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Pro-con: Should specially trained psychologists write prescriptions?

Victoria Advocate - 2/6/2017

Feb. 06--One hundred and eighty-five out of 254 Texas counties do not have a psychiatrist, according to a report by the Hogg Foundation for Mental Health.

And the number of psychiatrists in the Crossroads can be counted on one hand.

Sheila Schmidt used to drive more than 100 miles to see one every few months.

"It was really an all day thing," said the Victoria resident, who has had depression for much of her life. "It was difficult not being able to be taken care of locally. ... I think everybody, no matter what kind of health care it is, wants to be taken care of locally."

To address a shortage of psychiatrists, State Rep. Dustin Burrows, R-Lubbock, filed House Bill 593. It gives the ability to prescribe mental health medication to psychologists who complete a postdoctoral training in psychopharmacology, ace a nationally recognized exam and meet other criteria.

Some psychologists are willing to step up, while their counterparts think this measure could be dangerous.

PRO: Psychologists could prescribe medication safely

The clinical psychologist behind House Bill 593 can tell the difference between a thyroid disorder and depression, which have similar symptoms.

That's why Cheryl Hall, who has practiced in Lubbock for about 20 years, is confident specially trained psychologists can prescribe medication safely.

"In all the states where psychologists have been prescribing and in the military, there have not been any malpractice suits," she said, "and that's a lot of years because the military has been prescribing for twenty-five."

Hall, the president-elect of the Texas Psychological Association, asked State Rep. Dustin Burrows, R-Lubbock, to carry HB 593. She pointed out that the only controlled substance psychologists would prescribe under HB 593 is needed to effectively treat Attention Deficit Hyperactivity Disorder.

HB 593 would not give psychologists the ability to prescribe opioids, which are not used to treat mental health disorders, she said.

And this isn't the first time the Legislature will be asked to decide whether specially trained psychologists should write prescriptions.

In 2003, State Rep. Richard Joel "Rick" Noriega introduced HB 3451, which is similar to HB 593. HB 3451 was left pending in the Public Health Committee, though.

Hall thinks this time will be different because the need is more urgent and on Texans' minds.

Burrows, who serves on the House County Affairs Committee, has heard repeatedly from constituents about the shortage of psychiatrists. HB 593 is a cost-effective way to address that, he said.

Additionally, Hall thought efforts to attract psychiatrists to underserved areas by assisting them with their student loans were good, but didn't go far enough.

She estimates that if HB 593 were to pass, 125 psychologists would earn the privilege of writing prescriptions and be able to help people with mental illness living in underserved areas.

Hall earned a postdoctoral master's degree in clinical psychopharmacology in 2001. If HB 593 passes, she'd need to complete an additional year of training and ace an exam before she'd be eligible to write prescriptions.

"I think we have to be creative to find as many solutions as we can," Hall said. "Psychiatrists do good work, but there's just not enough of them, and the wait lists are too long. We're not trying to compete with psychiatrists at all. We know they're still going to have plenty of work."

Con: Televideo could address shortage

Psychologists have different educational backgrounds from psychiatrists and that doesn't prepare them to write prescriptions, Dr. Leslie Secrest said.

Secrest has been a psychiatrist longer than he said he would care to admit, and the way he sees it, prescribing medication hasn't gotten any easier.

For example, Secrest recently had to answer a patient's question about whether taking Prozac would cause him to have an irregular heartbeat. The patient had a new pacemaker, and if the Prozac affected it, he could die.

Then, another patient taking medication for a mood disorder was bruising more easily. It took Secrest's years of medical training and consulting with other doctors for him to figure out the bruising was caused by combining the medication with aspirin, which the patient was taking for another condition, he said.

Although there's a shortage of psychiatrists, Secrest, who is on the faculty at UT Southwestern in Dallas, thought their reach could be expanded by using televideo conferencing software.

Another way to address the shortage is to expand the student loan repayment assistance program, said Greg Hansch, the public policy director for the National Alliance on Mental Health-Texas.

Senate Bill 239 established the program in 2015. Back then, 199 of Texas' 254 counties were designated as mental health professional shortage areas.

In order to be eligible for the program, the mental health professional must provide services in one of those areas to patients on Medicaid, on CHIP or in certain state-operated correctional facilities.

Hansch also suggested making peer support services Medicaid reimbursable. Peer supporters have mental illness and are in recovery. They help others also on their road to recovery. In Texas, an organization called "Via Hope" trains and certifies them.

Lastly, Hansch said, there are not enough psychiatric residency slots in the Texas. If they do their residency in Texas, they're more inclined to stay.

Dr. Robert Lyman opened his practice in Victoria in 2005.

He's never accepted patients who had Medicaid because the reimbursement is so poor.

Like Secrest, Lyman didn't think the criteria psychologists must meet under HB 593 to be able to write prescriptions was equivalent to a psychiatrist's training.

He also thought in states where psychologists can write prescriptions, such as New Mexico and Louisiana, few psychologists had applied for the privilege, and those who had didn't move to rural areas anyway.

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