Health care reform: Congress should ensure that psychologists' services are key in primary care initiatives

by Government Relations Staff
Februray 2009

In health care reform legislation Congress should fully integrate psychologists and their services in initiatives that strengthen the role of primary care in the health system. The APA applauds President Obama's and Congress's intent to strengthen the role of comprehensive primary and integrated care and chronic care management in the health care system. Psychologists provide vital mental and behavioral health services as part of primary and chronic care management today, and Congress should recognize their services in reforming the system.

In addition, Congress should ensure that:

  • Any primary care model that it adopts will provide for full collaboration among physician and nonphysician providers, where providers autonomously deliver services within the full scope of their licensure and without unnecessary physician supervision.

  • Careful consideration is paid to the role of psychologists and non-physician providers in the medical home model, which should be more appropriately named the "health home model."

  • Community health teams — which would include psychologists — should be encouraged, particularly in rural/underserved areas where the medical home model may not be viable.

  • Payment and other incentives to promote provider primary care collaboration and accountability should be available to all providers, not just physicians.

The Veterans Health Administration has undertaken a national initiative that Congress may consider as a model. The VA integrates primary care and mental health services by having both mental health and primary care providers physically present in the primary care setting with shared responsibility for evaluation, treatment, planning, and monitoring of outcomes.

Psychologists are in primary and integrated care settings now. Psychologists work in primary care settings with physicians and other health care professionals, often serving as members of multidisciplinary treatment teams and taking a lead when a patient has a primary mental health or substance abuse diagnosis. These settings include a variety of facilities, such as hospitals, health maintenance organizations and community agencies, but psychologists also provide services in their private practices as part of community networks.

As team members, psychologists provide patient-centered mental and behavioral health services, such as prevention, diagnosis, evaluation, assessment, treatment and management services. Typically, psychologists design, implement and evaluate behavioral interventions to address the patient's treatment compliance in the management of acute and chronic health conditions such as diabetes, heart disease, obesity, cancer and depression.

For example, in providing primary care services as part of a team to older adults, psychologists:

  • Conduct cognitive, capacity, diagnostic and personality assessments that differentiate normal aging from pathology, side effects of medications, adjustment reactions or combinations of these problems.

  • Offer behavioral health assessment and treatment that provide older adults with the skills necessary to effectively manage their chronic conditions.

  • Diagnose and treat mental and behavioral health problems (e.g., depression or suicide risk).

  • Offer consultation and recommendations to family members, significant others, and other health care providers.

  • Contribute research expertise to the design, implementation, and evaluation of team care and patient outcomes.

  • Develop interventions that are responsive to specific individual and community characteristics that may impact the treatment plan.

As primary care providers, psychologists are vital in treating and preventing a range of health and mental health concerns in children, teens and adults:

Chronic illnesses. These are among the most prevalent, costly and preventable of all health problems. Of the 10 leading causes of death identified in 2001, seven (heart disease, cancer, stroke, chronic respiratory disease, diabetes, suicide and accidents) have significant behavioral components that psychologists have the expertise to address. Psychologist services can improve the patient's quality of life, promote healthy behavior, and lower the overall healthcare costs.

Depression. In a given year, 18.8 million American adults (9.5 percent of the adult population) will suffer a depressive disorder. The cost of depression to our society is staggering. Depression is highly treatable with effective therapeutic interventions routinely provided by psychologists.

Diabetes. Patients with both diabetes and depression are more likely to experience diabetes complications than those without depression. In addition to addressing their emotional needs, psychologists use psychotherapy and behavioral health interventions to help diabetic patients better manage their diet, level of exercise and medication regimens.

Cardiovascular disease. Including psychological interventions in the treatment of cardiovascular disease produces both economic and health benefits. In a groundbreaking study conducted jointly by researchers at the Duke University Medical Center and APA, patients who were taught to manage their stress in addition to usual medical care had fewer adverse cardiac events and cost less to treat over a sustained period of time.

Cancer. Psychologists serve on multidisciplinary teams that treat cancer patients, working directly with patients and their families to personalize decisions, manage symptoms and treatment side-effects, improve communications, provide support and enhance recovery.

Mental health services are key primary care services, especially in rural and underserved areas. The President's New Freedom Commission on Mental Health cited primary care as an area where patients need to receive more effective mental health assessment and treatment. Physicians, particularly in rural and underserved areas are carrying the burden:

  • Research shows that 24 percent of patients who present themselves to primary care physicians suffer from a well-defined mental disorder, and 69 percent of these patients present to physicians with physical symptoms and many of their mental health needs remain undetected.

  • Of individuals who die by suicide, approximately 90 percent had a mental disorder, and 40 percent of these individuals had visited their primary care doctor within the month before their suicide.

Primary care physicians increasingly rely on the vital and unique mental and behavioral health services that psychologists provide to patients in primary care. No other provider is so highly trained to work with primary care physicians in addressing these needs of patients.