The next wave of change for psychology and mental health services in the health care revolution

Recent national changes in the de facto system of health and mental health care are described. Although the percentage of people without health insurance (always or sometimes) has not decreased, the organization of insured care has changed dramatically. Of the insured population, 75% are under some form of managed care. For 88% of the managed care population, mental health care has not been integrated with health care: the so-called carve-out. The author argues that system integration (carve-ins), for a variety of reasons, will begin soon and will occur very rapidly. A tilt toward carve-ins will have substantial impact on psychologists' training, service delivery, and research.     

Health psychology and uptake of preventive health services: A review of 30 years' research on cervical screening

Abstract

A review of thirty years' research in cervical screening was conducted to assess the role of social and psychological factors in screening utilisation. The role of age, social class, attitudes towards and beliefs about screening as well as social influence and personality variables are considered. A reanalysis of reasons for non-attendance following an invitation for screening from ten previous studies is presented and the importance of theoretical accounts of service utilisation in this area are assessed. Research findings show significant associations for both demographic and psychological factors though poor operationalisations and statistical analyses in previous research make difficult the assessment of their importance as additive, interactive or mediational variables. The significance of service provision issues in terms of both providers' behaviour and the flexibility of delivery is highlighted. The need for further research using a theoretical framework which can unify demographic, psychological and service provision variables is identified.     

Counselling psychology in primary health care: A review

This paper reviews the development of counselling psychology within the field of primary health care. Issues discussed include liaison between counselling psychologists and other professionals, evaluation of treatment in primary care, family therapy in general practice and general practitioners’ skills in counselling. The need for training and evaluation of counselling are discussed and suggestions are made for further research.     

Rural America. Unique opportunities for health care delivery and health services research

A general deterioration is occurring in the quality of life of rural Americans, and it is affecting the quality of health and mental health service delivery. About 24% of the U.S. population lives in nonmetropolitan areas where the citizens are older, less well educated, have lower incomes, and are more homogeneous in terms of race and ethnicity. Medicare and private insurance discriminate against rural services in their reimbursement policies, and there is a shortage of health personnel in rural areas. However, there has been renewed congressional action to meet rural needs. Both the House and Senate have established rural caucuses, and an Office of Rural Health Policy has been established in the federal executive branch. Legislative successes were achieved between 1985 and 1988. Rural initiatives will provide psychology with unique opportunities in the next several years.     

Health psychology and clinical psychology: a comparison through content analysis.

Extension of a previous analysis of articles published in two journals representative of health psychology and two in health education showed some similarities and differences. The present analysis of 100 papers from two journals in health psychology and 495 from two in clinical psychology clearly shows health as a subspecialty of clinical psychology.     

Clinical psychology in medical settings: Psychology's role in health care

The number of clinical psychologists working in medical settings has grown along with the range of services provided by psychologists to patients with a multitude of medical problems across the lifespan. Medical care cost savings brought about by these psychological interventions is highlighted along with issues of public policy and specialization of training. The opportunity for ongoing development of clinical psychology in medical settings is described as unlimited and the mission of the newJournal of Clinical Psychology in Medical Settings is presented as supporting that growth.     

Health psychology. The science and the field

Reviews scientific and professional trends in the field of health psychology. I discuss recent research on health promotion, psychological factors in the development of illness, cognitive representations of health and illness, stress and coping, social support, interventions to promote coping, and trends that will affect progress in the field, such as the need for cost containment and the aging of the population.     

Integrating mind and body: Graduate psychology education in primary behavioral health care

Extensive research supports the biopsychosocial model, but the current health care system generally operates according to a model of mind-body dualism. Integrated primary behavioral health care offers an alternative to this dualism. This paper describes the University of Louisville Graduate Psychology Education (GPE) program, a pre-doctoral integrated primary behavioral health care training program. This program emphasizes four shared psychosocial determinants that have been associated with physical health status: Victimization and potentially traumatic stress exposure, emotional functioning, social relationship functioning, and illness representations. It does so within the broader context of providing care for individuals who are underserved and economically disadvantaged. The initial phase of the program is evaluated and implications for graduate psychology education and patient care are discussed.     

Health incongruence in later life: implications for subsequent well-being and health care.

OBJECTIVE: The premise that pessimistic health appraisals compromise well-being whereas optimistic appraisals are compensatory was examined in a longitudinal study of 232 community-dwelling older adults (ages 79-98 years). DESIGN: Subjective health (SH) appraisals were contrasted with objective health (OH) to identify realists, whose ratings were congruent (SH = OH), distinguishing them from health pessimists (SH < OH) and health optimists (SH > OH), whose ratings were incongruent. Analyses of covariance were used to examine group differences 2 years later on well-being and health care. MAIN OUTCOME MEASURES: Outcome measures were psychological well-being (life satisfaction, positive and negative emotions), functional well-being (objective and perceived physical activity, activity restriction), and health care (health care management, hospital admissions, length of hospital stays). RESULTS: Compared with realists, pessimists had significantly poorer outcomes and optimists had better outcomes. Because perceived control (PC) was weaker among pessimists and stronger among optimists, supplemental analysis determined whether PC differences explained these findings. When accounting for PC, many pessimism and optimism effects became nonsignificant, yet effects on functional well-being remained unchanged. CONCLUSION: Findings have implications for older adults at risk of functional decline.     

