Why Appropriately Trained Psychologists Should Have Prescriptive Authority in Tennessee

1. Why Appropriately Trained Psychologists Should Have Prescriptive Authority in Tennessee Executive Summary and Response to the Opposition

2. Today we will show:

3. Today we will show: Why This Bill is Important

4. Today we will show: Why This Bill is Important Five Key Facts About our Bill

5. Today we will show: Why This Bill is Important Five Key Facts About our Bill The Extensiveness of Prescribing Psychologists’ Training

6. Today we will show: Why This Bill is Important Five Key Facts About our Bill The Extensiveness of Prescribing Psychologists’ Training Why Prescribing Psychologists’ training is much more extensive than that of a nurse practitioners’

7. Today we will show: Why This Bill is Important Five Key Facts About our Bill The Extensiveness of Prescribing Psychologists’ Training Why Prescribing Psychologists’ training is much more extensive than that of a nurse practitioners’ That the citizens of Tennessee need Integrated Mental Health Care

8. Today we will show: Why This Bill is Important Five Key Facts About our Bill The Extensiveness of Prescribing Psychologists’ Training Why Prescribing Psychologists’ training is much more extensive than that of a nurse practitioners’ That the citizens of Tennessee need Integrated Mental Health Care Why Prescribing Psychologists are Safe

9. 1. Why This Bill is Important

10. Importance Psychiatry has not disputed many of our arguments, including that:

11. Importance Psychiatry has not disputed many of our arguments, including that: • The unmet need for mental health services in Tennessee is tremendous (and failing to treat mental health disorders is tremendously costly)

12. Importance Psychiatry has not disputed many of our arguments, including that: • The unmet need for mental health services in Tennessee is tremendous (and failing to treat mental health disorders is tremendously costly) • There is a severe shortage of psychiatrists in Tennessee, and nationally that is not going to change

13. Importance Psychiatry has not disputed many of our arguments, including that: • The unmet need for mental health services in Tennessee is tremendous (and failing to treat mental health disorders is tremendously costly) • There is a severe shortage of psychiatrists in Tennessee, and nationally that is not going to change • A recent independent state-wide survey documents patients’ lack of access to Tennessee psychiatrists

14. Importance Psychiatry has not disputed many of our arguments, including that: • The unmet need for mental health services in Tennessee is tremendous (and failing to treat mental health disorders is tremendously costly) • There is a severe shortage of psychiatrists in Tennessee, and nationally that is not going to change • A recent independent state-wide survey documents patients’ lack of access to Tennessee psychiatrists • For BC/BS patients: average wait is 6 weeks (and almost 25% are not taking new patients)

15. Importance Psychiatry has not disputed many of our arguments, including that: • The unmet need for mental health services in Tennessee is tremendous (and failing to treat mental health disorders is tremendously costly) • There is a severe shortage of psychiatrists in Tennessee, and nationally that is not going to change • A recent independent state-wide survey documents patients’ lack of access to Tennessee psychiatrists • For BC/BS patients: average wait is 6 weeks (and almost 25% are not taking new patients) • For Medicare patients: average is 7 weeks (and almost 1/3 are not taking new patients)

16. Importance Psychiatry has not disputed many of our arguments, including that: • The unmet need for mental health services in Tennessee is tremendous (and failing to treat mental health disorders is tremendously costly) • There is a severe shortage of psychiatrists in Tennessee, and nationally that is not going to change • A recent independent state-wide survey documents patients’ lack of access to Tennessee psychiatrists • For BC/BS patients: average wait is 6 weeks (and almost 25% are not taking new patients) • For Medicare patients: average is 7 weeks (and almost 1/3 are not taking new patients) • For TennCare patients, the median state-wide wait is almost 3 MONTHS (82 days) (and a full 40 percent of psychiatrists are not taking new TennCare patients)

17. Importance Psychiatry has not disputed many of our arguments, including that: • Primary care physicians, who prescribe the majority of psychotropic drugs, are overburdened and unfairly expected to treat all the patient's mental health problems, and it is unreasonable to ever expect them to be able to do so effectively.

18. Importance Psychiatry has not disputed many of our arguments, including that: • Primary care physicians, who prescribe the majority of psychotropic drugs, are overburdened and unfairly expected to treat all the patient's mental health problems, and it is unreasonable to ever expect them to be able to do so effectively. • As an inevitable consequence of this situation, medications end up being over-utilized and other treatments end up being under-utilized, leading to out of control pharmacy costs. Care is often fragmented, and therefore inadequate, and therefore much more costly

19. Importance A Key Fact: • Non-psychiatric physicians prescribe 85% of the psychotropic medications in Tennessee.

20. Importance • In medical school, these non-psychiatric physicians have had, on average:

21. Importance • In medical school, these non-psychiatric physicians have had, on average: • A total of just 99 contact hours of training in all of pharmacology, including psychopharmacology (Source: www.AAMC.org)

22. Importance • In medical school, these non-psychiatric physicians have had, on average: • A total of just 99 contact hours of training in all of pharmacology, including psychopharmacology • A total of just 6.8 weeks of training in the diagnosis and treatment of mental disorders (Source: www.AAMC.org)

23. Importance Psychiatry is in fact very concerned about Primary Care Physicians’ lack of training to prescribe psychotropic medications:

24. Importance Psychiatry is in fact very concerned about Primary Care Physicians’ lack of training to prescribe psychotropic medications: Quotes from a recent Wall Street Journal article entitled: “Should Family Doctors Treat Serious Mental Illness?

