Prescriptive Authority for Psychologists: An Emerging, Exciting Reality

1. Prescriptive AuthorityforPsychologists:An Emerging, Exciting Reality American Society for the Advancement Of Pharmacotherapy Division 55 of the American Psychological Association January, 2008

2. Psychologists Prescriptive Authority Initiative Vision Statement Properly trained psychologists have successfully prescribed psychotropic medications for the past 15 years. Prescribing psychologists will improve access to safe, high-quality care for underserved populations.

3. Psychologists Prescriptive Authority Initiative Goals • Prescriptive authority for properly trained doctoral-level psychologists in all 50 states and U. S. territories • Better integration of psychotherapy and pharmacology • Less overmedication/polypharmacy • Improved monitoring of compliance and side effects • Greater access to mental health care

4. Current RxP/Mental Health Needs

5. Current RxP/Mental Health Needs Suicide • 2004 suicide rates: • Persons 35-64 years: 12.6 per 100,000 • Persons ≥ 65: 12.1 per 100,000 • About half of all suicides involve a documented mental health diagnosis, most commonly depression. • Physical health problems, most commonly in older adults, contributed to approximately 24.9% of the suicides. Source: (2006, July 7). Homicides and suicides -- National Violent Death Reporting System, United States, 2003-2004. MMWR Weekly. Retrieved on September 22, 2007, from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5526a1.htm

6. Current RxP/Mental Health NeedsChild and Adolescent Needs • Suicide rates have increased 18% since October 2004 (Brent, Am J Psych 2007. 164; 989-991) • 6-9% of children and adolescents have ADHD (males>females 3-10x) • Comorbidity: • Anxiety disorders: 34%; ODD: 40%; CD: 14% • Tic Disorders: School age children 15-20% have transient tics in lifetime • 7% of students in Special Education met criteria for Tic Disorders Kurlan, McDermott, Deeley, Como, et all. Neurology, 2001: 57:1383-1388 • Autism Spectrum Disorders; 34 per 10,000 • Yeargin-Allsopp, M., Rice, C., Karapurkar, T., Doernbeg, N., Boyle, C., & Murphy, C. (2003). Prevalence of autism in a US Metropolitan area. JAMA, 289, 49-55. • 72% of pediatric patients with Autism have sleep problems compared to 45% for “normal” children

7. Current RxP/Mental Health Needs The Federal Bureau of Prisons • Largest prison system in the nation • Census continues to grow • Up to 45% of inmates have a diagnosable mental illnessJames, D.J. & Glaze, L.E. (2006, September). Mental health problems of prison and jail inmates (Bureau of Justice Statistics Special Report NCJ 213600). Washington, DC.: National Criminal Justice Reference Service • New mission: civilly committed post-sentence sex offenders (Adam Walsh Act of 2006)

8. Current Mental Health Needs The Department of Veterans Affairs • It is estimated that 32% of current war heroes will seek VA healthcare • Nearly 20% of returning vets have suffered brain trauma, spinal injuries or amputations; another 20% have suffered other major injuries such as blindness, partial blindness or deafness, and serious burns. • 36% have been treated for mental disorders, particularly PTSD (about 30,000 soldiers). • Soldiers Returning from Iraq and Afghanistan: The Long-term Costs of Providing Veterans Medical Care and Disability Benefits - Linda Bilmes, John F. Kennedy School of Government - Harvard University, January 2007 (RWP07-001)

9. THE EXISTING SYSTEM

10. The Existing SystemToo Few Psychiatrists • Shortage of psychiatric care (Hartley et al., 1999): • 14.6 psychiatrists per 100,000 in urban areas, 3.9 per 100,000 in rural areas • 20 psychologists per 100,000 in urban areas, 15 per 100,000 in rural areas Hartley, D., Bird, D.C, & Dempsey, P. (1999). Rural mental health and substance abuse. In T.C. Ricketts III (Ed.), Rural health in the United States (pp. 159-178). New York: Oxford University Press.

11. The Existing System Relying on Primary Care • Reliance on primary care: • Primary care providers (PCPs) write 70% of prescriptions for psychotropics (Beardsley et al., 1988).* • 50% of office visits where psychotropics were prescribed involved PCPs, 25% involved psychiatrists (Pincus et al., 1998). Pincus, H.A., Tanielian, T.L., Marcus, S.C., Olfson, M., Zarin, D.A., Thompson, J. et al. (1998). Prescribing trends in psychotropic medications: Primary care, psychiatry, and other medical specialties. JAMA, 279, 526-531. • According to the American Journal of Psychiatry, only 17% of all psychotropic drugs are prescribed by a psychiatrist.

12. THE ALTERNATIVE

13. The AlternativePsychologists Prescriptive Authority Initiative • Psychologists prescribe in the military. • Psychologists prescribe in two states. • Psychologists consult on medication management across the country!

14. The AlternativePsychologists Prescribing in the Military • The Department of Defense Psychopharmacology Demonstration Project (PDP), initiated 1991 • 1991-1997: 10 psychologists trained to prescribe psychotropic medications • 1997: program ended because of political pressures • Several original graduates still prescribing • Independent evaluations from three separate agencies concluded PDP graduates were • Safe, effective, & efficient in delivering care • Appreciated by their supervisors & PCPs • Specifically requested to fill positions

15. The AlternativePsychologists Prescribing in Two States • One U.S. territory (Guam) and two states (New Mexico and Louisiana) have approved prescriptive authority for psychologists • New Mexico: March 2002 • Louisiana: May 2004 • So far, 16 other states have submitted bills • No evidence of highly adverse or life threatening outcome

16. BUILDING UPON THE YEARS OF TRAINING PSYCHOLOGISTS ALREADY HAVE

17. Current Requirements forLicensing as a Clinical Psychologist • Ph.D., Ed.D. or Psy.D. from an accredited program • Clinical internship • Two years of supervised practice • National board exam • State board exam

18. Summary • Properly trained psychologists can prescribe safely and have been doing so for 15 years. • Prescribing psychologists have increased access to services and improved quality of service for underserved patient populations. • Prescribing psychologists will meet the need for the decreasing number of psychiatrists in the very near future. • Prescribing psychologists will meet and exceed current standards for safety and efficacy.