Psychological services in health care have expanded beyond traditional areas of mental health to the full spectrum of health disorders, as research has increasingly shown the importance of psychological processes in health outcomes. Behavioural and psychological factors can contribute to the onset, course, or severity of many chronic diseases, and psychology has much to offer with clinically and cost-effective interventions. Good principles of care, involving appropriate assessment, evidence-based interventions, and close collaboration with other health care providers, are vital for effective chronic disease management, but can be difficult to realise given issues of timely access, patient volumes, and availability of psychological services in publicly funded health care. This article provides an overview of psychological interventions in diverse areas of health psychology, with examples of innovative Canadian clinical service delivery models, particularly focussing on integrated screening and treatment for cardiac patients, computerized delivery of insomnia treatment, screening and brief intervention prior to joint replacement surgery, and on-site psychological consultation for family physicians. The case examples, developed and implemented in Winnipeg, Manitoba, demonstrate components for consideration when redesigning psychological service models, such as more systematic approaches to identifying patient needs, stepped levels of care that increase intensity of service relative to need, integration into systems already handling large patient volumes, innovative use of technology, and location of psychological resources "in situ" for timely, brief access. Although still in early stages of development and evaluation, these models show promise for improved access and enhanced ability to deliver psychological service to relevant patient volumes.
This special issue of Canadian Psychology is entirely dedicated to the opportunities and challenges that we face as a profession. The issue includes articles on social media policies and guidelines for psychologists, training in statistics and quantitative methods, ethics and the so-called war on terror, medical aid in dying, and interprofessional collaboration. It also presents data on the situation of graduates in psychology and addresses such important questions as the unique qualifications of psychologists, lobbying and advocacy, and evidence-based treatments. The theme behind all of these articles is without a doubt professional identity. In this introduction to this special issue, the authors argue that psychologists must use what power and influence they have to continue to advocate for those who may not have a voice, and they must improve their practices to better serve the needs of society but also find a way to care for themselves as a profession. Until this is done, psychology will continue to be faced with more challenges than opportunities.
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