It is always a pleasure to be invited to address a meeting of one of our State, Provincial and Territorial Psychological Associations (SPTPA). At these meetings I have been given opportunities to put forth my vision for the future of psychology. Moreover, in the discussions, both formal and informal, that occur, I invariably learn many wonderful things about how psychologists who are “on-the-ground,” as it were, are advancing psychology’s agenda. I only regret that now that I am APA President-Elect my schedule has filled up, so that I cannot accept many of the invitations that have been extended. Hopefully these invitations will still continue to come after I finish my presidential year, when I will have more time.

     This particular trip to North Dakota began auspiciously. As the flight from Minneapolis to Fargo was descending, the person sitting behind me tapped me on the shoulder, and said “There are about dozen troops on board coming home from Iraq. Let’s stay in our seats to let them get off first to show our respect. Pass it on.” “What a wonderful idea,” I said, and passed it on as requested. And so when we deplaned, everyone except the soldiers kept their seats and spontaneously applauded these brave men and women, in a truly moving tribute, which the soldiers appreciated.

      Upon the kind invitation from APA Council Representative Lee Lipp, Ph.D., and NDPA Executive Director Bonnie Staiger, Paul Craig, Ph.D., a neuropsychologist from Anchorage, AK and member-at large of the APA Board of Directors, and I agreed to do workshops and presentations for the North Dakota Psychological Association in Fargo. In addition, at the gracious invitation of good friend and longtime member of APA governance Justin (Doug) McDonald, Ph.D., Director of the acclaimed Indians into Psychology Program (INPSYCH) at the University of North Dakota (UND), we agreed to present at the UND Northern Lights Conference and cooked up a plan to spend some time with Doug and his companion Tannis Power fishing for Walleye at Devil’s Lake.

      Fargo is one of the largest metropolitan areas in ND. It has a revitalized art deco style downtown area, containing some very nice restaurants, especially HoDo (short for Hotel Donaldson), where we enjoyed bison steak, intriguing art, and edgy music and one fascinating old book store, where Paul and I browsed and bought some wonderful treasures. Fargoans ask you if you have seen the movie “Fargo,” and hasten to point out that “Fargo is not like the movie.” I assure them that I understand, noting that “psychopaths are everywhere.”

     At the NDPA meeting on Friday, I presented a workshop on my main area of academic interest, the new psychology of men, titled “Men, Emotions and Psychotherapy” in the morning (c.f. Levant, 1998), while Paul presented in the afternoon on the “Neuropsychology of Traumatic Brain Injury: The Alaskan perspective.” Paul’s presentation was a highly engaging and humorous but tremendously informative talk, in which it became clear very quickly that to fully understand traumatic brain injury (TBI) in Alaska, you need to know a lot about the frontier (or “bush” as it is called locally) in addition to knowing neuropsychology. Just to give you a sample of this, consider that airplane accidents are a leading cause of TBI among men 25-39, and one frequent behavioral pattern for these accidents is a group of men preparing to go hunting in the bush in an overloaded small plane with more than a few belts under their belt, so to speak. In this connection, it was interesting to see how Paul’s talk overlapped with mine.

     On Friday evening NDPA held a banquet in honor of the association’s 50th birthday and the fifteen anniversary of the NDPA Executive Director Bonnie Staiger. I was asked to speak on my planned APA Presidential initiatives. I recognized the leadership of NDPA for creating such a vibrant SPTPA, in particular: Ken Stone, President, Kim LaHaise, President-Elect, Chris Kuchler, Past-President, Lee Lipp, outgoing Council Representative, and George O’Neill incoming Council Representative. In turn, the leadership of NDPA expressed their appreciation to CAPP and the Practice Directorate for making it possible for small SPTPA’s like NDPA to exist via the CAPP grants, and to APA Council for making it possible for such small states to be represented on Council.

     I gave the same talk on Saturday morning at NDPA and in the afternoon at the Northern Lights conference at UND. This talk is titled: “Psychological Approaches to the Management of Health and Disease: Health Care for the Whole Person” (Levant, 2004) Here is a synopsis:

     The 21st century promises monumental changes in health care. The technology currently available has already provided the tools whereby educated consumers can make critical decisions regarding their own health care and health care providers can call up databases to provide up to date health information. Yet despite these promising developments, the status of health care in the U.S. is very worrisome, with dramatically escalating health care costs every year, 45 million Americans now uninsured, tens of thousands dying from medical errors each year, and disturbing racial and ethnic disparities in access to and use of services.

