Divided No More: Psychology's Role in Integrated Health Care

Abstract Health-care providers increasingly recognize the need to address behavioural and emotional influences on physical health in order to provide quality and cost-effective services. As behaviour change experts, psychologists can be critically important in new models of integrated care that focus on both physical and psychological health. However, to be effective, psychologists must be prepared to address the major issues facing health-care systems today and be willing to re-examine and modify current modes of education and practice. This article describes important trends affecting health care and the ways in which psychologists could contribute. Lastly, two psychologists involved in new models of integrated care describe their training and the challenges and rewards of their current activities. An Historical Public Health Perspective Slightly over three decades ago, Marc Lalonde (1974), Minister of National Health and Welfare for Canada, issued his thought-provoking, if not truly revolutionary, report: A New Perspective On The Health Of Canadians: A Working Document. Good health is the bedrock on which social progress is built. A nation of healthy people can do those things that make life worthwhile, and as the level of health increases so does the potential for happiness. The Governments of the Provinces and of Canada have long recognized that good physical and mental health are necessary for the quality of life to which everyone aspires. Accordingly they have developed a health care system which, though short of perfection, is the equal of any in the world. At the same time as improvements have been made in health care, in the general standard of living, in public health protection and in medical science, ominous counter forces have been at work to undo progress in raising the health status of Canadians. For these environmental and behavioural threats to health, the organized health care system can do little more than serve as a catchment net for the victims. Physicians, surgeons, nurses and hospitals together spend much of their time in treating ills caused by adverse environmental factors and behavioural risks. It is evident now that further improvements in the environment, reductions in self-imposed risks, and a greater knowledge of human biology are necessary if more Canadians are to live a full, happy, long and illness-free life. The Government of Canada now intends to give to human biology, the environment and lifestyle as much attention as it has to the financing of the health care organization so that all four avenues to improved health are pursued with equal vigour. Its goal will continue to be not only to add years to our life but life to our years, so that all can enjoy the opportunities offered by increased economic and social justice. (Lalonde, 1974, pp. 5-6) This policy document contained a number of highly relevant observations regarding the fundamental questions before us today. Its relative silence, however, on the explicit potential role and contributions of Canada's health professions' educational institutions must not be overlooked. In most minds the health field and the personal medical care system are synonymous. This has been due in large part to the powerful image projected by medicine of its role in the control of infective and parasitic diseases, the advances in surgery, the lowered infant mortality rate and the development of new drugs. This image is reinforced by drug advertising, by television series with the physician as hero, and by the faith bordering on awe by which many Canadians relate to their physicians. (Lalonde, 1974, p. 11) And yet, there is also the clear recognition of the potential role that psychology can play. Past improvement has been due mainly to modification of behaviour and changes in the environment and it is to these same influences that we must look particularly for further advance (p. 13). When the full impact of environment and lifestyle has been assessed, and the foregoing is necessarily but a partial statement of their effect, there can be no doubt that the traditional view of equating the level of health in Canada with the availability of physicians and hospitals is inadequate. …