New state rules that would allow some psychologists to prescribe psychotropic medication is set to go into effect in the coming months, a move supporters say will expand access to mental and behavioral health treatment options for Iowans.
Opponents, however, argue the training isn’t adequate and the results could do more harm than help.
The Iowa Board of Medicine and Iowa Board of Psychology jointly implemented the rule, which was passed in the 2016 legislative session, at the end of last year.
Psychologists currently cannot write any prescriptions.
“I think this is a great move for mental health services,” said Dr. Elizabeth Lonning, a Davenport-based licensed psychologist who chairs the Iowa Psychological Association’s psychopharmacology committee.
Scott Young, a licensed psychologist at Des Moines Pastoral Counseling Center, is one mental health professional who plans to obtain prescribing authority. He recently completed his post-doctoral master’s degree in clinical psychopharmacology — from Fairleigh Dickinson University, in Teaneck, N.J. — one of the first steps in the advanced training requirements for psychologists to write the prescriptions.
“The medication piece isn’t my specialty yet, but certainly as a psychologist with a doctoral degree, I have a lot of experience with mental health,” Young said. “I think adding the medication piece makes a great deal of sense.”
Administrative rules are still being finalized, board officials said. The rules must be reviewed by the Administrative Rules Review Committee, a joint House-Senate committee at the Iowa Legislature, as well as the governor’s office before it can be implemented.
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Officials with the Iowa Board of Psychology and the Iowa Board of Medicine say it could be put into effect as early as this spring.
This law was passed by state policymakers with the hope to expand access to mental health services for Iowans by addressing the state’s workforce shortage.
Iowa ranks among the worst nationwide for its mental health care workforce, according to the National Alliance on Mental Illness, or NAMI. Iowa is 47th for its number of psychiatrists per capita, 44th in mental workforce availability to patients and 51st, including the District of Columbia, in the ratio of psychiatric beds to total residents.
“We just have such a gross shortage of qualified of psychiatric providers — psychiatrists or psychiatric nurse practitioners or psychiatric physician assistants,” Young said.
“We just don’t have very many, so the lion’s share of medications being prescribed for mental health issues are being prescribed by primary care providers.”
For diagnoses such as attention-deficit/hyperactivity disorder, Young said there is a more rigorous diagnostic process psychologists would take than a typical primary care physician.
“If they don’t have ADHD, it’s not good for them to be on those medications, and that’s something I can address with them,” he said.
Some groups, including the Iowa Medical Society, have voiced their opposition to the decision in the past.
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Dennis Tibben, the society’s director of government affairs, pointed out in a previous interview with The Gazette that psychologists — as with psychiatrists, who can write prescriptions — primarily are based in urban settings. Therefore, it would not improve access to services for rural areas.
Another concern of physician groups, according to letters submitted to the state boards, is that the training requirements are not strong enough and could negatively affect patient outcomes.
But those in support of the law disagree.
“We’re not asking to prescribe the entire amount of medication that a physician assistant can prescribe,” Lonning said. “We’re only asking to be allowed to prescribe those within our scope of practice in terms of psychologists.”
Only psychologists who have met education requirements and obtained advanced, supervised clinical training can receive a conditional prescribing certificate, meaning they can prescribe under direct supervision of a physician.
Once a psychologist has undergone at least two years under this conditional clinical experience, then they are eligible for a full prescribing certificate.
But even after psychologists have the full prescribing authority, they are prohibited from prescribing new, discontinuing or changing a patient’s psychotropic medication if the collaborating physician objects.
“Are (the rules) restrictive? Maybe,” Young said. “But I think there’s good reason for that.
“I think it’s something that needs to be treated with a great deal of respect and caution,” he said. “We want to be safe prescribers and we want to make sure we’re providing good care for our patients and we’re doing good rather than harm.”
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