APA’s Council of Representatives has recently approved a Clinical Practice Guideline for the treatment of PTSD. Arguments for and against the use of clinical practice guidelines have been extensively—even ferociously—debated in psychology. Some point to accrued evidence supporting the use of specific therapies, others fear a devolution to prescriptive, mechanized treatments. Whether pro or con, discussions of guidelines must take into consideration the fact that regardless of the modality employed, effect sizes for mental health interventions are not terribly convincing to begin with. In this column, I’ll examine the new guideline and some of the assumptions underlying it.
In recent weeks we have heard news that three corporate titans of America, Jeff Bezos, Warren Buffet, and Jamie Dimon, have banded together to form a healthcare company that is “free of the profit motive” to serve, at least initially, the hundreds of thousands of individuals employed by Amazon, Berkshire Hathaway, and JPMorgan Chase. While this may sound a bit surprising coming from three of the most successful capitalists in the world, the idea has merit. Details of the endeavor are understandably lacking, but in the absence of those details we can speculate about what a healthcare system free of a profit motive might look like.
Whether or not the advent of a new Gregorian or lunar New Year (the Year of the Dog starts 16 February) is important to you, most of us, however atavistically, attach significance to arbitrary markers of the passage of time. As this New Year lurched to its feet I found myself reflecting on the past year and what it held for psychology and mental health.
From the Executive Officer’s Desk—On the Ethics of Clinical Data Collection: Are Data Informative or Transformative?
All psychologists who do third party billing, and particularly those who work with electronic health records, provide, whether they know it or not, a steady stream of patient related data to an unseen army of analysts. Every coded encounter gets swept up and tossed into an analytic mill, where insurors, actuaries, and others chart healthcare engagement, costs, outcomes, and a myriad of other factors. Psychologists who work in most healthcare delivery settings, and even independent practitioners, are increasingly bound to the Promethean rock by two adamantine chains: electronic health records and outcomes data.
Psychologists often bemoan the perception that our profession is rarely accorded the prestige it deserves. We are underpaid, under-reimbursed, and undervalued. Our science is toothless and is of interest only to researchers themselves and the undergraduate psych majors who have to digest their inexplicable findings. Our professional organizations’ lobbying efforts are rendered impotent by lack of funds. In any case, lawmakers don’t want psychological science to get in the way of a predetermined legislative agenda. But we are increasingly prominent as a profession, in ways good and bad, and while our code of ethics clearly applies only to our activities as psychologists, we also have a role as public citizens.
September 1 marks the beginning of the new membership year for the National Register. I thought that this year I would begin a tradition and use my September column to provide a snapshot of the state of the organization over the past 12 months and a brief glimpse at what we hope to accomplish in the next year. Let me start with some very good news – the organization is as healthy as it has been in many, many years. For the third year in a row, we have attracted a record number of new Registrants, around 450 new annually. These are very good numbers for a voluntary, dues-driven organization in psychology.
The problems that our profession must strive to address are, as we have seen, enduring and present. Outside of political expression, attitudes towards race continue to exact a terrible toll. Social psychologists working in the field of attribution theory continue to demonstrate the effects of perceptions based on skin pigmentation or other external characteristics. Attribution theorists continue to remind us that even if “race” doesn’t exist as a genetic (relatively immutable) phenomenon, racism certainly is clearly linked to attributional (relatively mutable) phenomena.
It is my belief that we should view investments in healthcare as an investment in the future of our citizenry. That belief is well supported by evidence, both confirmatory and contradictory. On the confirmatory side we have studies that clearly demonstrate a link between health-related social spending and reductions in all cause morbidity and mortality. Investing in programs like school and afterschool programs, job training, and other aspects associated with healthcare results in an increase in life expectancy and an overall lowering of healthcare costs. Read more.
Middlemen in mental health care have a deservedly unsavory reputation. Any practicing clinician is too painfully aware of the arduous necessity of qualifying patients for treatment, and the seemingly endless cycle of denials and appeals orchestrated by low-level employees of major HMOs. All too often, clinicians and patients gave up out of sheer exhaustion if nothing else, which in effect makes a mockery of state and national parity legislation. As we are all aware, even though national parity legislation exists, this is quite variably applied and enforced.
From the Executive Officer’s Desk: Who Gets Left Behind Without Combined Treatments? Practically Everybody.
Combining psychopharmacological and psychological interventions for most mental disorders works. Whatever the outcome measure chosen, the accumulated evidence is convincing that pharmacotherapy alone is a suboptimal treatment for most forms of mental disorder. We as psychologists have probably intuited this throughout our professional lives, and those of us who were fortunate enough to be practicing during the heyday of combined treatment acquired early clinical evidence that such interventions were effective.
It’s been an odd spring in our nation’s capital. Following a very mild winter, our only significant snow storm bore down upon us in early March, bringing drifts and several days of freezing temperatures. Unfortunately, our famous cherry blossoms had been encouraged by the abnormally warm winter to pop out a bit early and were literally nipped in the bud, disappointing those who make the annual pilgrimage to the Tidal Basin. But we’ve had lots of other things going on to keep us busy.
From the Executive Officer’s Desk: Is Health Care Reform Possible? Yes, If We Focus On The Real Problem
The health care debate in this country is currently focused on who gets health care and how much they must pay for it. Both are incredibly important questions, but ignore a larger issue: quality. What are we getting in return? The American Health Care Act of 2017 is the first attempt by the current Congress to make good on campaign promises to repeal the Patient Protection and Affordable Care Act. The National Register is a non-partisan organization, and it is not my intention to provide a partisan analysis of what is, admittedly, a very partisan bill. That said, I’d like to provide a few highlights of this 122 page piece of legislation that by any objective standard should be of significant concern to psychologists and our patients.