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Unformatted text preview: Prescriptive Authority for Psychologists: An Emerging, Exciting Reality American Society for the Advancement Of Pharmacotherapy Division 55 of the American Psychological Association January, 2008 Psychologists Prescriptive Authority Psychologists Initiative Initiative Vision Statement Properly trained psychologists have successfully prescribed psychotropic medications for the past 15 years. Prescribing psychologists will improve access years Prescribing to safe, high-quality care for underserved populations. to Psychologists Prescriptive Psychologists Authority Initiative Authority Goals Prescriptive authority for properly trained Prescriptive doctoral-level psychologists in all 50 states and U. S. territories and Better integration of psychotherapy and Better pharmacology Less overmedication/polypharmacy Improved monitoring of compliance and side Improved effects effects Greater access to mental health care Current RxP/Mental Health Needs Current RxP/Mental Health Needs Suicide • 2004 suicide rates: Persons 35-64 years: 12.6 per 100,000 Persons ≥ 65: 12.1 per 100,000 Persons 12.1 • About half of all suicides involve a documented mental About health diagnosis, most commonly depression. health • Physical health problems, most commonly in older adults, Physical contributed to approximately 24.9% of the suicides. contributed Source: (2006, July 7). Homicides and suicides ­­ National Violent Death Reporting System, United States, 2003­2004. MMWR Weekly. Retrieved on September 22, 2007, from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5526a1.htm Current RxP/Mental Health Needs Child and Adolescent Needs Suicide rates have increased 18% since October 2004 (Brent, Am J Psych 2007. 164; 989­991) 6-9% of children and adolescents have ADHD (males>females 3-10x) • Comorbidity: Anxiety disorders: 34%; ODD: 40%; Anxiety CD: 14% CD: Tic Disorders: School age children 15-20% have transient tics in Tic lifetime lifetime • 7% of students in Special Education met criteria for Tic Disorders Kurlan, McDermott, Deeley, Como, et all. Neurology, 2001: 57:1383­1388 Autism Spectrum Disorders; 34 per 10,000 Autism Yeargin­Allsopp, M., Rice, C., Karapurkar, T., Doernbeg, N., Boyle, C., & Murphy, C. (2003). Prevalence of autism in a US Metropolitan area. JAMA, 289, 49­55. • 72% of pediatric patients with Autism have sleep problems compared to 45% 72% for “normal” children for Current RxP/Mental Health Needs Mental The Federal Bureau of Prisons The Largest prison system in the nation Census continues to grow Up to 45% of inmates have a diagnosable Up mental illness mental James, D.J. & Glaze, L.E. (2006, September). Mental health problems of prison and jail inmates (Bureau of Justice Statistics Special Report NCJ 213600). Washington, DC.: National Criminal Justice Reference Service New mission: civilly committed postsentence sex offenders (Adam Walsh Act sentence of 2006) of Current Mental Health Needs Current The Department of Veterans Affairs The It is estimated that 32% of current war heroes will It seek VA healthcare seek • Nearly 20% of returning vets have suffered brain trauma, Nearly spinal injuries or amputations; another 20% have suffered other major injuries such as blindness, partial blindness or deafness, and serious burns. deafness, • 36% have been treated for mental disorders, particularly 36% PTSD (about 30,000 soldiers). PTSD • Soldiers Returning from Iraq and Afghanistan: The Long­term Costs of Providing Veterans Medical Care and Disability Benefits ­ Linda Bilmes, John F. Kennedy School of Government ­ Harvard University, January 2007 (RWP07­001) THE EXISTING SYSTEM The Existing System Too Few Psychiatrists Shortage of psychiatric care (Hartley et al., Shortage 1999): 1999): • 14.6 psychiatrists per 100,000 in urban areas, 3.9 per 14.6 100,000 in rural areas 100,000 • 20 psychologists per 100,000 in urban areas, 15 per 20 100,000 in rural areas 100,000 Hartley, D., Bird, D.C, & Dempsey, P. (1999). Rural mental health and substance abuse. In T.C. Ricketts III (Ed.), Rural health in the United States (pp. 159­178). New York: Oxford University Press. The Existing System The Relying on Primary Care Relying Reliance on primary care: • Primary care providers (PCPs) write 70% of prescriptions Primary for psychotropics (Beardsley et al., 1988).* for • 50% of office visits where psychotropics were prescribed 50% involved PCPs, 25% involved psychiatrists (Pincus et al., 1998). 1998). Pincus, H.A., Tanielian, T.L., Marcus, S.C., Olfson, M., Zarin, D.A., Thompson, J. et al. (1998). Prescribing trends in psychotropic medications: Primary care, psychiatry, and other medical specialties. JAMA, 279, 526­531. • According to the American Journal of Psychiatry, only According 17% of all psychotropic drugs are prescribed by a psychiatrist. psychiatrist. THE ALTERNATIVE The Alternative Psychologists Prescriptive Authority Psychologists Initiative Initiative Psychologists prescribe in the military. Psychologists prescribe in two states. Psychologists consult on medication Psychologists management across the country! management The Alternative Psychologists Prescribing in the Military The Department of Defense Psychopharmacology The Demonstration Project (PDP), initiated 1991 Demonstration • 1991-1997: 10 psychologists trained to prescribe 1991-1997: psychotropic medications psychotropic • 1997: program ended because of political pressures • Several original graduates still prescribing Independent evaluations from three separate Independent agencies concluded PDP graduates were • Safe, effective, & efficient in delivering care • Appreciated by their supervisors & PCPs • Specifically requested to fill positions The Alternative Psychologists Prescribing in Two States Psychologists One U.S. territory (Guam) and two states One (New Mexico and Louisiana) have approved prescriptive authority for psychologists prescriptive • New Mexico: March 2002 • Louisiana: May 2004 Louisiana: So far, 16 other states have submitted bills No evidence of highly adverse or life No threatening outcome threatening BUILDING UPON THE YEARS OF TRAINING PSYCHOLOGISTS ALREADY HAVE Current Requirements for Licensing as a Clinical Psychologist Ph.D., Ed.D. or Psy.D. from an accredited Ph.D., program program Clinical internship Clinical Two years of supervised practice Two National board exam National State board exam State Summary Properly trained psychologists can prescribe safely Properly and have been doing so for 15 years. and Prescribing psychologists have increased access to Prescribing services and improved quality of service for underserved patient populations. underserved Prescribing psychologists will meet the need for the Prescribing decreasing number of psychiatrists in the very near future. future. Prescribing psychologists will meet and exceed Prescribing current standards for safety and efficacy. current ...
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