Friday Factoids: To Rx or Not to Rx–Psychology’s Ongoing Debate

I went home contemplating this week’s Friday Factoid. Time was pressed and I had no idea what to address. So I turned on my television and tuned in to the local channel 6 news. There it was, a short news story featuring a State of Illinois proposal that would in essence approve psychologists to exercise prescription privileges.

 

Immediately, I said, “Wow, that’s interesting.” I did a search for the local channel 6 website and located the article entitled, “Panel OKs bill to let psychologists prescribe.” According to the Springfield, Illinois (AP), “The proposal was signed off by an Illinois legislative panel recently on a 9-5 vote.” At this time things are looking bright as the proposal heads further along in the full approval process. If this peaks your interest (and I’m sure it has), then take a look at the Illinois website. Once there, look on the left panel and put in the number SB2187 to read a summary of the bill.

 

The debate over prescription privileges has caused differences of opinion among psychologists and other professionals. The local news article (2014 May 8), mentioned that a proponent of the bill, Rep John Bradley, says, “Letting psychologists prescribe drugs would help ease a doctor shortage.” However, opponents from the Illinois State Medical Society say, “Psychologists do not have enough medical training to safely dispense medication.” You can take a look at the fact sheet that was sponsored by the Illinois Psychiatric Society for a more complete summary of their opposition.

 

In closing, in her article, Physicians Fight to keep Psychologists from Prescribing, Melville (2013) expands on this very exciting debate.  More interesting was the fact that she indicated that during the mid 1990s, out of 170 proposals from various states, only three states granted prescription privileges, namely, “New Mexico, Louisiana and Guam.”

Have you considered your position in this ongoing debate?

 

References:
Illinois Psychiatric Society Do you want your medication prescribed by someone who took an online psychopharmacology course? http://www.illinoispsychiatricsociety.org/advocacy/Documents/IPS%20FinalFactSheet%20April%209.pdf

 

Melville , N.A. (2013). Physicians Fight to Keep Psychologists From Prescribing. Retrieved from http://www.medscape.com/viewarticle/781519

 

WPSD Local 6 News, (2014 May 8). Panel OKs bill to let psychologists prescribe. [Television Broadcast]. Retrieved from  http://www.wpsdlocal6.com/story/25465795/panel-oks-bill-to-let-psychologists-prescribe.

 

David J. Wright, MA., MSW
WKPIC Doctoral Intern

 

 

Friday Factoids: The Affordable Healthcare Act and the Practice of Psychology

 

 

 

Psy.D/Ph.D doctoral candidates in psychology, psychiatry, and other behavioral health care disciplines across the country will be face important decisions after graduation. The number one decision involves whether one will seek employment as a private practitioner or employment through a large employee based medical group.

 

 

The federal mandate and recent implementation of the “Patient Protection and Affordable Care Act” ( ACA; otherwise known as Obamacare) now provides all enrollees access to mental and behavioral health services as well as substance use and rehabilitation services as part of their insurance coverage (Varney, 2013). Additionally, the Mental Health Parity Law (MHPL), essentially requires insurance companies to provide same health care benefit coverage as other medical coverage and treatments, which will further guarantee coverage to clients. In her article, Obamacare Changes How Therapist Do Business, Varney (2013) explores the impact that the ACA and MHPL will have on new and seasoned psychologists, psychiatrists, marital therapists, and social workers as they contemplate how they will operate their business.

 

 

Interestingly, Varney mentions how mental health experts have seen a gradual shift away from “mom and pop” private practices, to mental health consortiums or large interdisciplinary medical groups. Due to the changes in ACA and MHPL, private practice therapists who have typically operated with a “cash & carry” practice, are now faced with countless insurance plans to sift through; as well as the bureaucracy of billing codes and hard to process insurance claims. Additionally, therapists who already process insurance claims may be asked by insurance companies to accept a cut or discount for patients enrolled in ACA and/or participate in the health care exchange program (i.e., pick or choose the type of insurance package).

 

 

This paradigm shift in business operations is prompting those in private practice to consolidate resources with other practitioners by joining a consortium where mental and behavioral health services are part of a continuum of care. I cannot imagine the challenges of dealing with the “bureaucratic” red tape of insurance companies and the health care delivery system, but according to Varney, therapists in large mental health consortiums often have bargaining power with the insurance companies and can negotiate directly with them for higher reimbursement rates. As a therapist, perhaps a limitation of working in a large medical group means losing flexibility and autonomous functioning, such as handling the day to day administration, such billing operations, scheduling clients, etc., that is common in private practice. Whether you choose private practice or a large medical group, one will surely have to navigate the complexities of working with insurance companies.

 

 

Reference:

Varney, S. (2013), Obamacare Changes How Therapist Do Business. Retrieved from http://medcitynews.com/2013/10/obamacare-changes-therapists-business/.

