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Illinois patients at risk as psychologists fight for prescribing privileges

By Linda F. Gruenberg, DO

As physicians we take an oath to do no harm. For our patients, prescribing medication must be done safely. A revised bill in the Illinois General Assembly, SB 2187, also known as RxP, would threaten the safety of our patients. This bill would allow psychologists to exchange years of education—premed courses, medical school and residency—for 425 to 450 hours of training, which could be completed online. Medical training would no longer be necessary to prescribe in the state. And Illinois’ patients and their families would be left with a lower standard of care.

No Biomedical Training

If RxP becomes law, a psychologist with no biomedical training can prescribe psychotropic drugs with the same independent authority as a board-certified psychiatrist with five to seven times the amount of training.

Moreover, a board whose members have no biomedical training will be responsible for the safety and competence of these new medical practitioners. Prescribing psychologists will essentially be operating outside the rest of the medical profession.

To fully understand the dangers presented by RxP, consider its requirements for administering medication to children. Under the bill, a 26-hour online course would suffice for their treatment, instead of the two-year fellowship in addition to three of the four years of general psychiatry residency training currently needed to practice child psychiatry.

Also consider that psychiatric medications are some of the most powerful in modern medicine; they have the potential to have lasting side effects and can negatively interact with drugs used to treat chronic medical conditions.

Medical professionals must learn to treat the whole body—not just the brain—to understand this crucial relationship. They must learn to treat all patients—children, expectant mothers, the elderly—and provide care during births and deaths. To prescribe psychotropics, such biomedical training is necessary.

False Arguments

Psychologists who want the prescribing privileges of physicians, registered nurses, advanced nurse practitioners, and physician assistants argue that Illinois lacks adequate resources to meet the rising demand for mental heath care. Proponents of RxP say the bill will increase access to mental health care in underserved and rural areas. But psychologists seldom practice in these regions and SB 2187 will not change that.

Viable Alternative Solutions

There are safer, cost-effective alternatives such as telepsychiatry, the practice of providing mental health care through telecommunications. The practice has been used for years to treat veterans, and research has proven it to be as effective as in-person treatment.

Alternatively, a collaborative program between Illinois’ 4,500 licensed psychologists and the state’s 15,071 prescribing medical professionals would increase access for all of the state’s mental health patients. In short, there are several solutions to address the state’s mental health needs; RxP is not one of them.

SB 2187 does not provide for cross-training of psychologists through an accepted medical program. The bill does not enact a program to help all the state’s psychologists to collaborate with the state’s medical providers. And the legislation will not bring psychological care to the state’s rural underserved. Instead, RxP will diminish the quality of mental health care in Illinois under the false guise of improving it.

No Scientific Studies

Currently, there is no evidence that prescribing psychologists have improved access to care. Despite nearly 18 years of experimentation in two states—Louisiana and Mexico—there is no scientific study proving that psychologists are able to safely prescribe medication without biomedical training. In fact, this measure has failed in 26 states and the Illinois legislature has already rejected it 16 times. And the Illinois chapter of NAMI (The National Alliance on Mental Illness), a leading advocate for mental health patients and their families, opposes RxP.

Physicians Must Rally

The medical community must rally around this issue to prevent a lower tier mental health system in Illinois. We must enforce biomedical training and protect health care standards. Most important, we must put the needs of our patients with mental health difficulties and their families first—before the interests of any professional group.

Inform your colleagues and contact your legislators. Tell them why Illinois cannot afford to enact this dangerous piece of legislation.

Dr. Linda Gruenberg is the president of the Illinois Psychiatric Society.

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