I'm all about anything that results in increased access to mental health care in underserved areas. Increased mental health care is not only beneficial to the individual, it's also a huge boost to the workforce and to medical costs. So whether it's giving (a very select group of) psychologists the opportunity to pursue prescriptive privileges, or doing anything possible to make psychiatry a much more attractive path for physicians, I'm for it.
But I'll also add that psychiatric meds are often too readily prescribed (by psychiatrists and especially by general physicians). I'm all about having prescribers who understand and value the effectiveness of psychotherapy for many mental health issues (especially ADHD, anxiety disorders and more mild to moderate mood disorders), whether psychotherapy alone or in combination with medication. Whether that's the (somewhat rare) psychiatrist who also provides therapy (or at least highly recommends therapy), or a psychologist with much additional training/education who can provide therapy and prescribe (and I agree - it should be limited medications for only certain limited diagnoses).
Sorry, somehow missed this. Agree for the most part. Certainly increased MH care in general being good for individuals and for society.
Maybe things are different where I practice or from my perspective, but while I could see it potentially increasing access to allow a select number of psychologists with extra training to prescribe, it just seems like there are so many other bigger factors limiting access. The shortage of Psychiatrists nationally is dramatic. The poor insurance coverage outside of the best Blue Cross plans is extremely limiting. I have to think that even if Psychologists were given more opportunity to prescribe, they would not be picking up the slack with the minimum wage paying Medicaid plans or awful HMOs. Sure, it could help a bit. I just don't think it would be a very large impact. Maybe I'm wrong on that.
Also, I personally value greatly the importance of psychotherapy. My wife, a Family Practice physician, who majored in Psychology does as well! Most (not all) of my colleagues do, also. The ones who like getting to know the patient definitely value therapy. If nothing else, the ones who aren't so good at talking to the patients are thrilled to unload that part of the patient care on a therapist. I am routinely 'accused' of doing psychotherapy even though I see patients for 25 minute visits. I guess even though it's not an hour, it's more than 5-10 minutes, and I do try to get to know the patient as a person, and guide them where I can. I routinely refer for therapy when they need more than I can provide. I want to refer way more often. My wife would love to also.
Why don't we refer more often? Financial and insurance constraints. None of the good therapists I know accept Medicare. None of them take HMOs. Same reason that most Psychiatrists don't. Most of the self pay patients can't afford therapy out of pocket. Not many people can afford to see a therapist for an hour more than once per month. It's cheaper to see a PCP or Psychiatrist because insurance offsets the cost. And they see us once every several months for 10-25 minutes. I'm not saying therapy isn't worth the price, I genuinely believe that it is ... I just don't think many people can afford it because of the financial and time setup.
In the VA, all the therapists are overloaded and end up seeing everyone once per month or less. Better than nothing, but not that much more than seeing me. And is that even therapy any more?
As I write this, I guess I'm not as against the idea of Psychologists prescribing to a limited extent as I thought, other than the turf thing. I just don't think it'll help that much in the areas where people want it to help.