 

 

David J. Wright, MA., MSW
WKPIC Doctoral Intern

 

 

Friday Factoids: A Soldier’s Story

 

 

The shootings at Fort Hood, Texas have inspired me to share my personal deployment experiences with you. I have not included relevant literature; rather, it is a brief personal account of my story in Iraq (2003). The intent is to initiate discussion between seasoned and neophyte therapists who have not had training opportunities working with men and women returning from combat. I will use the term soldier because of my Army experiences and like other organizations, there will be acronyms used that I will explain.

 

Receiving orders to deploy can be a frightening experience, especially when it involves a first time deployment. There are many factors involved once deployment orders are received including combat readiness training, medical history updates, family care plans, finance/insurance plans and more unit training to ensure the soldier is “squared away.”

 

The term squared away means to complete required paperwork expeditiously. There are countless hours of field training exercises required until the actual deployment. It seemed that I spent more time with my unit on post (Army installation) than with my loved ones at home.

 

The preparation phase literally accelerated from 0 to 100 mph within days of receiving

orders. Not only do you have to prepare for the unexpected, but thoughts of leaving your loved ones behind begin to ruminate. I deployed with the 101st Airborne Division, Screaming Eagles, 311th MI (military intelligence) BN (battalion), [Air Assault]. It was my first deployment after serving six

 

years of active duty service. I was among the enlisted ranks at the time as a Staff Sergeant (SSG) or E-6. Although I was in a leadership role and was required to be strong for soldiers in my squad, I was anxious, scared, and did not know what to expect. I was told by my First Sergeant (ISG; E-9) and Commander (0-3) that some of my fellow soldiers may not return home alive. At that point, one tries to contain fear because you are surrounded by soldiers dealing with the same fears.

 

Fast forward to the actual deployment and landing in Kuwait where there were literally thousands of soldiers waiting to surge into Iraq. The mission of the 101st was to convoy through enemy territory northward until positioned in Mosul, Iraq. The convoy was long and very scary. I remember convoying through Baghdad and seeing buildings blown to pieces while other buildings were riddled with bullet holes. Thoughts of death took center stage while traveling through Baghdad. CNN live camera feeds could not capture the magnitude of destruction of what I saw with my own eyes. Finally, we made it safely to an abandoned airfield called Qayarrah West located about 30 miles south of Mosul. Q-West as the airfield became known was my place of residence until I was redeployed home just shy of a 12-month tour of duty. The first few months at Q-West were pretty quiet. Conducting operations in and out of town for the most part were not met with resistance or gunfire.

 

However, after six months, there was incoming mortar fire that occurred nightly on the outer perimeters of Q-West.  Q-West Security measures tightened significantly. Our convoys began taking rocket-propelled grenade (RPG) fire and improvised explosive devices (IEDs). Cordon and search missions of local villages were daily occurrences looking for any signs of the enemy. Thankfully I was not engaged in any direct fire or had to discharge my weapon, but many infantrymen were engaged in fire; many were either killed or wounded. Hearing about a soldier killed in action has negative effects on one’s thoughts because perhaps maybe the next bullet or the next attack will involve you or your soldiers.

 

Post Traumatic Stress Disorder (PTSD) affects countless young men and women in uniform. What is the relevance of my story? What lessons could be learned for those who do not work with soldiers on a daily basis?  What was described briefly in my story was the deployment process, which involves three phases: pre-deployment, deployment, and post-deployment. Explaining each phase is not the scope of this post. For more information about the deployment process, checkout militaryonesource. Each phase carries with it a level of distress and anxiety. Many soldiers reintegrate with their family members feeling guilty, depressed, and anxious. Common behaviors involve substance abuse, domestic violence, and agitation that not only impact the soldier, but the family as a whole. While there is evidence in the literature to assume that direct gunfire may cause symptoms of PTSD, it cannot be discounted that having no exposure to direct combat excludes one from PTSD symptomatology. This can be an interesting topic for further research.

 

As therapists, what is significant is the examination of how the deployment process affects soldiers and their loved ones. It is also important to recognize that soldiers bring to therapy a culture unique to the Army experiences including language, acronyms, rank structure, and strict adherence to mission accomplishment. Many soldiers will want to talk with others who can relate to what they have gone through. As a therapist, breaking through these schemas will take time and requires understanding, empathy, and utilizing listening skills. The combat experience itself has exclusively been a huge part of the therapeutic process, but to gain greater insight into the soldier, one must look into their pre-deployment experience to develop a trusting and safe environment so the soldier feels connected and not judged.  Also, therapists should be mindful of confidentiality issues in the sense that Commanders can have access to therapy records, which can affect the soldier’s willingness to be forthcoming in sessions. The soldier may be fearful of unit stigmatization, loss of promotion opportunities, or being ostracized by fellow soldiers.

 

David J. Wright, MA., MSW
WKPIC Doctoral Intern

 

Reference:
Military Deployment Guide: Preparing you and your family for the road ahead.  Military One Source. Retrieved from http://www.militaryonesource.mil/12038/Project%20Documents/MilitaryHOMEFRONT/Service%20Providers/Deployment/DeploymentGuide.pdf

 

 

Friday Factoids: Re-ignite Those New Year Resolutions!

