Psychologists want ability to prescribe drugs

St. Louis Post-Dispatch - March 10, 2008 Mar. 10

--For the last five years, Donna McArthur has seen a psychologist every week for one hour.
Then once a month, she travels 80 miles to spend 20 minutes with a psychiatrist to get prescriptions for antidepressants. She wouldn't have to make the extra trip under a proposed law now making its way through committees in the Missouri Legislature. Two similar bills, sponsored by Rep. Danielle Moore. R-Fulton, and Sen. Jack Goodman R-Mount Vernon, would give psychologists the authority to prescribe some psychiatric drugs after receiving additional training. A similar bill was introduced in Illinois last year but did not make it through the approval process. Supporters in Missouri believe their bill has enough co-sponsors to get passed. Advocates say the law is needed to address the lack of psychiatrists in the state, particularly in rural areas. There are an estimated 350 psychiatrists and 1,800 psychologists in the state, according to the Missouri Psychological Association. On the other side of the debate, some doctors question the safety of expanding prescribing privileges to psychologists who don't undergo the same medical training. McArthur, a retired restaurant owner, travels to Springfield, Mo., to see a psychiatrist because she could not find one closer to her home in Branson. "If I happen to have a bad day two days after I've seen (the psychiatrist), the chances of me remembering that and bringing it to her attention are slim," said McArthur, 45. "The psychologist is going to be more apt to control, regulate and monitor my dosage. She's the one who's monitoring my ups and downs every week." Psychologists generally treat mental health disorders through behavioral and talk therapy. Typically, psychologists hold doctorate degrees in their field but are not required to attend medical school. Patients must visit a psychiatrist or another medical doctor to be prescribed medications, including those used to treat depression and anxiety. But the wait to see a psychiatrist can take months in many areas, says Mark Skrade, president of the Missouri Psychological Association. That's why primary care physicians such as gynecologists and general practitioners prescribe up to 85 percent of psychiatric medicines. Skrade argues that psychologists generally spend more time with patients and are better suited for mental health care. Two states, Louisiana and New Mexico, allow psychologists to write prescriptions. Psychiatrists who oppose the legislation say the training required would not be enough to protect patients. "Pharmacology is very complicated, and there's so much interaction between drugs," said Dr. David Ohlms, a psychiatrist at CenterPointe Hospital in St. Charles. "I think they're going to make mistakes." Others say the change could put more patients on drugs they might not need. A new British study comparing clinical trials shows that antidepressants are of little value to people with mild to moderate depression. Psychologists, through behavioral therapy, already have the power to treat the majority of their patients, said Dr. John Abramson, a clinical instructor at Harvard Medical School and author of "Overdosed America." "The cause of those symptoms is usually not medical," Abramson said. "It has to do with the way a person is living his or her life and often in relation to their past experiences." But psychologists say the prescribing power also would also allow them to take patients off drugs when appropriate. The main goal of the measures is to remove barriers to mental health care by allowing one caregiver the ability to evaluate and fully treat patients, Skrade said. "This is another tool in a psychologist's toolbox that opens up access to patients and decreases expense for patients," he said. Thomas Parquette of Branson, Mo., spoke last month to state legislative committees in support of the proposed law. Parquette, 60, has tried 28 combinations of drugs to treat bipolar disorder and depression. Having to see a psychiatrist or other physician to get the prescriptions has led to delays of five weeks in some cases, he said. "It requires modifications, changes, different pairings of prescriptions," Parquette said. "This is best handled from a patient's perspective by the psychologist who is treating me."

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