Lubbock Avalanche Journal
By: Josie Musico
Consider granting specially-trained psychologists the authority to write prescriptions, Rep. Dustin Burrows urges his fellow state lawmakers.
In the mental health profession, prescription privileges are limited to licensed psychiatrists. The Lubbock Republican filed a bill Dec. 13 that would change that.
“I’ve heard from multiple groups we have a lack of numbers of psychiatrists available, and part of the solution is to allow highly-trained psychologists to prescribe medication to their patients,” he said.
Burrows’ proposal, House Bill 593, would allow psychologists to prescribe medication if they’ve met certain criteria. Before they independently write prescriptions, those mental-health providers would have to complete two years of biomedical sciences training, a nationally standardized exam in psychopharmacology and a year of supervision by a physician.
“I support this bill because it’s going to provide more of what the citizens of Texas need, which is appropriate mental health medications,” Dr. Cheryl Hall said. From her office in Southwest Lubbock, the clinical psychologist described a patient demand for mental-health medication and a shortage of psychiatrists.
The Lone Star State’s psychiatric community, on the other hand, has concerns.
“We are very much opposed to this,” said Dr. Debra Atkisson in a phone interview. “It’s unsafe for patients — it really is.”
Atkisson is chairwoman of the Federation of Texas Psychiatry and a practicing psychiatrist in Fort Worth.
Pychologists are professionals who has completed a doctorate in the psychological field. Psychiatrists are medical doctors who specialize in mental disorders.
Atkisson, for instance, graduated in 1986 from Texas Tech’s medical school, then underwent four years of training in mental health. Next came two extra years training in child and adolescent psychiatry.
But you can’t become licensed overnight as a clinical psychologist, either. The doctorate can take about six years; training for presciption privileges would take an extra three years.
“We take very intensive training,” Hall said.
Atkisson considers medical school graduation a major difference between the two professions.
“I very much respect my colleagues in psychology — they’re excellent in providing talk therapy and doing psychological testing — but they are not trained to provide medical care … They have half the number of years of training we do, and their training is based on very different things.”
Atkisson emphasized the potential for misdiagnosis if a mental health professional lacks knowledge of overall medicine.
For example, she recalled a case in which a psychologist colleague diagnosed a 10-year-old boy with attention-deficit hyperactivity disorder, and told his mother he needed Ritalin. Because the psychologist was not legally allowed to write the prescription, she referred the family to Atkisson.
Atkisson’s exam led her to suspect the child’s difficulty in focus and attention could be caused by a brain disease or seizure disorder, so she referred him to a pediatric neurologist.
The neurologist found the cause of his ADHD-like behavior was a brain tumor. The neurologist was relieved the boy did not take Ritalin.
The scare reinforced Atkisson’s support for comprehensive medical knowledge for prescription privileges.
But while psychiatrists worry their counterparts in psychology don’t have enough medical training to prescribe medicine, those psychologists fear too many prescriptions for mental-health medication come from doctors with limited background in mental health.
Burrows’ bill claims roughly 80 percent of prescriptions for mental health medications come from general-practice physicians or nurse practitioners with limited mental-health training.
Dr. Michael Ratheal, a Lubbock clinical psychologist, recently responded to a call from the local medical school’s pediatric department. The erratic behavior of a patient, an 8-year-old girl, at first seemed synonymous with a movement disorder. Ratheal spent time with the patient, then offered a correct diagnosis: paranoid schizophrenia.
Ratheal and Hall can only speculate the time, hassle and taxpayer dollars they could save by writing a prescription for the girl’s treatment themselves.
“I would have got her on medicine immediately, and she would not have to go to the hospital, which is traumatic and unnecessary,” Hall said.
Ratheal and Hall point out that in the military and the four states that already allow prescription privileges to trained psychologists — New Mexico, Louisiana, Illinois and Iowa — those psychologists have received no malpractice suits.
“Basically, there’s no evidence that we are not safe and effective providers,” Hall said.
Hall and Ratheal also clarified if the bill passes, they will not prescribe opioids.
The situation with Ratheal’s young schizophrenic patient gets worse: Her family had been in the process of moving to a rural Panhandle county where no psychiatrists are in practice.
An American Medical Association map shows a few practicing psychiatrists in Lubbock and Hale counties, but none elsewhere in A-J Media’s rural coverage area. Statewide, the Texas Department of State Health Services’ Mental Health Shortage Report designated 207 of 254 counties as shortage areas.
And in locales with practicing pyschiatrists, seeing one isn’t always quick. A spokeswoman from Texas Tech Physicians Psychiatry, for instance, told A-J Media her clinic has a three-month wait for new patients. “There’s a crisis in the state right now — there just aren’t enough psychiatrists to go around, and they’re overwhelmed,” Hall said.
Texas psychiatrists say the solution, though, is to recruit more psychiatrists.
Atkisson, the Fort Worth psychiatrist, supports Texas Senate Bill 239. That bill would help with student loan repayments for certain mental health professionals.
Other ideas could include the collaboritive care model, in which professionals in areas work closer together, and telemedicine, in which patients videoconference with doctors. “We have a blueprint already; it’s just a matter of the Legislature using what we already have in place and getting appropriate funding for it,” Atkisson said.
Meanwhile, psychologists see the bill as vital for their patients.
“The need is desperate,” Ratheal said. “If this legislation doesn’t pass, these underserved people remain underserved. There’s not a backup plan.”