The institution of the institutional practice of psychology: health care reform and psychology's future workforce

Implications for the future of professional psychology are discussed and related to the Patient Protection and Affordable Care Act, patient-centered health care homes and accountable care organizations, and the growing importance of interprofessional competencies in health care. The need for increased information about the psychology workforce is related to the history of the institutional practice of psychology and how that data must be used to plan for the supply of psychologists required to meet the service demands of the changing health care system. Several challenges to the field of psychology are offered, along with steps that must be taken by the profession to prepare for increased institutionally based health care services in the future. (PsycINFO Database Record (c) 2011 APA, all rights reserved).     

Technological and medical advances: implications for health psychology.

Behavioral telehealth, health informatics, organ and tissue transplantation, and genetics are among the areas that have been affected by advances in technology and medicine. These areas illustrate the opportunities and the challenges that new developments can pose to health psychologists. Each area is discussed with respect to implications for practice, research, public policy, and education and training: recommendations are provided.     

Ethnic minority adolescents and the use of community mental health care services

Examined the utilization rates, treatment dropout rates, and length of treatment for minority adolescents in the mental health care system. Data from the Los Angeles County Department of Mental Health from 1983 to 1988 were used. Ss were 853 African Americans, 704 Asian Americans, 964 Hispanics, and 670 whites. Analyses showed that Asian Americans and Hispanics are underrepresented in existing public mental health facilities while African Americans are overrepresented. For dropout rates, no ethnic differences are found between minority groups and whites; but, for length of treatment, Asian Americans tend to stay longer in treatment while African Americans tend to stay in treatment for a shorter period of time than whites. African Americans also have more outpatient episodes than whites. Implications of the results are discussed, and recommendations for future research are suggested.     

Extending the influence of positive psychology interventions into health care settings: Lessons from self-efficacy and forgiveness

The goal of this article is to explore strategies to extend the influence of positive psychology interventions into environments where strength-promotion is not generally embraced. Particularly, we are interested in examining the potential benefits and barriers to extending positive psychology interventions into health care settings (really illness-treatment settings), such as hospitals, community mental health centers, and disorder-focused psychotherapy practices where psychologists increasingly work. Patients primarily come to these settings to reduce suffering rather than to develop strengths. We argue that positive psychology interventions and concepts may become more valued within such contexts if they can be shown to be cost-effective in improving important health care targets. By examining positive psychology-based interventions that have already become relatively mainstream within health care (e.g., self-efficacy-based interventions), we identify strategies for making promising but less-influential positive psychology interventions (e.g., forgiveness training) more valued in today's health care marketplace. Through these examples, we suggest that extending the influence of positive psychology into health care settings is desirable, but will involve several conceptual, evidentiary, and educational or marketing challenges.     

A role for clinical psychology in health care and policy concerning the physical environment

Some persons adversely react to specific environments, while others are impervious or actually thrive. Medical attention often overlooks such sensitivities to the physical environment. Such sensitivities, including phobias and seasonal affectivity, fall within clinical psychology's purview. A theoretical/clinical approach called the Synchronous Systems Model, which defines and uses individual differences in people and in settings, could serve medical health care and policy. When specific people are matched appropriately with specific treatments within the most propitious settings, cost effectiveness and medical efficacy rise. Such documented accountability could make clinical psychologists central to triage of medical services as well as health care policy in these days of the shrinking health care dollar. The Synchronous Systems Model provides theory, supportive data, and clinical assessment devices to strengthen clinical psychology's role in medical settings.     

Evolution of the biopsychosocial model: prospects and challenges for health psychology.

Although advances have been made in specifying connections between biological, psychological, and social processes, the full potential of the biopsychosocial model for health psychology remains untapped. In this article, 4 areas that need to be addressed to ensure the continued evolution of the biopsychosocial model are identified and a series of recommendations concerning initiatives directed at research, training, practice and intervention, and policy are delineated. These recommendations emphasize the need to better understand and utilize linkages among biological, psychological, social, and macrocultural variables. Activities that facilitate the adoption of a multisystem, multilevel, and multivariate orientation among scientists, practitioners, and policymakers will most effectively lead to the kinds of transdisciplinary contributions envisioned by the biopsychosocial perspective.     

Suicides in users of mental health care services: treatment characteristics and hindsight reflections

The current study aims to describe the patient and treatment characteristics of a sample of 505 suicides by mental health care patients, and to determine how clinicians view the care provided and what they learned. The results indicate that the quality of mental health care for suicidal patients could be improved by focusing on communication among clinicians, continuity of care, suicide risk assessment procedures, and the involvement of relatives.