Introduction to the special section on the future of health psychology.

Following 25 years of landmark progress, health psychology faces even greater change in the foreseeable future. Evolving patterns of health and illness and developments in medicine and related fields will shape the future of health psychology. The articles in this special section discuss these future issues in several areas: the biopsychosocial model, changes in demographics, prevention, clinical health psychology interventions, health care financing, and new technologies. In every case, the future holds a variety of important challenges and opportunities in research, practice, training, and policy.     

Prevention and health promotion: decades of progress, new challenges, and an emerging agenda.

Daily habits (e.g., smoking, diet, and exercise) and their immediate consequences (e.g., obesity) confer risk for most of the major health problems in industrialized nations. Hence, determinants of these behaviors and their modifications have been central topics in health psychology. Considerable scientific and applied progress has been made, but the field faces important challenges and opportunities in the future. These challenges and opportunities include changes in demographics and patterns of health, the need for a more comprehensive model of the domain of health behavior and prevention, the need to integrate behavioral and psychosocial risk and resilience, the incorporation of new technologies, and addressing a variety of professional and economic barriers to the implementation of prevention in health care.     

Report of the Working Group on Clinical Services

Prepared by the Working Group on Clinical Services from the November 1995 Georgetown conference sponsored by the Association of Medical School Psychologists, this paper focuses upon issues related to the effects of health care reform and changes to the health care system on psychologists practicing within academic health care settings. Discussion of the changes in the health care economic system and the call for cost-effectiveness produced five specific suggestions for psychology to establish accountable, data-based models of behavioral health care.     

Advancing Psychology as a Bio-behavioral Science

Concerns for the integrity of psychology as an independent discipline have caused some psychologists to object to introducing any knowledge from the biological sciences into the training of psychologists. However, calls for the greater incorporation of the behavioral sciences in medical education, increased attention to research on the mechanisms of bio-behavioral interaction, and initiatives in translational medical research and clinical care, have prompted increased interest in interdisciplinary research, health care, and teaching. These changes, in turn, are resulting in a re-conceptualization of the structure of academic medicine with increasing emphasis upon multidisciplinary knowledge and interdisciplinary collaboration, and less emphasis upon disciplinary insularity and competitiveness. If clinical health psychology is to play a role in this evolving concept of academic health care, it must adequately prepare its trainees to function in interdisciplinary academic health care settings. This will require not only expertise in the role of behavioral factors relevant to medical disorders, but also some basic familiarity with the biological processes to which those behavioral factors relate. With the evolution of its fund of knowledge, clinical health psychology has the potential to utilize its science to discover, describe, interpret, teach and clinically apply knowledge of the mechanisms of interaction between biological functions and behavioral, learning, cognitive, socio-cultural and environmental processes. By failing to seize this initiative, clinical health psychology risks becoming irrelevant to the evolving model of medical research, education and health care. Presented, in part, to the Association of Psychologists in Academic Health Centers, Minneapolis, MN, May 2007.     

Cuban health psychology: A priority is the primary health care system

Cuban health psychology has experienced a great expansion during the last 25 years, both in the number of psychologists and in range of activities in the field. Today, psychologists are integrated at all levels of the national health system, an achievement which is particularly interesting in that Cuba is a developing country. In a position isolated from trends in international psychology, Cuba has developed a role for psychologists within the field of health which is adapted to its situation as a poor and socialistic country. Priority is given to preventive and community-based psychology within primary health care facilities. Psychologists in primary health care serve a composite client-group, with high priority given to pregnant women and to children. The work of these psychologists covers a wide range of health problems—-physical as well as mental—and focuses upon individuals as bio-psycho-social units. Their responsibilities include health promotion, disease prevention, consultation and treatment, rehabilitation, research and education. This report is based on a 2½ month long field study in Cuba, where Cuban health psychology, particularly as it relates to primary health care, was explored.     

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.     

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).     

Psychological correlates of negative self-assessed health

The recent growth in the area now subsumed under the title health psychology can be seen to reflect real changes in the societal pre-occupation with health promotion. Established models within health psychology have tended to focus on the interface between the individual and the health care system. Moreover, as a consequence of employing the tripartite model of health, illness and sick-role behaviour as separate entities, research has tended to construct barriers between these behaviours. In is necessary to develop psychological models within health psychology rather than use the education model of the medical orthodoxy. This study explored the distinguishing features of a sub-group of women within the sample who were identified as having relatively negative self-assessed health. Data was obtained on their experience of health and illness, their involvement in health-related behaviours (HRB) and their health beliefs. It was shown that this group was more likely to be involved in damaging HRB, but involvement in positive HRB did not differ from the main sample. They tended to anticipate an improvement over time from their present health status which they felt had been influenced by their own behaviour and by their experience of motherhood.     

