Why would a former president of the APA, now well into his octogenarian years, and who could be resting on his laurels join a new activist organization like NAPPP? Why after nearly six decades as a psychologist when he has the health and means to just enjoy life would he still be fighting for psychology. The answer is simple: the profession I love is once again in trouble. Practices are languishing and a malaise has swept over our colleagues. We are in a deep hole and the harder we dig the deeper it gets. We need a fresh, new perspective.
I entered private practice in 1948 during an era when there was no licensure, malpractice insurance or societal recognition of psychology as a profession. For the handful of us who took this bold step it was scary and lonely. We looked to the APA for help to obtain licensure and malpractice insurance, but got a hostile response as our national organization was deeply opposed to the idea of private practice for its members. In desperation we formed the Dirty Dozen, fourteen pioneer activist practitioners who risked everything in a thirty year struggle for professionalism (see R.H. Wright and N.A. Cummings (2001), The Practice of Psychology: The Battle for Professionalism. Phoenix, AZ: Zeig, Tucker and Theisen). We obtained licensure, malpractice insurance and societal recognition of psychology, but it was a mighty struggle.
The battle was fierce, and one example will have to suffice. In 1965 the Dirty Dozen obtained a twelfth hour reprieve from Health, Education and Welfare Department Secretary Joseph Califano, a remarkably sympathetic and responsive cabinet member originally appointed by President John Kennedy. All we had to do was to get a letter to him by Monday (this was now on Friday) from the APA president making the case for the inclusion of psychologists as providers in the newly enacted Medicare program. The APA board of directors was meeting that weekend, and we struggled all day Saturday and most of Sunday to be granted fifteen minutes to present the case. APA President Jerome Bruner steadfastly refused until finally, President-Elect Nicholas Hobbs, persuaded him to grant us a few minutes, which was eventually extended to an hour as the board listened to our plea. It was decided I would remain in Washington Sunday night, draft the letter and have it early Monday morning for Professor Bruner to sign before he flew back to Harvard. I worked all night drafting a suitable letter, typed it myself on APA stationary, and presented it to the APA executive officer at 9:00 a.m. I was assured the letter would go to Secretary Califano by special messenger, and I left to catch a flight home to San Francisco. Several months passed and I got a phone call from Professor Bruner's secretary asking me what I wanted done with the letter to Secretary Califano. We were left out of Medicare! Ironically, in 1990 I testified with Bryant Welch on behalf of APA before the Congressional committee that finally approved psychology's participation after 25 years of being shut out thanks to APA disinterest.
Professional psychology needs to be proactive, not just reactive. Tired initiatives like parity have been meaningless in spite of its being one of the most successful legislative efforts in the history of mental health. Passed in 39 states and embraced by the federal government, we spend less money as a percentage of the total federal healthcare budget today than we did before parity. Third party payers, fearing run-away claims, have instituted more draconian hurdles for mental health than for physical health. In addition, the millions of prescriptions for psychotropic medications written by primary care physicians can be construed to be mental health services. In contrast to the APA's reactive stances, look at the proactive agenda of the NAPPP. It sure looks like today's successor to the Dirty Dozen. This is why I joined the NAPPP with enthusiasm and sit on the board of directors.
Nicholas A. Cummings, Ph.D., Sc.D.
Distinguished Professor, university of Nevada, Reno
President, Cummings Foundation for Behavioral Health
Board Chair, CareIntegra
Former President, American Psychological Association
CummFound@aol.com