Health Care Reform Priorities

April 2009

The American Psychological Association (APA) is the largest scientific and professional organization representing psychology in the United States and is the world's largest association of psychologists.  Our membership includes 150,000 researchers, educators, clinicians, consultants, and students. APA’s unique and overarching goal in health care reform is to facilitate the use of scientific knowledge and professional applications from the discipline of psychology for the prevention, assessment, and treatment of physical and mental disorders, as well as the promotion of health and wellness.  We believe that contributions from psychology are fundamental to improving the public’s health and reforming the health care system.

The determinants of health include a complex array of biological, behavioral, psychological, sociocultural, and environmental factors, as well as an individual’s coping resources and access to health care.  In fact, modifiable behavioral factors such as smoking, improper diet, lack of physical activity, and excessive alcohol consumption, among others, are the leading causes of chronic health problems and mortality in the United States from conditions such as heart disease, diabetes, and many forms of cancer. These behavior-linked illnesses account for nearly 75% of health care spending. In addition, mental illness, especially depression, is one of the primary causes of disease burden around the world, given its association with premature mortality and years of chronic suffering.   As a consequence, new and successful models of health care practice include the integration of psychosocial and behavioral assessments and interventions with medical treatments.  Thus, psychology, as the science of behavior, has much to contribute to improving the health status of our nation and is integral to health care reform.  As noted in the eight health care priorities outlined below, health care reform must go beyond covering the uninsured to include changes in the way health care is delivered in this country:

Integrate mental and behavioral health care into primary care and other health care services for persons across the lifespan, with psychologists recognized as vital members of interdisciplinary health care teams.

Rationale: Integrated health care is an approach that is characterized by a high degree of collaboration among the various health professionals serving patients in terms of assessment, treatment planning, treatment implementation, and outcome evaluation. Evidence suggests that coordinated care that integrates psychological care within primary care and other services can enhance access to services, quality of care, and lower overall health care expenditures.

Ensure access to quality mental and behavioral health promotion, screening and referral, prevention, early intervention, and wellness services for persons across the lifespan, with particular attention to at-risk populations.

Rationale: Prevention and early intervention efforts can benefit those at-risk of, or currently experiencing, health problems. As experts in human behavior, psychologists work to prevent disease and promote the health and wellness of individuals across the lifespan. Psychology has been at the forefront of developing effective health promotion and chronic disease management programs and strategies to enhance healthy behaviors and lifestyles.

Develop and maintain a diverse psychology workforce competent to develop and apply evidence-based behavioral and psychosocial assessments and interventions to address the current needs and changing demographics of our nation’s population.

Rationale: There is overwhelming evidence that our nation’s mental and behavioral health workforce must be expanded and retooled to respond adequately to the health care needs of our increasingly diverse population. Psychologists as researchers and practitioners are integral to a health care system in which approximately half of U.S. mortality is linked to behavior and in which mental health problems are a significant public health concern.

Ensure that quality mental and behavioral health care and access to psychologist providers are included in benefit plans for persons across the lifespan.

Rationale: Mental and behavioral health problems can adversely affect physical health, functional ability, and emotional well being. While effective treatments for mental and behavioral health problems exist, many individuals in need of care do not receive these services.

Eliminate disparities in mental health status and mental health care through the use of psychological and behavioral research and services that are culturally and linguistically competent.

Rationale: Research demonstrates critical racial and ethnic disparities in mental health status, services provision, and outcomes, with minorities receiving less mental health treatment that is of a lower quality, resulting in poorer outcomes. Psychologists play an important role in reducing and eliminating mental health disparities through the provision of culturally and linguistically competent care and research.

Increase federal funding for basic and translational psychological and behavioral research and training to develop and evaluate empirically-based treatments to improve health care.

Rationale: Treatment success rates for certain mental disorders are comparable to, or even better than, those for many physical conditions. Psychological and behavioral research will dramatically enhance our capacity to prevent and treat mental and substance use disorders. The understanding of behavioral variables is also critical to achieving such health care goals as preventing and treating diabetes, cardiac disease, obesity, HIV/AIDS, and cancer.

Include strong privacy and security records protections in the development of health information technology, with special attention to mental health records.

Rationale: The movement of patient records from a paper-based to an interoperable, electronic system has the potential to greatly improve patient care through better coordination and reduced medical errors. Records privacy and security are particularly vital for mental health and substance use treatment where even a potential breach could be devastating for the patient.

Enhance the involvement of psychologists and other health care professionals with consumers, families, and caregivers in planning, implementing, and evaluating health care initiatives.

Rationale: Professionals, consumers, families, and caregivers all serve as essential members of the health care team. Efforts to improve and reform our nation’s health care system must reflect the invaluable contributions of each of these important groups.