Prescriptive Authority for Psychologists: An Emerging, Exciting Reality

American Society for the Advancement Of Pharmacotherapy Division 55 of the American Psychological Association January, 2008

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.

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

Current RxP/Mental Health Needs

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

Current RxP/Mental Health Needs Child 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

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 illness New mission: civilly committed postsentence sex offenders (Adam Walsh Act of 2006)

James, 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

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)

THE EXISTING SYSTEM

The Existing System Too 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.

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.

THE ALTERNATIVE

The Alternative Psychologists Prescriptive Authority Initiative

Psychologists prescribe in the military. Psychologists prescribe in two states. Psychologists consult on medication management across the country!

The Alternative Psychologists 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

The Alternative Psychologists 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

BUILDING UPON THE YEARS OF TRAINING PSYCHOLOGISTS ALREADY HAVE

Current Requirements for Licensing 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

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.