A Battle Royale in the Works for Psychiatrists

Psychologists introduce legislation enabling them to prescribe medications By Cheryl England

On Feb. 15, Illinois Senate President Pro Tem Don Harmon (D-Oak Park) introduced SB 2187, a measure that would allow psychologists to prescribe psychotropic medications to patients. Not coincidentally, Rep. John E. Bradley (D-Marion) introduced HB 3074 an identically worded bill to the House. It’s no wonder that groups such as the Illinois Psychiatric Society (IPS) and the American Psychiatric Association (APA) are fighting back—and hard—since patient safety is at stake.

IPS is moving quickly to combat the bills. In less than a month, the group has created a series of YouTube videos of physicians explaining the dangers of non-medically trained practitioners prescribing potent medications; met one-on-one with numerous legislators; developed talking points; and sent alerts to a variety of physician groups throughout the state. Many of the IPS discussion points highlight the fact that because psychologists are trained in social sciences, not medicine, they are ill-equipped to understand interactions between organ systems, much less the interactions between psychotropic medications and other prescription drugs. In addition, the IPS argues, psychologists are unable to spot medical conditions that may cause an altered mental state for which psychotropic medications may be ineffective and even harmful while the underlying condition goes untreated.

Conflict of interest has also reared its ugly head in the drafting of the bills. The bill proposes that after completing their doctorate, psychologists only need an additional 462 hours of training in order to prescribe medications, training that could be as simple as an online course. The training could be conducted by psychologists and oversight of these practitioners would be the responsibility of the psychology licensing board, not the medical licensing board.

The various psychology groups backing the bills are doing their best, however, to bolster their case with an “access to care” scare tactic. They cite the lack of psychiatrists in rural and underserved communities as a key reason the bills should be pushed through the legislature. But IPS President-elect, Linda Gruenberg, DO, pushes back, saying that access to mental health care in a community is not limited solely to the availability of psychiatrists. “Not only can psychiatrists prescribe psychotropic drugs,” she says, “but also internists, family practitioners, and pediatricians.”

In addition, she says, physician assistants and advanced nurse practitioners may also prescribe medications, but they do so only in collaborative agreement with a physician. In both bills, the wording is altered so that psychologists are required to have a “collaborative relationship” with a physician, which could simply be communication after a medication has been prescribed. No contracts between the physician and psychologist are required.

The IPS also notes that telemedicine is yet another solution for access to care concerns. Newer technologies allow physicians to interact face-to-face with patients as well as provide services such as heartbeat monitoring or even eye examinations remotely. In Illinois, telepsychiatry is widely practiced throughout the state by organizations such as the University of Illinois at Chicago, Veterans Administration, Southern Illinois University School of Medicine, the prison system, federally qualified health clinics, and more. Another Senate bill, SB 2366, sponsored again by Senator Don Harmon, is already in the works to require insurers to pay for covered services delivered through telehealth methods.

Proponents of the psychologist-backed bills are working diligently to get the measures passed in Illinois. Only two states so far—Louisiana and New Mexico—have passed similar legislation. Psychologists view Illinois as key to creating a domino effect, opening the door for similar legislation to pass in numerous other states.

The Illinois Senate Public Health Committee, where SB 2187 was assigned, has already voted 8-0 to advance the proposal.