Psychologists Want Prescription Permission, Insurers Doubtful

In a major paradigm shift in mental health care, American psychologists are formally asking for the ability to prescribe psychotropic drugs for the mentally ill patients under their care. Considering the fact that, statistically, more than a fourth of American adults in any particular year have some form of diagnosable mental health issue (such as bipolar disorder and depression), yet less than half receive treatment for it, the request is neither unreasonable nor misadvised.

Under current regulations, psychologists are not permitted to prescribe psychotropic medications: only those with a medical doctorate degree have that ability, except in a few parts of the country. Whether it is a psychiatrist or podiatrist, an MD gives license to prescribe powerful mental health medications, whereas psychologists cannot. The American Psychological Association and many state and local trade associations for psychologists claim that if they were allowed to prescribe the proper drugs to those under their care that the number of untreated mental health issued would drop dramatically.

According to recent studies, many of those who avoid treatment for mental health problems do so for two main reasons. The main reason cited is the stigma associated with seeing a psychiatrist: “shrinks” are perceived with mistrust. Psychiatrists are holders of a medical degree (MD) in mental health, although they rarely see patients in a therapeutic setting. The majority of people who do receive prescriptions of mental health medications receive them from their primary care physician, usually a general practitioner, because they feel comfortable discussing such personal issues with that doctor, who has treated their other problems.

The second reason is access to service providers who are authorized by their insurance companies. Access to psychiatrists is difficult in rural areas, and even when a psychiatrist is available the wait to see them is significant. The Tennessee Psychological Association released the results of a recent study which claims that the average wait to see a psychiatrist for a non-emergency visit by residents of Tennessee was 54 days for those with private insurance and 90 days for those with TennCare, Tennessee’s Medicaid provider.

“It’s a huge access issue,” says Katherine Nordal, who is the executive director of professional practices at the AMA.

As many people with mental health issues discuss their problems with their GP, who has few local options for referrals or the wait is too long for a particular patient, this means prescription of psychotropic drugs by a physician who is not well-versed in the field. The increase in prescriptions of these kinds of drugs has been steady in the past several decades, and the rates of suicide attributed to under- or over-medication of psychotropic meds could easily be attributed to incorrect prescription of these potent and misunderstood drugs.

Psychologists, who have to attend a university to receive their doctoral (but not MD) degrees, are much more abundant. They specialize in talk and therapeutic behavioral programs, and are not able to prescribe mental health meds except in New Mexico, Louisiana, the military, and in Indian Health Service clinics. In order to receive licensure to dispense psychotropic drugs psychologists must receive the equivalent of a second master’s degree in psychopharmacology, a much more advanced training program than that received by a pediatrician or dermatologist, who has no similar roadblocks in issuing prescriptions.

Psychiatrists are not usually active participants in the treatment of their patients, as psychologists are, through talk and behavioral therapy. A national study presented the fact that only 10.8% of psychiatrists offer any other kind of treatment to their patients other than pharmacological treatment, which although effective is not always enough. The pairing of therapy and medications is the most effective treatment protocol for almost every mental illness.

This issue has been recently thrown into the forefront due to the recent health care reform regulations, which will give approximately 32 million American mental health coverage; there will be a shortfall of psychiatrists to treat these people of at least 45,000 by 2020, which could conceivably be met by qualified psychologists. Under the old health care system, psychotropic drugs were usually covered, but therapy rarely was—although psychological care is much more accessible and cost-effective, when compared to psychiatric care.  The over-reliance of psychiatrists upon psychotropic meds drives up health care costs, while the inability of psychologists to prescribe them limits their ability to give complete care.

The solution can be found in a more effective integration between primary and mental health care, a more holistic and comprehensive view of overall well-being. Since a universal health care system must emphasize preventive care, the fact that people with chronic, expensive illnesses such as diabetes, cardiac problems, and asthma are much more likely to also have mental health issues, and that people with serious mental problems die 25 years earlier than those without.