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TENNESSEANS SUPPORTING PRESCRIPTIVE AUTHORITY
FOR PSYCHOLOGISTS
This is an open letter, sincerely
asking for your understanding and
your help with the following:
There are so few psychiatrists in Tennessee—the only
physicians who work in the mental health field—
that it normally takes from six weeks to three months to
make an appointment. About 60% of Tennessee
counties have no in-county psychiatrists available. And
it’s not getting better.
Further, once a patient does link up with a
psychiatrist, the average length of visit is 15 minutes or
less and there is typically no on-going weekly therapy.
An unfortunate off-shoot of this scarcity model is a
reliance on primary care physicians for drug
prescriptions aimed at solving mental health needs. In
Tennessee, close to 85% of psychotropic drug
prescriptions are written by family doctors and their
assistants, individuals who may have only 6.8 weeks of
training in long-term mental health care.
Because really knowing the patient is generally
impossible with these constraints, it is often the case
that patients are prescribed drug after drug after drug,
sometimes with serious side effects. In a kind of
ongoing drug “sprawl,” Tennesseans spend more money
on drugs than any other state in the nation.
As concerned citizens and members of the
community of Practicing Psychologists, we ask for
your help. Please help us pass legislation that will
enable psychologists with appropriate advanced
training to write prescriptions in a therapeutic setting—
where medication use can be monitored week to week
and used judiciously in a cohesive and unified approach
to healing and wellness.
The current situation:
We’ve reached a crisis point
in our mental health system.
AND IT’S NOT GETTING ANY BETTER.
Median wait times to see a psychiatrist in
Tennessee:
• With commercial insurance—
six weeks (42 days).
• If elderly and on Medicare—
seven weeks (49 days).
• With TennCare—
three months (84 days).
“There are only a handful of
available psychiatrists in my
area…. This has left me with
having to go to my ob/gyn for
medicine knowing they have little
understanding of my behavioral
well-being.”
It’s not hard to think of someone you know—a friend,
a family member, a spouse, perhaps yourself—who
has faced depression, anxiety, trauma or great loss at
some time or other and required temporary or long-
term medication and therapy.
In the wake of divorce, accident, physical illness or
natural disaster, a core part of recovery has to do with
treating the whole person, addressing emotional needs
and fostering a reservoir of hope.
Study after study has shown that an integrative
treatment model is more effective than a “medical
model” where therapy and prescriptive drugs are
provided separately.
Department of Defense psychologists who have
been given authority to prescribe have chosen to give
drugs to only about 30% of their patients. Also, in an
HMO study, when 8,000 psychologists took over
mental health care in nearly one million patient
contacts, the use of medications declined from 68% at
outset to 13% at discharge.
Psychologists spend time with their clients, often
once a week. As they come to know each patient, they
are more and more able to eliminate over-prescribed or
wrongly-prescribed medications.
When doctors don’t know their patients well as
individuals, and hence the medicines don’t fit the
individual, the toll can be serious and oftimes
debilitating. Fortunately we can all pitch in and do
something about it.
AN ISSUE OF IMPORTANCE
CAN TOUCH ANY OF OUR LIVES,
AT ANY TIME.
“Every psychiatrist I knew saw me for a total of 15 minutes once amonth. This was really irritating because they barely knew me and Ihad to squeeze in a whole month of problems and experiences.Having such short appointments left no time to build a relationshipand connectedness with my psychiatrist, let alone communicate whatwas happening regarding my medications”
“If everything went as wished, there would be one person who would
provide both medication and psychotherapy—and that would save
money.”— a representative of the Tennessee Psychiatric
Association, testifying before a Tennessee
House Subcommittee in 2003
Ihad frantically tried to get her help but there were no
child psychiatrists in our city.
I took her to a psychologist she liked but Tennessee
law wouldn’t allow her psychologist—the doctor who
knew her best—to prescribe the medication she needed.
I simply couldn’t wait the six weeks to three months it
took to see a psychiatrist. (And even when she did
finally find a psychiatrist, he wouldn’t take my
insurance or her dad’s TennCare.)
