How to expand access to mental health care in Texas without spending tax dollars
Ranked Texas the last among the 50 states and the District of Columbia in accessing mental health services, according to a recent study by Mental Health America.
With such a shoddy record, the recently convened Texas legislature will inevitably debate Whether to increase funding for mental health. But simply pouring more money into the system isn’t necessarily the best way to boost results.
In fact, one way to increase access to mental health services without spending any taxpayer dollars was enacted by Texas’ neighbor to the west, New Mexico, two decades ago. Texas’ neighbor to the east, Louisiana, embarked on a similar program 17 years ago. Both removed barriers to clinical psychologists’ ability to prescribe medication.
As in most states, Texas require Clinical Psychologists to earn a PhD in Psychology—which averages five years of graduate study—which must include at least 1,750 hours of supervised clinical training, completion of at least another 1,750 hours of postgraduate training, and passing a proficiency test Consolidated in order to obtain a license. Unlike many other states, Texas also requires clinical psychologists to pass a jurisprudence exam.
Clinical psychologists diagnose mental health problems and participate in talk therapy. Under current Texas law, if their patients require medication to facilitate psychotherapy, psychologists must refer them to licensed prescription medications, most commonly to a psychiatrist.
Nowadays, this is not so easy. Almost half Psychiatrists do not accept insurance. An initial visit with a psychiatrist is possible cost As much as $500, and follow-up visits range from $100 to $300 an hour. At present, less than 11% Few psychiatrists engage in talk therapy – instead, they primarily practice drug therapy.
Suppose psychiatrists are too far away, too expensive, or too reserved to see clinical psychologist referrals? In this case, psychologists can always refer patients to a primary care practitioner or another licensed physician—even a general surgeon like me—to prescribe medications for mental health. In some cases, the psychiatrist may know more about the medication, dosage, and side effects than the practitioner writing the prescription.
But in Texas, only licensed doctors can prescribe psychiatric medications.
As I explain in my Briefing paper From the Cato Institute, the Department of Defense began a pilot program in the 1990s to expand the workforce for prescribing military mental health providers. They have developed a program, supervised by psychiatrists, that teaches clinical psychologists psychopharmacology and trains them to medically manage mental health problems. It’s been so successful that today’s prescribing psychologists — or RxPs — treat patients on commissions from the US Public Health Service and Indian Health Service.
Impressed by how RxPs can increase access to medically assisted mental health care, the territory of Guam licensed prescribing psychologists in 1999. In 2002, New Mexico became the first state to allow competent clinical psychologists to prescribe psychiatric medications.
Three years later, Louisiana followed suit. That state’s licensing board calls RxPs “medical psychologists.” In the years since, states as diverse as Idaho, Iowa, and Illinois have removed regulatory barriers to prescribing psychologists.
Each of the five states psychologists may describe has different licensing requirements. However, they all require RxPs to have accredited graduate-level training in clinical psychopharmacology (usually a master’s degree), an internship, or some other form of hands-on clinical experience treating mental health problems with medication and pass a pharmacology exam The Unified Psychiatry for Psychologists.
New Mexico has the fewest barriers of the five states currently described by competent clinical psychologists. The state requires RxPs to have at least 450 hours of postdoctoral instructional instruction and 400 hours of clinical experience in clinical psychopharmacology. Unlike Illinois, New Mexico avoids extraneous educational and clinical experience requirements. The state allows RxPs to practice independently but only after they have been supervised by their primary care provider for two years.
Appointing clinical psychologists has a nearly 30-year track record of providing skilled, comprehensive mental health care to people with mental illnesses. Amid growing mental health needs and a lack of mental health resources, Texas lawmakers will find that removing barriers to psychologists prescribing medication is a free way to help improve access to mental health care.
Jeffrey A. Singer, MD, practices general surgery in Phoenix and is a senior fellow at the Cato Institute. This column was written for the Dallas Morning News.
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