Transcript Prescriptive Authority for Psychologists An Emerging

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
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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
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Suicide rates have increased 18% since October 2004
(Brent, Am J Psych 2007. 164; 989-991)
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6-9% of children and adolescents have ADHD (males>females 3-10x)
• Comorbidity:
 Anxiety disorders: 34%; ODD: 40%;
CD: 14%
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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
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Autism Spectrum Disorders; 34 per 10,000
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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
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Largest prison system in the nation
Census continues to grow
Up to 45% of inmates have a diagnosable
mental illness
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
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New mission: civilly committed postsentence sex offenders (Adam Walsh Act
of 2006)
Current Mental Health Needs
The Department of Veterans Affairs
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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
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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
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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
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Psychologists prescribe in the military.
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Psychologists prescribe in two states.
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Psychologists consult on medication
management across the country!
The Alternative
Psychologists Prescribing in the Military
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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
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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
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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
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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
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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
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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.