     Psychology plays an under-recognized but extremely important role in health and illness. This becomes obvious when one considers the importance of behavioral risk factors for morbidity and mortality, the high costs associated with psychosocial pathways that lead to unnecessary utilization, and the ineffective treatment of the lion’s share of mental health problems by primary care providers. Further, as evidenced by the rising prevalence rates of chronic disease, traditional health care providers lack appropriate tools to tackle the behavioral health issues associated with the current chronic disease epidemic, whereas psychologists have developed and validated numerous disease management programs aimed at treatment adherence and lifestyle improvement. In addition, the psychological impact of having a chronic medical condition is not well addressed by conventional medical treatments.

     Psychology thus offers a key to saving billions of dollars annually and dramatically improving the U.S. health care system. It is thus imperative that psychologists be more centrally involved in the healthcare system. An integrated biopsychosocial approach to health promotion and disease management in which experts in the fields of medicine and psychology synthesize their knowledge offers a most promising alternative to the current biomedical health care system, and is likely to become an increasingly significant component of psychology’s future. This integrated system will truly offer Health Care for the Whole Person.

     Interestingly, at the NDPA conference I asked how many folks were aware of these issues and knew about the Health and Behavior (H & B) codes which allow psychologists to be compensated for their work in the general health care delivery system, and about 75% raised their hands. This is very different from what I typically find, which is less than 10%.

     Part of this may be due to the dynamics of a rural state where there are too few providers, but there is more to it than that. George W. O'Neill, Ph.D., Clinical Director of Mental Health for Blue Cross Blue Shield of North Dakota, told me that Blue Cross Blue Shield of North Dakota was probably the first private carrier in the country to cover H&B codes. This illustrates the importance of psychology being at the table locaaly, where policy decisions are implemented. Dr. O’Neill, being a psychologist and an employee of BC BS was in an excellent position to educate BCBS about the importance of the H & B codes for their subscribers and to reassure them that costs would be reasonable, which indeed turned out to be the case.

     Dr O’Neill noted: “Our rules for H&B claims are few (so far): 1) service must be for a non-psychiatric condition, 2) provider must use a diagnosis established by a physician, 3) provider cannot bill an H&B code and a psychotherapy code on the same day, and, 4) these codes are NOT to be used to cover preventive medicine or risk factor reduction. I recently looked at claims from April 2002 (when our first claim was submitted) through May 2004. During that period 450 H&B claims were submitted, attributable to 240 unique members. Of the 450, 35 occurred in 2002, and 320 in 2003. At the current rate, we estimate that 348 H&B procedures will occur in 2004. However, I have been promoting the use of these codes through various presentations across the state and expect the number to exceed this projection for 2004. Total dollars allowed for H&B codes have approximately 0.1% of all BCBSND mental health expenditures.” “From May '03 to May ‘04, we have had 112 claims for initial assessment, 168 claims for re-assessment, 74 claims for individual therapy, 47 for group therapy, 29 for family therapy w/ patient present, and 20 for family therapy w/o patient present. Diagnoses involved have been for CNS disorders (e.g. strokes, head injuries) - 45%; musculoskeletal (mostly pain management) - 10%; tobacco cessation in patients with respiratory disorders (e.g. COPD, lung cancer) - 8%; other respiratory disorders (mostly asthma) - 5%; miscellaneous other - 33%.” After the presentations on Saturday, Doug McDonald honored Paul Craig and I by creating an “Inipi,” or Indian sweat lodge ceremony. This is a sacred ceremony for purification and also for renewal and for creating a sense of community. All who participated felt that this was an extremely powerful ritual. I could write much more about it, but will save that for another time.

     As always, I welcome your thoughts on this column. You can most easily contact me via email: (new address): levant@uakron.edu.

References Levant, R. (1998). Desperately seeking language: Understanding, assessing and treating normative male alexithymia. In Pollack, W., & Levant, R. (Eds). New psychotherapy for men. (pp. 35-56). New York: John Wiley & Sons.
Levant, R. (2004, May 22). Psychological approaches to the management of health and disease: Health care for the whole person. Keynote speech, University of Nevada, Reno, Conference on Psychological Approaches to Disease Management.

¹ Dedicated to the inner adolescent!

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Ronald F. Levant, Ed.D., M.B.A., A.B.P.P., is President-Elect of the American Psychological Association. He was the Chair of the APA Committee for the Advancement of Professional Practice (CAPP) from 1993-95, a member at large of the APA Board of Directors (1995-97), and APA Recording Secretary for two terms (1998-2000, 2000-2003). He is Dean and Professor, Center for Psychological Studies, Nova Southeastern University, Fort Lauderdale, FL.

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