Population health and psychology’s role

Envision a future where people receive help for psychological distress at the earliest stages of need; where people routinely engage in self-care and try to build their behavioral health literacy. Imagine having greater access to supports and interventions across the spectrum of need that are part of a larger infrastructure for public mental health. What if the places where we live, work, play, and worship are not just passive environments, but “engines for mental health and wellbeing” (SG Workplace Framework 2022) (PDF, 3MB)?

Achieving this reality is possible, but it requires that the field of psychology expand our current paradigm for behavioral health and work toward a population health approach.

This means taking a social-ecological perspective that acknowledges the broader cultural, economic, and systemic contexts that influence health status. It means promoting the health of the entire population—providing effective and efficient clinical care to those with a behavioral health diagnosis; intervening early or mitigating risk for those likely to develop challenges or with subclinical symptoms; and maintaining or optimizing health for those who are relatively healthy. It means acknowledging, as we emerge from the covid-19 pandemic, psychologists need to partner with other professionals to meet the great need that exists and is expected to grow.

Psychologists can play a diverse set of roles in this effort—from providing direct services, to conducting and translating research, to applying psychology to public policy. In fact, a policy recently adopted by APA’s Council of Representatives lays out the critical role of psychology and psychologists in leading this effort and delineates four principles (PDF, 149KB) that psychologists can use to promote population health through their own work.

Psychologists are encouraged to “work within and across diverse systems” and collaborate with partners to expand society’s understanding of health and develop a deep understanding of the communities and systems in which they live and work.

APA advocates for the routine collection of information about social determinants of health (PDF, 395KB), and psychologists may be well positioned within their organizations to facilitate systematic collection and use of this data to guide decision making. Partnering with others to develop, promote, and disseminate science-based solutions tailored to the unique challenges of a community is key. Psychologists and trainees can engage in collaborative partnerships with community leaders and local institutions to develop a deep understanding of local systems and needs and advocate for resources for lasting strategies to address and advance health.

Psychologists are encouraged to “work upstream by promoting prevention and early intervention strategies.”

For instance, given that use of tobacco and other substances are significant contributors to the development of several physical health problems and premature death, psychologists can contribute to improved health within their patient populations by offering smoking and tobacco use cessation and brief substance and alcohol abuse services. A critical piece of this work involves exploring financial incentives and alternative payment models to increase access to essential prevention and early intervention services. APA and APA Services, Inc. are advocating for psychologists to have access to billing codes that allow them to be reimbursed for population-directed services. Already, CPT^® codes exist for some of these services, although psychologists should confirm that they have access to these codes with third-party payers. For instance, telephone assessment and management service codes allow psychologists and other providers to deliver relatively brief and directed services, potentially reducing the escalation toward crisis and preventing greater distress.

The discipline of psychology also needs to invest in educating “psychologists and community partners on population health.”

As psychologists, we have a wide range of skills to assist with this effort—including understanding how systems operate; utilizing data and measurement; producing, translating, consuming research, including multi-level research; and developing, implementing, and evaluating programs—all of which position psychologists as leaders in this work. Given that collaboration within communities is integral to define, measure, and track progress toward valued health outcomes and goals, educators and supervisors can embed these practices within training programs by establishing ongoing, reciprocal partnerships with local organizations. And APA uses its policies to guide and influence its work with other organizations, such as the National Council for Mental Wellbeing, which adopted population health as a guiding principle for its framework.

Finally, “a diverse array of community partners” is necessary to advance population health. Local stakeholders are crucial for providing knowledge and guidance, but often larger entities have greater resources to implement policies and programs.

As psychologists, we must be intentional about establishing partners both within the traditional health care arena and outside of it. Population health will only be achieved when businesses, schools, law enforcement, community-based organizations, and others are working in partnership towards identified goals. Creating psychologically informed programs that are delivered or embedded in environments where people are naturally, such as schools, can meet important population health goals by improving health, social skills, school performance, and reducing problematic behavior such as bullying or substance use. APA is also working with numerous entities to drive meaningful impact. These partnerships—along with psychologists’ efforts to provide leadership and consultation through roles with other national organizations—enable us to more effectively reach different segments of the population and promote their health.