Protect Tennesseans!

Protect Tennesseans!

Our TN Legislature is entertaining a dangerous piece of legislation to allow Psychologists to prescribe medications.  
Psychiatric drugs are medications that affect not only the mind but the entire body, including other organ systems, and they can interact poorly with other drugs. With more than half of patients with mental illness also having an underlying physical illness, safe and appropriate prescribing demands expert medical knowledge. This is why medical doctors/physician specialists, psychiatrists, and even mental health nurse practitioners have a clear advantage over psychologists when it comes to safely prescribing and managing mental health medications. Psychiatrists complete medical school, residency, and often a fellowship, which ensures they understand how psychiatric drugs affect organ systems, interact with other medications, and allows them to differentiate between psychiatric conditions and other medical illnesses that may present similarly. Mental health Nurse Practitioners (PMHNPs) are nurses who receive specific psychiatric advanced training (this generally amounts to 3.5 to 4 years of medical training) and then are supervised by a physician/psychiatrist.  For patient safety, it is essential that a medically-trained clinician like a psychiatrist oversees a patient’s medication regimen.
The extensive medical training that psychiatrists receive is NOT comparable to the training of psychologists (non-medical doctors). Psychiatrists accumulate 12,000 to 16,000 hours of specialized clinical psychiatric training, while psychologists have no clinical medical training. The difference in training is substantial; the suggested curriculum for prescribing psychologists falls significantly short of the hours completed by psychiatrists, Nurse Practitioners, and Physician Assistants.  This gap in medical knowledge is critical, as psychiatric medications can impact nearly every body system, potentially leading to serious side effects such as respiratory failure, cardiac arrest, liver failure, and severe skin conditions. Medicare itself recognizes this difference and does not reimburse psychologist prescribing, stating that federal experts believe psychologists lack the “knowledge and ability to perform evaluation and management services”.
While psychologists are vital members of the mental health team, providing crucial services like therapy and psychological testing, their role does not involve the medical training necessary for safe prescribing. If we are considering making psychologists prescribers, they should at a minimum, get a nursing degree and then get 18-24 months of advanced practitioner training so that they understand medical care.  
For the well-being of Tennessee residents, it is imperative that our state legislature enact policies that prioritize training, and care coordination and ensure that a trained medical doctor, a psychiatrist, oversees prescribing when a patient’s mental health condition requires medication. 
WE have alternatives.  Last year, TPA helped pass legislation to advance the Collaborative Care model, we need help implementing it.  Family physicians and Rural clinics need funding to adapt the model to make it easier for mental health care to be coordinated between different types of clinicians, with physician oversight.