The situation forced us to go to her family doctor
for medication. Her psychologist was concerned about
Becky being prescribed certain antidepressants because
of our family history, but her family doctor persisted
and the next thing we knew Becky was out of control,
suicidal, driving recklessly. Thank God we didn’t
lose her.
Since that scare, she’s been on all sorts of
medicines—sometimes four or five at once—all given to
her piecemeal, one medicine for each symptom, rather
than someone taking the time to understand her as a
whole person before prescribing.
In a psychiatrist’s office, it comes down to ten to
fifteen minutes every month or two without the doctor
really knowing what’s going on with her in any kind of
meaningful way.
It’s just a lot of drugs; no lifestyle changes, just lots
of drugs, lots of expense, lots of side effects, no
prescriber with time to listen.
Now she’s 50 pounds heavier and I’m still not sure
she’s on the right medications.
The one person who knows her best and who
would be the best person to decide what medication to
give her—and which ones not to give her—is not allowed
to do so by Tennessee law, even though other
providers—doctors, nurses and physician assistants,
even her gynecologist—can do so.
In my mind the system is broken—and people are
getting hurt—every day.
Wouldn’t you want someone in your family to
be given medications by a person who both knows
the person and knows the medicines? It just
seems practical, reasonable and a good solution for
everyone involved.
a mother’s story.
MY DAUGHTER BECKY WAS 16 YEARS OLD
WHEN WE NEARLY LOST HER.
“Access (to psychiatrists) may actually be even worse that the survey reflects.”
— a representative of the Tennessee Psychiatric
Association, testifying before a Tennessee
House Subcommittee in 2003
The rigorous program we have set forth for
Prescribing Psychologists would require five years
of prescriptive pharmacology coursework and
supervised training after seven years of graduate training
as psychologists, at least meeting or exceeding the
pharmacology training given psychiatrists and well
beyond nurses and physician’s assistants in both
content and duration.
In our state, where we are experiencing a severe
shortage of psychiatrists, over 30 psychologists have
already enrolled in this intensive psychopharmacology
curriculum. These professionals average 20 years of
graduate work and clinical experience before starting
this training.
Moreover, exhaustive evaluations of Department of
Defense psychologists, trained and authorized to
prescribe medications, stated that the program
graduates’ quality of care was, without exception, “good
to excellent” and that “It is more cost effective to train
psychologists to prescribe than to use a combination of
psychologists and psychiatrists to provide the same
mental health care.”
Such holistic and integrative training makes more
than good economic sense; it shores up our endangered
mental healthcare system in Tennessee. As the U.S.
Surgeon General has said, “If we can demonstrate that
psychologists have the training to prescribe, then they
should be allowed to prescribe.”
Why appropriately trained psychologists are
THE BEST CHOICE TO FILL A CRUCIAL GAPin our system:
Leaving things as they are leaves a lot of folks in a sinking boat.
WE CAN MAKE A WORLD OF DIFFERENCE.
There are over 1.5 million Tennesseans in need of
mental health treatment. Only one third of these
citizens will receive treatment of any kind and, for
those who do, the prognosis—given our present system—
is not good.
We need your help, legislators and constituents
both, to close this large and critical gap in healthcare in
our state—a gap that delays access to effective integrated
care, overburdens primary care physicians and leads to
out-of-control pharmacy costs.
With a concerted, unified effort, we can create a sea
change that gets patients the help they need more
quickly, more efficiently and more cost effectively.
That success, in turn, will get more people back to
a productive life, a life that builds community and
self-worth rather than draining the very life force of
our state.
THANK YOU FOR YOUR INTEREST AND YOUR CARE.
Tennessee Psychological Association
P.O. Box 281296
Memphis, Tennessee 38168
www.tpaonline.org
Voice: 901.372.1015
Fax: 901.372.1015
TPA wishes to thank TFACT for the Tennessee citizen letters used in this brochure. www.tfact.org