NAMI Illinois Rejects Psychologists’ Attempts to Gain Prescription Privileges

[HereSince1628]

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Illinois is the latest state to hand psychologists seeking prescription privileges a defeat, with NAMI Illinois siding on the side of not supporting the bills in front of the Illinois legislature. After intense lobbying by both sides of this issue, they concluded, “NAMI Illinois opposes SB 2187 and HB 3074 in its current form to expand prescriptions privileges to psychologists.”

When will psychologists learn?

The movement that is supported by some psychologists to gain prescription privileges is called RxP. The rationale behind the movement is that, in some communities in the U.S., psychiatrists are few and far between. With too few psychiatrists, patients often have little choice but to wait weeks or months for an appointment, or travel long distances to see another psychiatrist. Psychologists argue that their existing training prepares them to take an additional set of courses (which can be taken exclusively online) and training (supervision under a physician) that results in them being high-quality prescribers — equivalent to a medical doctor.

NAMI Illinois’ statement is worth a read, so we’ve posted a copy of it here. But here’s a highlight:

"If we don’t fully address integrated health care needs, mental health needs become moot if people continue to die so early from physical causes. NAMI Illinois cannot advocate for the creation of more silos that hinder full integration of physical and mental health care needs. "

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[Duer 157099]

1. Somehow this slipped under the radar of big pharma

I would have thought they'd have their lobbyists all over this. Weird.

[HereSince1628]

2. There is a multi-state effort on to gain prescibing privileges to non MD therapists.

IMO, a computer algorithm can do reasonably well at this sort of work, so there is really no reason why, with proper training a PhD couldn't learn how to do this. Other areas have expanded prescription powers...at the Milwaukee V.A. I don't see an MD for cholesterol Rx's, rather my prescriptions are written by PhD pharmacist interns working under an experienced pharmacist.

From a perimedical point of view, the politics of medicine involve a lot of artificial delineations. One of the seriously harmful delineations is the artificial separation of mental health from medicine.

The problems with that go well beyond mere protecting of profitable positions within the healthcare marketplace. It creates an illusion that mental illnesses are something distinct from medical illnesses and that they don't deserve, or receive, equivalent treatment from health care funders.

So NAMI's position is complex. On balance the NAMI Illinois folks have decided that insisting that prescribing psychiatric medication be a role of an MD is in the best interest of integrating medicine and psychiatry.

[dixiegrrrrl]

3. "the artificial separation of mental health from medicine. "

" It creates an illusion that mental illnesses are something distinct from medical illnesses"

PLUS
Physical problems can create "Mental Health" problems and vice versa, yet I have met very very few Mental Health docs who routinely ruled out any physical problems or even took a lengthy social history which would point to family illness history.
A good social history and eval. workup takes time, at least an hour, which can cut into billing hours, don'tcha know.

[HereSince1628]

5. I can't speak beyond my personal experience

The APA certainly placed caveats within the DSM often stating something to the effect not better explained by a medical condition.
And Axis III was recognized as 'medical' conditions that contribute to symptoms of mental illness.

My personal experience was that I did have to undergo a medical exam prior to V.A. mental health outpatient care.

I don't know about different providers/insurers but it seems that evaluation sessions do also get billed.

I was not part of it, but have been told that during the late 90s and early 2000's there was a pattern of 'fast therapy' which basically was do what you can in 10 visits and then clients were on their own. I can understand that trying to shoe-horn all treatment into such constraints could result in short-cuts

[dixiegrrrrl]

7. I worked for a long time in Mental Health.

I watched insurance cut down inpatient stays from 28 to 21 to 18 to 14 days,
so moved over to outpatient, which, at the time, insurance was supporting since it cost much less than inpatient.

The inpatient facilities did full physical workups, including labs.
The outpatient programs, in different centers, rarely even referred to medical unless the client was already under dr. orders, but I never once had a physician contact me about the patient's mental health treatment, even when our center prescribed drugs on top of what the dr. was prescribing.
The ONLY except to this was when I worked with two drs, from India, who had to work at non-profit centers as part of their visa program.
THOSE guys were extremely good at holistic health approaches, tho they did tend to be a bit brusque with the mostly all female staff.
In all the time at outpatient, rarely was the "medical condition" aspect of the Mental health diagnosis addressed in staffing or on the charts.
Axis 3 would be noted, in the profile and 5 Axis diagnosis, but after than,rarely was mentioned.
Used to drive me crazy, since I was very much into holistic work.

Interestingly, at the rural clinics I preferred to work in, I did not see a lot of insurance driven treatment limits.
We DID have high non-compliance with all but the very seriously mentally ill, tho, so perhaps treatment limits did not have a chance to factor in very often.

[Sgent]

8. Most psychiatrists I know of do perform a medical workup

they usually don't perform physicals (none I know take referrals from sources other than MD's / NP's who have already performed that), but do tend to eliminate endocrine, thyroid, nervous system, etc. issues -- I've even seen them order some more esoteric tests when they thought it warranted, including specialized labs, CT's / MRI's, etc.. They also have a lot more training in monitoring side effects including medical interactions and possible true side effects -- cholesterol and liver problems, development of diabetes, treatment of thyroid issues along with psychiatric issues when warranted, etc.

In addition, the have expertise in neurology that psychologists do not -- including training in dealing with concurrent issues (dementia vs. depression or psychosis). Remember in most residencies psychiatry and neurology have the same program for the first 18 mos to 2 years.

Having worked in a CMHC, CHC's, and with a large cross section of behavioral issues from social workers, LCSW's, clinical and educational psychologists, family physicians, nurse practitioners, and psychiatrists, my vote would be to leave the physicians in charge of medical treatment -- including prescriptions. Family physicians a fair amount of training in mental health (more than psychiatric np's for instance), and are adequate for most outpatient treatment. Psychiatric NP's and internal medicine doc's don't usually have as much training, but are certainly capable of managing and monitoring based on a plan of action from a specialist. For brittle cases or inpatient care a specialist is obviously warranted.

[bananas]

4. link

http://psychcentral.com/blog/archives/2013/04/06/nami-illinois-rejects-psychologists-attempts-to-gain-prescription-privileges/

[HereSince1628]

6. Thanks, my mistake