must be seen in-person for continued coverage of their telehealth services.  2). The Increasing Mental Health Options (IMHO) Act (H.R. 8458/ S. 669) which would increase Medicare beneficiaries’ access to mental health care by removing outdated Medicare requirements for physician oversight and referral for services provided by psychologists; and, 3). The COMPLETE Care Act (H.R. 5819/ S. 1378) which would increase access to mental and behavioral health services by adopting a ‘model-neutral’ approach to assisting practitioners with adoption of integrated care.

“We are proud of these members for their work elevating APA priorities and the needs of their profession and communities, especially since this was the first time advocating for some of these participants.  We are grateful for the time they took to share insights and anecdotes from their experiences as clinicians, educators, researchers, and especially students – the future of the profession.”

Earlier in the year with similar success, the 2024 PSLC conference brought together over 300 colleagues under the leadership of APA President Cynthia de las Fuentes and enthusiastic APA staff including soon retiring Dan Abrahamson.  Jared Skillings, APA Chief of Professional Practice and a second-generation psychologist: “PSLC started as a grassroots effort for state leaders to connect to learn from each other and to develop national approaches for profession-wide issues.  We are here to honor that legacy.

“On Saturday evening we will hear more about that legacy from Dan Abrahamson, Deputy Chief of Professional Practice.  After owning and managing a successful independent practice and then a nearly 20-year career as senior APA staff, Dan let me know last year of his intention to retire, at the end of this month.  We are so pleased that his wife, Lynn, has joined us.  We will honor Dan at the closing session, where he will offer reflections on his career and the legacy of PSLC and the connections between APA and SPTAs.  [Dan’s moving, heart-felt message: “PLC/SLC has changed the lives and professional trajectories of so many psychologists over 40 years.  There is something infectious about coming together with others who share your passion….  And for many who attend PLC, they never look back.”]

“Today we are a profession awakened to crisis and called to improve the health and mental health of all.  We must ask the hard questions about how to utilize our psychological science, our cultural and contextual expertise, our clinical wisdom to expand our reach.  Our world has changed significantly in recent years.  We are here to face these new challenges head-on!  We must ask ourselves: What can we do?  What should we do? to meet the needs of people in our changed and changing world?  How are we strategically positioning psychology and psychologists for the future?

“Consumers have increasingly more options for healthcare, including digital.  High-touch in-person care is no longer the only option.  Psychotherapy isn’t the typical entry point to access care for a person in mental distress; within the health system it is primary care or the emergency department.  In the community, it is the school, barber/hairdresser, bartender, or a spiritual leader.  Population and value-based care holds the promise of cost savings, operating efficiencies, and improved care quality and safety.  To make this happen, it requires leadership commitment and ongoing culture change; and, having actionable, clear data and meaningful partnerships and infrastructure to support these models.  I am very pleased with the vision of APA’s Council of Representatives to pass our profession’s first population health policy in 2022.  We are working to make structural changes, and thus the transition to a population approach will be easier.”  As always, this year’s PSLC remains the highlight of my professional year.

Our Ever-Changing Health Care Environment

As Jared consistently notes, the advances occurring within the technological fields has resulted in unprecedented change and accompanying different societal expectations within all aspects of health care, including behavioral and mental health care.  From a public policy perspective, this is evident clinically, educationally, and scientifically; thereby requiring significant structural changes which can be quite unsettling for many with the anticipated unpredictable consequences.  For example, Jin Lee, President of the Colorado Psychological Association, recently reported that her legislature has expressed renewed interest in enhancing the availability of telehealth care which is especially critical throughout rural America.  Hopefully, this will allow providers who are outside of the state to practice to the fullest extent of their home licensure (including RxP).   Over a year ago, Brad Potts alerted us to the substantial interest within the leadership of one of Ohio’s medical schools in developing a cadre of mental health physician assistants (PAs) which were initially conceptualized as possessing somewhat restrictive diagnostic and prescriptive authority, while their license to practice would be limited to the “Buckeye State.”  At that time, the proposed authorization legislation was not expected to become law.  However, times are “a’ changing” and it now appears that Brad’s legislature may act favorably on this proposal.