Hartmann, health, and homosexuality: some clinical aspects of "Ego Psychology and the Problem of Adaptation"

Hartmann's theories have experienced a remarkable rise and fall in popularity over the past fifty years. In this paper, an effort is made to arrive at a balanced view. The genetic and economic aspects of Hartmann's ego psychology are found to be problematic, but the dynamic aspect led to a sophisticated psychoanalytic concept of health as yet unsurpassed. Hartmann always called for the clinical application of his ideas. In this spirit, a vignette is offered from a clinical area in which questions of "health" and "illness" are particularly vexing at present.     

The Future of Psychology in Family Medicine

Psychology has been integral to the field of family medicine since its inception as a medical specialty in the 1960s. Psychologists and other behavioral scientists contribute to family medicine in teaching clinical skills, in defining research questions, in developing research methodology, and in creating integrated physical/mental health care delivery systems. Future developments in the field of psychology in family medicine are likely to emphasize development and evaluation of screening measures which identify mental health problems in primary care, development of early intervention for those mental health problems, and more precise measurement of process and quality of care and health outcomes. Psychologists have an important role to fulfill in educating physicians on alternatives to pharmacologic and medical interventions for common presenting problems in primary care. However, current economic forces shaping the practice of medicine may work against further enhancing the efficacy of the physician in dealing with psychosocial issues. The future role of psychology in family medicine is not yet delineated, and while the move toward parity of reimbursement for mental and physical health care delivery may enhance this collaboration, there is a need to continue to evaluate how the psychological well-being of patients is influenced in the evolution of new models of care delivery.     

Undergraduate psychology students' experiences of volunteering at a chronic mental health facility

A volunteer program for undergraduate psychology students at a chronic mental health facility was evaluated. All 53 volunteers found the program beneficial, 96.2% reported improved understanding of psychopathology, 98.1% noted increased knowledge of the mental health care system, 86.8% reported increased interest in clinical psychology, and 47.2% felt less anxious about working with persons with mental illness as a result of the program.     

How changes in population demographics will impact health psychology: incorporating a broader notion of cultural competence into the field.

U.S. population demographics are undergoing striking changes that will impact health care and the research and practice of health psychology. An increase in the number of people who are older; belong to an ethnic minority group; have disabilities; identify as lesbian, gay, bisexual, or transgendered; or live in poverty will influence definitions of aging, health, and illness, and will challenge current psychological and medical treatment models. The authors argue that health psychologists need to become context competent for the field to be relevant and viable over the course of this new century. Health psychologists need to become aware of the multiple, overlapping contexts in which people live and apply this knowledge on a regular basis to research, practice, education and training, and policy in health psychology.     

The state of the psychology health service provider workforce

Numerous efforts to describe the health service provider or clinical workforce in psychology have been conducted during the past 30 years. The American Psychological Association (APA) has studied trends in the doctoral education pathway and the resultant effects on the broader psychology workforce. During this period, the creation and growth of the PsyD degree and the formalization of the predoctoral internship placement system (the APPIC Match) have been well noted, but efforts to gain a complete understanding of professional practice are lacking. Specifically, piecemeal research on the provider workforce has led to the study of specific subpopulations using varying approaches and definitions of those providing direct clinical service. Consequently, estimates of the supply and need for health service providers are distinctly divergent and generate protracted debate in organized psychology. The APA membership directory and the APA Doctorate Employment Surveys have traditionally been relied on for workforce analyses. Yet, these data have become characterized by limited generalizability in recent years because of declining survey response rates and the fact that APA member data may not be as representative of the entire psychology health service provider population as they were previously. The 2008 APA Survey of Psychology Health Service Providers targeted these limitations by including nonmember psychologists in the sampling frame. Results revealed emerging themes in the demographics, work settings, and delivery of health services of the psychology health service provider workforce. Future areas of research for APA and organized psychology to undertake in addressing need and demand are suggested.     

