The summer of 2016 may very well go down as the “Summer of Outrage.” National elections are never the calmest of events, but this particular cycle seems to be marked by heated passion (to say nothing of unbridled invective) in degrees not seen for quite some time. And it’s not a uniquely American phenomenon. Outraged Britons have chosen to depart the European Union, a passionate decision that they apparently may be coming to regret. Their counterparts across the Channel are responding with outraged rejoinders of “good riddance,” a stance that is likely not in their best self-interest. But closer to home (and to the theme of this column), it seems that psychologists are increasingly joining the ranks of the outraged. Listservs seem replete with outraged comments about this thing or that, this insurer or that new therapy, this new drug or that new medical device.
Why psychologists trained in rational thinking fall prey to this can be partly explained by understanding how popular discourse affects professional communications, and how the media we use shape both our messages and emotional responses. We have, for example, platforms like Twitter, which due to restrictions on the length of communications essentially guarantee that a post will be free of both nuance and context. The ability to broadcast such messages widely adds to the temptation of communicating unfiltered emotion to as large an audience as possible. The ease with which we can cut and paste electronic material allows us to alter original authors’ intent to fit our own points of view. More than ever, the airwaves seem to be full of commentators who encourage us to make decisions based on emotion, rather than reason. Though as psychologists we pride ourselves on being scientists and rationalists, we are as susceptible to the fads of popular culture as anyone else. Even so, I find this vulnerability to be a bit odd, since we as professionals spend so much of our time helping patients understand the roots of their emotions, the difference between emotional reasoning and rational thinking, and how unacknowledged emotions inflect our beliefs, actions, and words.
Outrage is an understandable emotion of the disenfranchised: those who have no recourse to political, legal, or economic systems to address injustices or wrongs, or are barred from participation in governance due to constraints imposed by law, prejudice, or repression. For these groups, social media can be a powerful, and perhaps their only, mechanism of communication of grievances and ideas. The profession of psychology, however, has other options. We are, without being coy about it, the elite. We are among the most highly educated individuals on the planet, and we enjoy the benefits that education has bestowed on us. We as highly educated professionals are not, as a group, disenfranchised—unless we choose to be.
And unfortunately, many of us are choosing to become professionally disenfranchised, by dropping membership in APA, state psychological associations, and other professional organizations. This is definitely not good for the profession, and it’s not good for the patients on whose behalf we advocate. Admittedly, professional organizations are imperfect, often consensus-driven organizations, prone to political correctness (whatever that is) and institutional timidity, and they make plenty of bad decisions. But regardless of the warts and pimples that any large organization accrues by its mere existence, we need organized psychology. And unless we’re involved, we have no standing to criticize the bad decisions organized psychology makes or to have input into the making of better ones.
The Mental Health Reform Act of 2015 (S. 1945) provides an excellent, real-time example of why professional organizations are vital to our continued existence. As I wrote in my last column, comprehensive mental health reform is moving forward in the Congress, and a conference committee will soon be called to reconcile this bill with the recently passed House version. The profession of psychology was specifically called out in numerous places in both bills. Significantly, in the Senate bill, psychology is called out as a potential recipient of mental and behavioral health training grants which would subsidize graduate psychology education, predoctoral internships, and postdoctoral training. The legislation also contains provisions for Integration Incentive Grants, with psychologists specifically identified as members of integrated healthcare delivery teams. Under the proposed bill, such teams will be eligible for grants of up to $2M annually for a period of 5 years. Without effective input from organized psychology, it is quite likely that psychology training would have been ignored.
There is much to be done, on the legislative front and elsewhere. If comprehensive mental health reform is enacted this year, we will be in the dubious position of not having enough appropriately trained psychologists to meet program expansion driven by mental health reform. Not only are we short in numbers, but we still have not adequately addressed our graduate training programs’ inability to efficiently produce psychologists armed with the clinical skills needed to work in an integrated healthcare delivery system. As I noted in my last column, this is not a trivial observation. Our graduate programs must have the courage to address wholesale curricular reforms, otherwise our place at the healthcare table will be overtaken by more nimble professions able to train to meet current needs.
A final reminder on this point: Some time ago, I reported that fewer than 20% of Accountable Care Organizations (ACOs) were judged capable of providing the range of mental health services expected under Obamacare. Unfortunately, a new analysis indicates that this remains a major problem. Busch and colleagues report in the July 2016 issue of Health Affairs that ACO contracts did not reveal improvements in mental health spending, readmission or other pertinent outcomes parameters (Busch, A. B., Huskamp, H. A., & McWilliams, J. M.; Early efforts by Medicare Accountable Care Organizations have limited effect on mental illness care and management, Health Affairs, July, 2016). In sum: We are not producing enough graduates to meet the growing need. Those graduates entering the healthcare marketplace are almost always poorly equipped to work in integrated care settings, and those settings still struggle to provide needed services. All of these problems are fixable, but only if academic trainers and organized psychology agree to do so – and soon. This is the proper role for organized psychology: To advocate for change, both within and outside the profession, that will empower us to advocate, via both the services and opportunities we provide, for those in need of the benefits psychological intervention can offer.