 

 

The New Year arrived with great fanfare, and you began an exercise program, a diet regimen, a book reading class, or Dr. Vaught’s leadership course. Whatever choice you made, as time went by, your commitment waned. You may have said, “I just don’t have the time.”

 

We are all governed by time. How fast does time pass? I know I may  date myself, but I’m reminded of an old T.V. commercial when a man talks with an owl and says, “How many licks does it take to get to the center of a lollipop? Then the owl responds, “Let’s see… one… two… three,” and eats the lollipop. Then the commercial ends saying, “The world may never know.” The commercial reminds me of the concept of time; no one never knows where the time has gone. Ok, probably not a very good analogy, so let’s get back to the matter at hand.  Four to five weeks into the New Year, life again begins to beat you down. Work schedules increase, long afternoon meetings appear, the calendar fills, classes begin again, hours of study are required, and you tell yourself, “I do not have time.” Suddenly, a month passes, two months, perhaps three months have passed. No results! Now what?

 

Make the most of time. Be honest and set realistic goals. Sounds like familiar comments from others? In her news article entitled, “This Is Why You Can Never Keep Your New Year’s Resolutions,” Columnist Carolyn Gregoire writes about making decisions about how you will live your life. The answer may be hidden in a single word “habit.” Exercising good habits is a motivator in which one gains a sense of comfort and tough mindedness in self and one’s abilities. Gregoire (2014) quotes Charles Duhigg, a reporter and author of The Power of Habit, stating, “Routines and habits are a powerful force underlying much of our behavior.” After a brief review of the literature, Duhigg (as cited by Gregoire) found that nearly half or 50% of daily decisions are habit-driven. Not to oversimplify its significance, but if one develops a habit of doing anything, such as bathing, brushing teeth, or putting on deodorant, it no longer becomes a task, rather a lifestyle change and ultimately will no longer an issue of time.

 

Duhigg writes about five evidenced-based steps to re-ignite a not so old resolution. I will give you the first step: “Make it an action, not a goal.” Remember, these steps can apply to any situation, not just exercise. Take a look at the remaining steps here.

 

Reference: Gregoire, C. (2014).  This is why you can never keep your new year’s resolutions. The Huffington Post. Retrieved from http://www.huffingtonpost.com/2014/01/01/the-psychology-of-making-_n_4475502.html .

 

David J. Wright, MA., MSW
WKPIC Doctoral Intern

 

 

Friday Factoids: A Look At “When Spring Brings You Down” by Linda Andrews

 

 

Spring time is in the air, woohoo! Finally! With the cold weather behind us and the polar vortex no longer a significant threat, it is time to peel off the long winter coat and open the window blinds in your office to let the sun in [given there are windows in your office]. With the spring comes many perks, such as viewing the beautiful landscape of the soft Kentucky bluegrass, the green leaves hanging on the oak trees, colorful flowers, and the fresh smell of daffodils.

 

Sounds fantastic, right!

 

Well, not so fast.

 

In her article, When Spring Brings You Down, Andrews (2012) writes about two issues that are not so welcoming with the change of season. She mentions “seasonal allergies and reverse seasonal affective disorder (SAD).”  Seasonal allergy sufferers are vulnerable to inflammation and infection. As a result, Andrews states that the molecule, cytokines, forms clusters around the infected area (Mandal, n.d.), which has been linked to depression and in severe cases, suicide. An additional reading source by David Dobbs, entitled, Clues in the Cycle of Suicide, provides more information about suicide rates during the spring and into the summer months.

 

Interestingly, Andrews further talks about SAD and the possibility that it is not specific to the winter months, but to the summer as well.  As the DSM-5 begins to take center stage, SAD will no longer be a separate diagnosis. Rather, SAD will take the form of several specifiers for major depressive disorder, recurrent and bipolar I and II disorders (DSM-5; pgs153-154; 187-188).

 

Yes, you may have already noticed that specifiers rule in DSM-5.

 

In the end, however, the spring air, filled with its freshness and good spirits, may not be a time of optimism for some individuals.

 

References:

 

American Psychiatric Association. Diagnostic and statistical manual of mental disorders, fifth edition (DSM-5).

 

 

Andrews, L. (2012). When spring brings you down. Retrieved from
http://www.psychologytoday.com/blog/minding-the-body/201203/when-spring-brings-you-  down.

 

 

 

Dobbs, D. (2013).  Clues in the cycle of suicide. Retrieved from http://well.blogs.nytimes.com/2013/06/24/clues-in-the-cycle-of-suicide/?_php=true&_type=blogs&_r=0.

 

 

Mandal, A. (n.d.). What are cytokines? Retrieved from http://www.news-       medical.net/health/What-are-Cytokines.aspx.

 

 

 

David Wright, MA, MSW

WKPIC Doctoral Intern