Monday, February 25, 2008

Should Psychologists Be Allowed to Prescribe?

"We don't have ready access to psychiatrists . . ."
Psychiatrist Calls Proposed Training Hours "Ludicrous."
A State Senate committee has approved a bill that would allow psychologists to prescribe certain medications to patients after attaining a certain amount of additional training.

Supporters of the bill say the legislation would improve patient access to mental health services. They cite a shortage of psychiatrists -- especially in rural areas, like Southwest Missouri. But opponents believe the bill goes to far and could complicate the health of some patients in the longrun.

You can watch the debate in my Monday KY3 News @ 10 report HERE.

The group, Missouri Families for Access to Comprehensive Treatment, notes that House Bill 1739, along with a companion bill by State Senator Jack Goodman, requires psychologists to complete two years of additional training in psychopharmacology as well as to maintain an ongoing relationship with a physician.

Springfield psychiatrist Dr. Julie Warren believes that still won't be adequate.

"The hours that they're talking about for training are ludicrous," Warren said. "The greater risk would be that they delay the treatment that would be really needed." Warren said because of a lack of formal education, psychologists might not notice the patient had other illnesses because they are only trained to look at one system.

Missouri Psychological Association President Dr. Mark Skrade called the battle a turf war that could end up costing everyone more in the long run because patients will end up in emergency rooms. Skrade said the wait for mental health patients to get in to see a psychiatrist can run from weeks to up to nine months.

"We called every psychiatrist office in southwest Missouri and not one would take a Medicaid patient," Skrade said.

Warren said she understands the problem, but disagrees with Skrade's proposed solution. "The problem is limited resources. We're trying to slice up a pie that's too small," Warren said of the resources available for health care professionals who deal with mental health issues.

This is the fifth year supporters have tried to push this bill through. It currently has 85 co-sponsors, and is now awaiting approval from a House committee.


Rebecca said...

Missouri Families for Access to Comprehensive Treatment is a political action committee of the Missouri Psychological Association, hardly a neutral party in the RxP debate. House Bill 1739 and companion Senate Bill 917 do not require psychologists to complete 2 years of additional training in psychopharmacology. If passed, the bills would require "a minimum of at least four hundred hours of didactic education." This is the full-time equivalent of 10 weeks of classroom instruction, not 2 years. Further, the bills require no clinical training. Also, the "ongoing relationship with a physician," i.e. a "written referral agreement" according to language in the bills, fails to stipulate that the physician be a psychiatric physician. Any physician will do. Opposition to HB 1739 and SB 917 is not a "turf war." It is a patient safety issue. Physicians and others who oppose this legislation are undeniably concerned that allowing non-medically trained individuals to prescribe potent medications poses a real and present danger to individuals with serious and persistent mental illnesses. Ask yourself this question: “If I have a medical condition such as high blood pressure, diabetes, cardiovascular problems, who would I rather have prescribe my psychotropic medications – a non-medically trained psychologist or a medically trained physician?”

Tom said...

First, Rebecca, an introduction. I am Thomas Parquette, the state director of MOFACT, Missouri Families for Access to Comprehensive Treatment. Now that you have recited the talking points page of the AMA or the psychiatric associations, lets look at the facts.

First, MOFACT is emphatically NOT a "political action committee" of the Missouri Psychological Association nor a lobbying group of any kind. MOFACT is exactly what the name says it is. It is a group of patients, families, friends and employers with similar interests in improving the access and seamless continuity of comprehensive mental health care in Missouri. These interested persons number into the several thousands from all areas of Missouri.

The additional educational requirements of the legislation before the Senate as SB917 and before the House as HB1739 specifically represent the requirement that psychologists obtain a post doctoral masters degree in psychopharmacology and meet other specific requirements of licensure including reporting and liability.

The requirement of an ongoing relationship with a physician is part of the licensure requirements to address the continued input and availability of consult where deemed appropriate and necessary in recognition of the individual patients medical condition. It is a good and sound addition. That consult need not be a psychiatrist. A consult with a medical doctor is very sufficient and appropriate. Such consult would be on a medical rather than psychiatric level, thus, adding a psychiatric consult would in effect exacerbate the existing problem of lack of access to the psychiatrists in Missouri and create mental health redundancy and added expense.

This issue is not about psychologists, psychiatrists or primary care physicians. It is about the tens of thousands of Missourians who, as a result of the obstructionists such as yourself and your professional organizations, are getting far less than efficient mental health care.

Lets talk about your patient safety issue. A recent national study performed by the School of Psychiatry of the University of California at San Francisco relative to the mental health training which is incorporated into medical school curriculum throughout the country revealed some alarming facts. UCSF found the following;
ONLY 81.5% of medical schools offered psychiatric/mental health programs containing some form of didactic teaching and clinical rotation and of those, only 57.4% required it.
UCSF found further that the average medical school program over a 3 year residency required ONLY an average of 69.5 hours of mental health education over the 3 years with most of this in an outpatient setting.

To use your canned rhetoric, Rebecca, the answer to your final question is clear. If I have a mental health condition and a medical condition, that trained Doctor of Psychology with an advanced degree in psychopharmacology and close to 8 years of mental health focused advanced education is EXACTLY the person I want prescribing for me.UCSF went further and surveyed practicing primary care physicians who reported a "glaring deficit" in psychiatric or mental health training throughout the medical school system and "glaring evidence of inadequate training in diagnosis and treatment of mental health disorders". Tell me about patient safety.

In Missouri alone our suicide rate exceeds the rate of homicide by almost 2 to 1. Our attempted suicide rate is from 10 to 20 times that of the effected suicide rate with the attendant hospitalizations. Of those aged 35 to 69 our suicide rate exceeds even that of motor vehicle accidents as a cause of death. This under the present regulations and lack of access to continuity of seamless care. Tell me all about patient safety.

The American Psychiatric Association did not even acknowledge the term "patient safety" until late 2002 when it formed the American Psychiatric Association Committee on Patient Safety. The formation of which was the result of outrage within factions of the profession who found it untenable that any reporting of medication errors by psychiatrists were largely lacking due to "self policing" and "self reporting" methodology. Many prominent psychiatric journals and publications have yet to acknowledge patient safety or medication errors as a topic of any kind. Tell me about patient safety.

Rather than the talking points you have chosen, Rebecca, why not look at ALL of the pertinent facts without bias and then talk to the people this legislation will effect the most. The patient can and does speak for him or herself.They are not ignorant, or lacking in ability to quantify the elements of the issue before them and effecting them.

Thomas Parquette
state director
Missouri Families for Access to Comprehensive Treatment
Branson, Missouri