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This article discusses the concerns surrounding psychologists prescribing medication, highlighting the importance of medical training and the risks to patient safety. It also addresses the limitations of current scope of practice legislation and offers alternative solutions to improve access to care.
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Scope of Practice:Concerns AboutPsychologists Prescribing [NAME], M.D. [TITLE AND AFFILIATION]
Overview • [BILL NUMBER] • Context of scope of practice legislation • Psychologist prescribing is NOT the solution • The importance of medical training • Psychotropic medication and children • Real solutions to improve access to care
Overview of [BILL NUMBER] • Include a brief overview of the legislation
Partners Opposed to [BILL NUMBER] • List any partners who you are working with to oppose the legislation in your state.
Supporters of [BILL NUMBER] • List any groups that are publicly supporting the legislation in your state.
History of Scope of Practice Legislation • 47 states and the District of Columbia prohibit psychologists from prescribing • Only New Mexico and Louisiana have passed laws giving prescriptive authority to psychologists • No formal study of impact • Few psychologists are prescribing
International Perspective *Only in New Mexico, Louisiana and US Military Source: Lavoie KL, Barone S. Prescription Privileges for Psychologists: A Comprehensive Review and Critical Analysis of Current Issues and Controversies. CNS Drugs, 2006; 20(1): 51-66.
Department of Defense Pilot • In 1992, the Department of Defense implemented a program to train psychologists to prescribe medication. • Trained 10 psychologists to prescribe • Cost more than $610,000 per psychologist = $6 million • Psychologists only allowed to treat active military personnel between 18-65 with uncomplicated cases, and only after patients received full medical evaluation. • Not authorized to treat children or elderly. • Terminated in 1996 • General Accounting Office (GAO) investigation found the program to be too expensive and unneeded. • Recommended that program be discontinued unless psychologists practiced under psychiatrist supervision.
Risks to Patient Safety • Psychotropic medications are the most powerful in modern medicine – they impact all parts of the body, not just the brain. • If improperly prescribed, psychotropic medication can have dangerous side effects: • convulsions • epilepsy • heart arrhythmia • blood disease • seizures • coma • stroke • death
Risks to Patient Safety • Case example: a patient reports that they are lethargic and gaining weight. • These are common symptoms for both depression AND hypothyroidism. • A psychologist is not trained to distinguish between the conditions, leading to possible misdiagnosis and the unnecessary prescription of an antidepressant. • There is a consistent lack of evidence about the safety of granting prescription privileges to psychologists.
[BILL NUMBER] Will Not Improve Access to Care • Psychologists are generally located in the same geographic areas as physicians and psychiatrists. • Will not alleviate the shortage of mental health providers in rural and underserved areas. • Few psychologists have completed training and become licensed to prescribe in NM and LA.
Medical vs. Medication Training • MEDICAL training involves scientific coursework in biology, anatomy, and chemistry, as well as clinical experience in real life settings. • Competence is measured by multiple evaluation methods, including real world observation, to assure one can practice safely. • MEDICATION training involves learning to identify and distinguish between medication types and categories, NOT the biological basis of medical conditions. • Competence is measured by written exams and does not include real world observation. • MEDICAL training would prepare one to distinguish between a mental illness (schizophrenia) and conditions that may mimic a mental illness (brain tumors and thyroid disease). MEDICATION training would not.
Equivalent Years of Biomedical Education and Training for Prescribing Practitioners 2 years child psychiatry training 3 years general psychiatry training 1 year pre- med physical science courses, and 4 years medical school *State laws vary regarding the restrictions on types and schedules of medications that nurse practitioners are able to prescribe. ** Physician Assistants are solely licensed to prescribe under physician supervision. Training Comparison Adapted from the American Psychiatric Association
Psychotropic Medication and Children • Children’s bodies metabolize medication differently than adults. • Children with mental illness can be on more than one medication, creating possible drug-drug interactions. • The wrong treatment plan can cause serious setbacks to a child’s emotional and physical development, or even death.
Prescribing Psychotropic Medication to Children and Adolescents • Prescribing psychoactive medications for children and adolescents requires the judgment of a physician with training and qualifications in the use of these medications in this age group. • Before prescribing medication, a physician does a comprehensive medical evaluation, including: • symptoms • co-morbid psychiatric conditions • co-morbid physical condition • family history • laboratory tests, if necessary
Case Example: The Need for Medical Training • Include an example of a real-life child patient situation from your state in which you felt the training of a child psychiatrist was essential to positive outcomes.
Recommendations • Provide consultative reimbursement between child and adolescent psychiatrists and primary care physicians • Increase the child and adolescent psychiatric workforce: • Provide incentives for medical students to go into child and adolescent psychiatry. • Provide funding to child psychiatry training programs to fund additional residents • Provide funding for the creation of post-pediatric training programs • Increase funding for the overall mental health system
Collaborative Models of Care* Has implemented a collaborative model No known collaborative model Mental Health and Pediatric Collaborative Care Models • Pediatricians are well-positioned to detect mental health problems. • 50% of the treatment for common mental health problems is provided within a primary care practice. • Collaborative models are cost-effective. • The model is used successfully in many other pediatric subspecialties (endocrinology, hematology, neurology). *Please note that this list is not exhaustive and other models may exist. Source: The American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry.
Massachusetts Child Psychiatry Access Project • Provides PCPs with timely access to child psychiatry consultation via telephone. • Designed to support PCPs in managing children with less complex mental health needs, freeing the limited child psychiatry workforce for more complex cases. • Implemented through managed care organization, which contracts with 6 regional academic medical centers.
Massachusetts Child Psychiatry Access Project • Grew out of discussions among Medicaid personnel to find solution to the lack of access to high quality mental health services. • Funded by Massachusetts Department of Mental Health. • Included as a budget line item • Program has enrolled most PCP practices in state, representing 95% of all youth.
State Initiatives to Increase the Child and Adolescent Psychiatric Workforce • Louisiana and Virginia provided stipends to training programs to fund additional child psychiatry residents. • Programs have since been cut from state budgets. • Pennsylvania introduced legislation that would have provided up to $50,000 in loan forgiveness for each year of specialty training in child psychiatry.
Contact Information [NAME] [TITLE, AFFILIATION] [PHONE] [EMAIL]
