March 10, 2009 – A stalled bill that would give psychologists the right to prescribe medication has divided Illinois’ mental health community.
House Bill 527, which has been stuck in the Illinois House Health Care Licenses Committee since it was assigned there three weeks ago, could expand underserved residents’ access to mental health care and reduce overprescribing, said Rep. Bill Black (R-Danville), the bill’s sponsor.
Black said the bill would address a rising need for mental health services in the state – particularly downstate, where few psychiatrists, who are medical doctors, practice. Often, he said, residents taking psychotropic drugs have to travel up to 150 miles to see their prescribing doctor.
“It became obvious it was getting harder and harder [for area psychologists] to have a collaborative relationship with a medical doctor for psychiatric disorders,” he said.
Committee Chairman Dan Reitz (D-Sparta) said he would likely not call the bill for a vote this year because advocates have not presented sufficient evidence to warrant such a shift in licensing and health policy.
“That bill, as many do in Health Licensing, takes a period of time before they become law,” he said.
Reitz has received significant campaign contributions from the Illinois State Medical Society, which actively opposes the measure. The medical society donated $17,500 to Reitz in the last three years alone and remains one of the representative’s biggest donors.
Reitz said the issue has caused a “turf war” and hopes the medical and mental health communities can work together to make comprehensive mental health services more accessible without legislation, especially in rural areas where those services are most needed.
Not all psychologists would qualify for the prescription certification under the current bill. Only licensed clinical psychologists who complete a 300-hour curriculum in pharmacology, physiology and related subjects, and treat 100 patients under supervision are eligible.
Two states – New Mexico and Louisiana – have passed similar laws since 2002, and identical bills have been introduced in five other states – Tennessee, Missouri, Hawaii, Montana and North Dakota this year.
Kathy Parker, co-chairwoman of the Illinois Psychological Association‘s prescriptive authority legislation committee, said related bills can be expected in seven more legislatures around the country this year.
Parker said the program has been successful in New Mexico and Louisiana. No malpractice or other complaints have been filed in either state, and many psychologists have taken patients off unnecessary medications prescribed by misinformed general practitioners, she said.
“The authority to prescribe is also the authority to unprescribe,” she added.
The Illinois legislation is backed by the Illinois Psychological Association, which has proposed similar bills in three previous sessions with no success. Parker said the medical community has impeded its progress each time.
“Our opposition has been irresponsible with using fear and worry and not data to back up their claims,” she said.
The Illinois Psychiatric Society disagrees, saying concerns about giving non-medical doctors the authority to prescribe medication are valid.
Meryl Sosa, executive director of the psychiatric society, said unlike psychologists, medical doctors are equipped to manage medications because they are trained to recognize, diagnose and treat serious side effects that may occur.
“We feel that only doctors should be able to prescribe,” she said. She added that, “overall, they are more capable because they know all of the biological systems in the body.”
But Illinois already allows nurse practitioners, dentists, optometrists and podiatrists, none of who are required to attend medical school and all of who receive fewer years of education than psychologists, to write prescriptions, said Parker.
Arnold Ordman, a clinical psychologist who practices in Northfield, said he would not seek a prescription license if it were available.
“Personally, I’m more comfortable referring people [to physicians or psychiatrists], and for my practice that has worked fine,” he said.
But, he said, “adding psychologists to the ranks of people who can prescribe makes it more affordable and more available.”
Although the bill has little chance for success this year in Illinois, Black said he hopes it will spark honest debate about the need for, and deficiencies in, mental health services in the state.
“I thought it was time to introduce the bill and start the dialogue,” he said.