The 1999 Surgeon General’s report (Mental Health: A Report of the Surgeon General) revealed that fewer than one-third of all people with a diagnosable mental disorder in the U.S. receive treatment in a given year. And, the 1998 report from the Schizophrenia Patient Outcomes Research Team (PORT) study revealed that fewer than 50% of all people with schizophrenia receive even minimally adequate treatment in a given year. These treatment access problems are even worse for children and adolescents with severe mental disorders.
There are many factors contributing to low rates of treatment and services for people with mental illnesses across the country. One contributing factor is the lack of qualified psychiatrists and other mental health providers in many regions of the country, particularly in rural areas.
One solution proposed to address access to care barriers is to expand prescribing privileges to psychologists. In 2002, New Mexico became the first State to enact legislation expanding prescription privileges to certain psychologists. Emboldened by success in New Mexico, it is anticipated that psychologists will push similar legislation in other states with renewed vigor in 2003 and beyond. In fact, Task Forces to explore the feasibility of expanding prescription privileges to psychologists have been formed in 31 states.
There are many difficult questions that must be addressed as the debate on prescription privileges for psychologists ensures. These include:
- What impact would expanding prescription privileges to psychologists have on the quality of care, safety and well-being of individuals with mental illnesses?
- What amount of academic training, hands-on experience, and clinical supervision and oversight is necessary to adequately prepare psychologists to prescribe psychiatric medications?
- What impact, if any, will expanding prescription privileges have on access to care and quality of care for individuals with mental illnesses residing in rural or under-served regions?
- Should different standards apply to psychologists prescribing medications for the treatment of acute, temporary mental health conditions (e.g. situational depression) versus prescribing medications for the treatment of chronic, severe mental illnesses (which are often compounded by other complex medical conditions)?
- Should psychologists authorized to prescribe medications be limited to prescribing certain medications on formulary or afforded unlimited authority to prescribe all psychiatric medications?
- Are the experiences of other allied mental health professionals with limited prescribing authority in many states (such as physicians assistants and nurse practitioners) instructive in informing the debate on whether psychologists should prescribe?
What outcomes have been derived in current or previous experiences with psychologists prescribing medications (e.g. the Department of Defense Psychopharmacology Demonstration Project, the year old New Mexico law) that can help inform this debate?Prescribing Privileges Task Force Report and Recommendations to the NAMI Board of Directors