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Mental Illness: RxP to the Rescue

The deregulation answer to inadequate access

Who says bipartisanship is always a bad thing? In Colorado, a Democratic governor has signed a bill sponsored by two Republicans and two Democrats that has solid potential to boost access to services for the mentally ill.

In most states, because they are not medical doctors, psychologists are legally barred from authorizing pharmaceuticals for their clients. Jeffrey A. Singer, an Arizona-based physician and senior fellow at the Cato Institute, explained the resulting harm:

The 45 states with complete bans on psychologists prescribing medications impose regulations that reduce access to mental health care and leave patients less safe. They reduce access by limiting the number of competent mental health practitioners who can prescribe medications. They leave patients less safe by allowing clinicians with less training to prescribe psychotropic medications but prohibiting clinical psychologists with more training from meeting that need. States permit primary care doctors, general surgeons, orthopedic surgeons, and other surgical specialists to prescribe psychotropic medications despite the fact that they have little knowledge or experience treating mental health problems. Those 45 states incongruously allow clinicians with less expertise to prescribe while prohibiting those with more expertise from prescribing. They prohibit [psychologists] who have passed a national exam on pharmacology from prescribing but impose no barrier to prescribing by medical doctors, and in some cases by nurse practitioners and physician assistants, who have not passed that exam.

In the late 1980s, the U.S. Department of Defense began an experiment in which “DoD psychologists” received “intensive postdoctoral training in a congressionally authorized program” that allowed them “to prescribe psychotropic medications.” The door had swung open for the prescriptive authority for psychologists, or “RxP,” movement.

Progress has been slow, but encouraging. In the late 1990s, Guam became the first U.S. territory to legalize RxP. A few years later, New Mexico — just about the last state one would to look to for policy innovation — followed. Then came Louisiana, Illinois, Iowa, and Idaho. Colorado is now #6.

No two states have the precisely the same regulatory schemes. In Idaho, psychologists can obtain a “two-year provisional certificate to prescribe under the mandatory supervision of an MD” after completing “a postdoctoral master of science degree in clinical psychopharmacology” and a “supervised practicum in clinical assessment and pathophysiology,” as well as passing “a national examination.” In Colorado, a psychologist must

get a master’s degree in clinical psychopharmacology, pass a national psychopharmacology exam, complete 750 hours of prescribing practice under a supervising physician, be approved by the state boards of psychology and medicine, and complete 40 hours of continuing education in psychopharmacology every two years. In addition, the psychologist would have to maintain their current psychology license, malpractice insurance and psychology-based continuing education.

All evidence suggests that permitting psychologists, given appropriate training, to prescribe mental-health medications is safe. And the need has never been greater. Singer noted that even before COVID-19, resources were stretched thin, and “government‐mandated lockdowns increased isolation, anxiety, and despair while also reducing access to mental health services.” (A recent poll found that “approximately 40 percent of Americans said they could not get mental health services in the past 12 months, particularly services requiring drug‐based therapy.”)

On Mental Health America’s Access Ranking, Arizona scores a dismal 45th. The Grand Canyon State’s Senate Bill 1457 empowers psychologists to write prescriptions. It’s currently under consideration in the House, after being approved by the upper chamber with bipartisan support. Beginning to see a trend?

By D. Dowd Muska

Dowd brings nearly 30 years of research and writing experience to the Institute. A veteran of several think tanks, he is an expert on government at the municipal, county, state, and federal levels.

Raised on an apple orchard in the Connecticut River Valley, D. Dowd Muska is a researcher, writer, editor, and commentator. His focus is the nexus of fiscal policy, economic development, and technology.

Mr. Muska is the author of numerous policy studies, and his writing has appeared in newspapers throughout the nation, including the Las Vegas Review-Journal, The Detroit News, the Orlando Sentinel, the Cape Cod Times, the Santa Fe New Mexican, the Hartford Courant, the Waco Tribune-Herald, the Albuquerque Journal, the New Haven Register, and The Oklahoman. A graduate of The George Washington University, he lives in the Albuquerque metro area, but has started (very) early planning for a relocation to the Sierra Blanca in Lincoln County, New Mexico. He recently launched the Substack platform No Dowd About It.

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