Investing in our future: unrealized opportunities for funding graduate psychology training

PURPOSE: Changes in the health care environment have brought challenges and opportunities to the field of psychology. Practitioners have been successful in modifying service models to absorb losses of financial support for behavioral health care, due to managed care and public policy changes, while simultaneously managing the growing need for these services. However, in this reactive mode of responding to evolutions in the health care system, the field of psychology has at times lost sight of the long-term vision required to promote psychology's inclusion in the health care system of the future. In particular, a focus on training psychologists and ensuring the availability of funding to support these activities must be a priority in planning for the future. This article provides an overview of federal programs that currently offer funding for psychology training, as well as other opportunities for federal funding that have been unrealized. Details regarding advocacy efforts that were required to secure available sources of funding are given, followed by consideration of strategies for taking advantage of existing resources and prioritizing advocacy for additional funding. CONCLUSION: Funding for psychology training provides an avenue for increasing the number of well-trained psychologists who can serve patients' mental and behavioral health needs and thereby improve health outcomes. Moreover, capitalizing on available funding opportunities for psychology training and promoting efforts to expand these opportunities will help ensure that the field of psychology is positioned to remain an important contributor to the health care system of the future.     

A new role for psychologists--hospital ethics committees

Over the past decade psychology has begun to appreciate that it represents more than "merely mental health care" and has become increasingly involved in the generic health care arena. The participation of psychologists in Hospital Ethics Committees (HECs) is presented as a professional activity for which psychologists are particularly well suited. The clinical mission of HECs, the historical importance of ethical considerations to psychology, and the field's specific training and psycho-social expertise suggest valuable contributions that psychologists can make in this particular area. Further, as psychology actively increases its participation in HECs, other professional disciplines outside of the mental health field will systematically have the opportunity to become more familiar with psychology and its clinical and research expertise.     

The professional identity of counselling psychologists in health care: a review and call for research

Despite (a) anecdotal evidence which suggests that it is possible to be a counselling psychologist in non-traditional settings, and (b) the potential integration of counselling psychology foci with the medical model, there has been some discussion about whether counselling psychologists who practice in health care settings might experience a change in their professional identity. Professional identity is defined here as a sense of connection to the values and emphases of counselling psychology. The retention of professional identity seems important for counselling psychologists in health care settings. This is considering that the application of counselling psychology principles has the potential to make their contributions unique among mental health professionals in the health care arena. Here, the authors describe the evolution of ‘counselling health psychology’ and address issues of professional identity. Limitations of existing literature are examined. Recommendations for future research are also made.     

Psychology's future in medical schools and academic health care centers

An exciting challenge exists for psychology to establish itself in the general health care delivery system. Advances in treating physical as well as emotional disorders offer the discipline the chance to expand its traditional and formerly limited role. Convincing empirical evidence suggests that psychology can simultaneously improve health care treatment and reduce its costs. Opportunities and obstacles on the path to success in this expanded venture are examined.     

Clinical Psychology in India

Scientific Psychology in India has seen steady development since its inception in the early 1900s. With clinical psychology developing as an independent profession, clinical psychologists have been functioning in various roles, offering a wide range of services in consultation, training, research, and private practice on multidisciplinary teams as well as in independent practice. This paper focuses on the historical roots of clinical psychology in India and highlights the role of clinical psychologists in the general mental health care and the contributions made by the profession in a wide range of public and private health care settings. Ancient Indian systems of Medicine, mental health care and psychotherapy in India, and training-related and organizational issues are discussed. This paper reflects on the growth and development of clinical psychology that has occurred in India in spite of current difficulties and the challenges that lie ahead.     

The detection and management of mental health disorders in pediatric primary care

We reviewed the literature on the detection and management of mental health disorders within the context of pediatric primary care. Pediatricians have displayed a low sensitivity and high specificity in research investigating the detection of mental health impairment in children. Active management efforts characterize approaches to identified cases with more recently trained primary care pediatricians displaying a wider range of skills in managing mental health disorders. Few efforts have been made by pediatric psychologists to develop strategies for enhancing detection rates and management or to empirically evaluate the integration of pediatric psychology services into the primary care context. A conceptual model of factors influencing detection rates and ongoing management of mental health disorders within pediatric primary care is presented. Recommendations are made for more direct involvement of pediatric psychologists within the primary care context.