25. Importance Psychiatry is in fact very concerned about Primary Care Physicians’ lack of training to prescribe psychotropic medications: Quotes from a recent Wall Street Journal article entitled: “Should Family Doctors Treat Serious Mental Illness? • “General doctors often lack specialized knowledge on how to diagnose the most severe types of mental illness,” and

26. Importance Psychiatry is in fact very concerned about Primary Care Physicians’ lack of training to prescribe psychotropic medications: Quotes from a recent Wall Street Journal article entitled: “Should Family Doctors Treat Serious Mental Illness? • “General doctors often lack specialized knowledge on how to diagnose the most severe types of mental illness,” and • “Psychiatrists [argue] that general-practice physicians don’t have enough specific training to dispense drugs to people with serious mental illness.”

27. Integrated Care Our Bottom Line #1: With Tennessee’s skyrocketing psychotropic drug costs, and with Tennessee #1 in the country in prescriptions per capita, there is a critical need for clinicians who will provide Integrated Mental Health Care:Treatment which combines psychotherapeutic, behavioral, and lifestyle intervention with judicious medication use; hence,Tennessee needs Prescribing Psychologists

28. 2. Five Key Facts about our Bill

29. 1. The bill does not pertain to all psychologists — only to those psychologists who have gone on to complete the FIVE YEARS of additional postdoctoral training to become Prescribing Psychologists.

30. 2. Prescribing Psychologists seek prescriptive authority only for those drugs, laboratory tests, etc., “rational to the practice of psychology”—we are not seeking prescriptive authority for an unrestricted formulary.

31. 3. Prescribing Psychologists will not treat any patients who do not have an established relationship with a primary care physician.

32. Even after completion of all training, practicum, and two years of collaborative practice with a physician, the Prescribing Psychologist must still, permanently:“establish and maintain effective intercommunication with a physician to make provision for the diagnosis and treatment of medical problems”

33. Note: This provision simply reiterates a statute that already applies to all psychologists, and which has worked well for over 52 years.

34. Similar bills authorizing Prescribing Psychologists have already been passed in New Mexico and Louisiana, and currently 7 other states have bills pending.

35. 3. The Extensiveness of PrescribingPsychologists’ Training

36. Resistance to Change Regrettably, and predictably, organized psychiatry has relentlessly opposed all other professions’ efforts to expand their scope of practice, because: (to quote the Pew Health Professions Commission):“organized medicine has no institutional incentive to compromise…”

37. Resistance to Change Regrettably, and predictably, organized psychiatry has relentlessly opposed all other professions’ efforts to expand their scope of practice, because: (to quote the Pew Health Professions Commission):“organized medicine has no institutional incentive to compromise…”Psychiatry recently appears to be to shifting the focus of their opposition to the issue of relative amounts of “biomedical training,” (including undergraduate), among prescribing professionals…

38. Resistance to Change Apparently, here’s their argument: Equivalent Years of BIOMEDICAL Education and Training for Prescribing Practitioners Prescribing Psychologists (Per our calculations)

39. Resistance to Change Apparently, here’s their argument: BUT: Our assertion is that this near-exclusive focus on biomedical training contributes to the problem of over-prescribing (“when all you have is a hammer, everything looks like a nail…”)--it does not promote what is needed in this state: more access to Integrated Mental Health Care. Equivalent Years of BIOMEDICAL Education and Training for Prescribing Practitioners Prescribing Psychologists (Per our calculations)

40. Recall that in medical school, the average non-psychiatric physician has had, on average: • A total of just 99 contact hours of training in all of pharmacology, including psychopharmacology • A total of just 6.8 weeks of training in the diagnosis and treatment of mental disorders (Source: www.AAMC.org)

41. The Solution to Over-Prescribing An obvious fact: To adequately treat Mental Health problems and avoid over-prescribing, a prescribing professional MUST have adequate training inBOTH:1.Biomedical issues AND2. Mental Health Care In other words, they must have training in Integrated Mental Health CareLet’s look at the facts:

42. The Facts about the TPA-Endorsed Post -Doctoral Master’s Degree in Clinical Psychopharmacology, administered by Fairleigh Dickinson University

43. The University • Fairleigh Dickinson University is accredited by the Middle States Association of Colleges and Schools • Two campuses in New Jersey and one in England • App. 10,000 students, 35% graduate

44. The School of Psychology • APA-accredited Ph.D. Program in Clinical Psychology • New Psy.D. Program in School Psychology • Two other master’s degrees • Undergraduate programs in psychology and sociology

45. The Program • 2000: Created as a certificate program by the Department of Psychology at University of Florida • Developed by Dr. Anita Brown, a DoD graduate • Eliminated unnecessary portions of DoD Program

46. The Program • 2000: Created as a certificate program by the Department of Psychology at University of Florida • Developed by Dr. Anita Brown, a DoD graduate • Eliminated unnecessary portions of DoD Program • 2000: Moved to FDU when Florida’s Department of Psychiatry pressured the university to close the program (i.e., moved due to political pressure)

47. The Program • 2000: Created as a certificate program by the Department of Psychology at University of Florida • Developed by Dr. Anita Brown, a DoD graduate • Eliminated unnecessary portions of DoD Program • 2000: Moved to FDU when Florida’s Department of Psychiatry pressured the university to close the program (i.e., moved due to political pressure) • 2002: Converted to a Master’s program after: • Year-long internal review • Review by all institutions of higher education in NJ • Is also authorized as a Master’s degree program in Tennessee by Tennessee Higher Education Commission, and reviewed by them annually • (and the THEC does not authorize “mail order diplomas”)

48. The Program

49. The Program • Is approximately two years in length

50. The Program • Is approximately two years in length • Provides a Post-Doctoral Master’s Degree in Clinical Psychopharmacology