Jeffrey A. Singer
Almost exactly one year after Colorado became the sixth state to allow mental health patients access to doctorate‐level prescribing psychologists (RxPs), Utah lawmakers passed SB 26, which grants that freedom to Utahns. The bill has gone to Governor Spencer Cox’s desk for his expected signature.
As I explained in a 2022 Cato briefing paper, RxPs have been providing medication‐assisted psychotherapy in the US Military Health System, US Public Health Service Commission Corps, and US Indian Health Service for more than 30 years. In 1999, the territory of Guam granted its residents access to competent doctorate‐level clinical psychologists trained to prescribe mental health meds to their patients. New Mexico became the first state to grant its patients access to RxPs in 2002, followed by Louisiana in 2005, and, subsequently, Iowa, Idaho, Illinois, and Colorado.
While prescriptive authority laws vary by state, they generally follow the guidelines the military health service developed in the 1990s: clinical psychologists with PhD or PsyD degrees must obtain a two‐year Master’s Degree in Clinical Psychopharmacology (MSCP), which includes supervised clinical experience, and pass a standardized Psychopharmacology for Psychotherapists Exam (PEP). Next, they get a provisional license that allows them to practice under the supervision of a licensed prescribing health care practitioner for two years. When they complete those two years, they receive an unrestricted license. Utah lawmakers have adopted similar requirements.
As explained in the briefing paper, the US has a worsening shortage of mental health care practitioners. Clinical psychologists significantly outnumber psychiatrists. Roughly half of psychiatrists don’t accept health insurance. One recent study shows less than 11 percent of psychiatrists engage in talk therapy these days—most practice pharmacotherapy.
In most states, if clinical psychologists engaging in talk therapy determine their patients need adjunctive medication to facilitate treatment, e.g., antidepressants, governments require them to refer their patients to a licensed prescribing health care practitioner for the prescription. This makes it more costly and inconvenient for many patients and fragments their care.
Psychiatrists are often unavailable and, if they are, may not accept insurance. In such cases, psychologists may refer their patients to any other licensed prescriber. Among licensed prescribers that state governments authorize to prescribe psych meds are general surgeons like me, orthopedists, OB‐GYNs, and ENT doctors.
States also permit family physicians, nurse practitioners (NPs), and physician assistants (PAs) to prescribe mental health meds. In most cases, clinical psychologists who have taken the additional training that RxPs must undergo know more about clinical psychopharmacology than doctors, NPs, or PAs.
A study published last summer found a statistically significant drop in suicide rates in New Mexico and Louisiana (the two states with the oldest RxP laws) after they granted competent clinical psychologists prescriptive authority.
The American Medical Association and the American Psychiatric Association have long opposed expanding appropriately trained clinical psychologists’ scope of practice to include prescribing mental health meds. The AMA boasts to members about its ongoing battle against what it calls “scope creep.”
The American Psychiatric Association voices concern that the additional didactic and clinical training RxPs undertake is not enough for them to safely prescribe. It’s curious, therefore, that the American Psychiatric Association doesn’t lobby state lawmakers to restrict physicians who are in other medical specialties, such as the surgical specialties, Ob‐Gyn, cardiology, and family medicine, from prescribing mental health meds. Doctors in these fields rarely receive didactic or clinical training in clinical psychopharmacology that begins to approach what RxPs must complete.
In October 2022, I moderated an online event with prescribing psychologists and the American Psychiatric Association President, discussing this and other issues in greater detail. You can watch it here.
For decades, organized medicine’s entrenched incumbents have successfully dissuaded state lawmakers from granting prescriptive authority to competent psychologists. But, as the country’s mental crisis worsens, government walls blocking access to mental health care are starting to crumble.
Now Utah joins the list of states making it easier for people to get access to medication‐assisted mental health services.