Further, as Jared has also postulated, our evolving health care environment has placed a greater priority than ever before on team-based, integrated interdisciplinary care.  To be successful, this evolution requires developing an appreciation for the skills, expectations, and culture of the various other professional disciplines.  Under the leadership of President Steven Curtis Division 55 (the Society for Prescribing Psychology) recently bestowed Honorary Fellowship to three military physicians, one of whom was a psychiatrist, who were absolutely instrumental in the shaping and implementation of the DOD psychopharmacology program in its earliest stages.  In so doing, the Division has formally recognized the invaluable contributions of another discipline to psychology.

Steve Ragusea: “These visionaries understood that defending physician turf was not consistent with the traditional Hippocratic Oath.  They chose to stand in defense of patients rather than their wallets.  The Hippocratic Oath requires that physicians not practice malfeasance, intentionally wrongful behavior that harms patients.  They are required to adhere to the idea of beneficence which is the principle that a physician is obligated to act only to benefit the patient and to remove conditions that cause harm to any patient.  It is clear that medicine has not trained enough psychiatrists to meet society’s needs for many decades now, and there has been no indication that this shortage will end anytime soon.  In addition, psychologists are demonstrably the best trained mental health providers in the nation who, with the addition of a post-doctoral master’s degree in psychopharmacology, are clearly qualified to prescribe psychotropic medications.  These three courageous physicians recognized that patients seeking care would get more care, better care, sooner if psychologists were permitted to prescribe a limited range of medications.  Their combined faith in psychology was proven accurate because psychologists have now been prescribing safely and effectively for over a quarter of a century!”

Licensure Mobility

When I served as APA President in 2000, we considered the issue of licensure mobility for practitioners; however, it was clear that the time had not yet arrived.  Today, the health care environment and societal expectations have dramatically changed.  Advances in technology and our personal experiences during the recent pandemic have generated a new wave of change.  The underlying public policy issue has resurfaced: Why should practitioners be required to take several state-based licensing examinations in order to provide care to their patients?  Is it that some state psychological association leaders possess a belief that their standards are higher than other jurisdictions’ standards or a sense of disgruntlement that not all of the licensed psychologists in their jurisdiction would qualify and so could not join PSYPACT (due to those jurisdictions having equivalency in education requirements when PSYPACT requires APA-accreditation)?  Patients and practitioners do travel and expect that the advances in communications technology will allow them access to whatever services (health, shopping, or otherwise) they might require.  Is change really that difficult to us to accept?

Currently there are 42 jurisdictions which have adopted the APA endorsed PSYPACT Commission legislation.  This provides their psychologists with Licensure Mobility by authorizing interjurisdictional practice from their home state into the receiving state (where the patient is located) and further authorizes psychologists to temporarily provide face-to-face psychological services in the distant PSYPACT state.  However, there are still 13 jurisdictions in which  practitioners and potential patients do not possess this flexibility; 10 of which have never even introduced the necessary legislation (the Sleepy Ten).

Reasonable colleagues can disagree, especially if looking from the ground level rather than a higher level policy perspective.  Long time colleague Jeff Younggren: “We need interjurisdictional practice.  However, PSYPACT was a great concept that has suffered severely in application.  First, those who practice interjurisdictionally agree that they will understand and operate consistent with the requirements of the licensing laws in the distal state.  My experience so far is the most providers do not know that and do not even review the regulations of distal PSYPACT jurisdictions.  Second, the PSYPACT Commission decided to limit membership to psychologists who graduated from APA approved programs and internships when there is no evidence that those who graduate in other programs are more at risk in any way.  Third, the home boards of psychology are in the position of disciplining their regulated psychologists for violations of acts that are not part of their regulation.  This, frankly, is very unlikely and clearly creates potential appellate issues.  And fourth, when a complaint is made in a receiving state, the home state licensing board is required to apply receiving state law and regulations.  This will be a challenge, especially when state laws vary significantly.  Where does this take us?  A solution would be to just let duly licensed practitioners practice in a distant jurisdiction for up to 30 days and if they need more than that, they need to get a license.  This design has worked just fine in states like California.”  “Stand by me, stand by me” (Stand by Me, Ben E. King).  Aloha,

Pat DeLeon, former APA President – Division 29 – July, 2024

Be the 1st to vote.

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

DeLeon, P. (2024, July). “WHEN THE NIGHT HAS COME.  AND THE LAND IS DARK”. Psychotherapy Bulletin,

References

0 Comments

Submit a Comment

Your email address will not be published. Required fields are marked *