TENNESSEANS SUPPORTING PRESCRIPTIVE AUTHORITY

FOR PSYCHOLOGISTS

This is an open letter, sincerely

asking for your understanding and

your help with the following:

There are so few psychiatrists in Tennessee—the only

physicians who work in the mental health field—

that it normally takes from six weeks to three months to

make an appointment. About 60% of Tennessee

counties have no in-county psychiatrists available. And

it’s not getting better.

Further, once a patient does link up with a

psychiatrist, the average length of visit is 15 minutes or

less and there is typically no on-going weekly therapy.

An unfortunate off-shoot of this scarcity model is a

reliance on primary care physicians for drug

prescriptions aimed at solving mental health needs. In

Tennessee, close to 85% of psychotropic drug

prescriptions are written by family doctors and their

assistants, individuals who may have only 6.8 weeks of

training in long-term mental health care.

Because really knowing the patient is generally

impossible with these constraints, it is often the case

that patients are prescribed drug after drug after drug,

sometimes with serious side effects. In a kind of

ongoing drug “sprawl,” Tennesseans spend more money

on drugs than any other state in the nation.

As concerned citizens and members of the

community of Practicing Psychologists, we ask for

your help. Please help us pass legislation that will

enable psychologists with appropriate advanced

training to write prescriptions in a therapeutic setting—

where medication use can be monitored week to week

and used judiciously in a cohesive and unified approach

to healing and wellness.

The current situation:

We’ve reached a crisis point

in our mental health system.

AND IT’S NOT GETTING ANY BETTER.

Median wait times to see a psychiatrist in

Tennessee:

• With commercial insurance—

six weeks (42 days).

• If elderly and on Medicare—

seven weeks (49 days).

• With TennCare—

three months (84 days).

“There are only a handful of

available psychiatrists in my

area…. This has left me with

having to go to my ob/gyn for

medicine knowing they have little

understanding of my behavioral

well-being.”

It’s not hard to think of someone you know—a friend,

a family member, a spouse, perhaps yourself—who

has faced depression, anxiety, trauma or great loss at

some time or other and required temporary or long-

term medication and therapy.

In the wake of divorce, accident, physical illness or

natural disaster, a core part of recovery has to do with

treating the whole person, addressing emotional needs

and fostering a reservoir of hope.

Study after study has shown that an integrative

treatment model is more effective than a “medical

model” where therapy and prescriptive drugs are

provided separately.

Department of Defense psychologists who have

been given authority to prescribe have chosen to give

drugs to only about 30% of their patients. Also, in an

HMO study, when 8,000 psychologists took over

mental health care in nearly one million patient

contacts, the use of medications declined from 68% at

outset to 13% at discharge.

Psychologists spend time with their clients, often

once a week. As they come to know each patient, they

are more and more able to eliminate over-prescribed or

wrongly-prescribed medications.

When doctors don’t know their patients well as

individuals, and hence the medicines don’t fit the

individual, the toll can be serious and oftimes

debilitating. Fortunately we can all pitch in and do

something about it.

AN ISSUE OF IMPORTANCE

CAN TOUCH ANY OF OUR LIVES,

AT ANY TIME.

“Every psychiatrist I knew saw me for a total of 15 minutes once amonth. This was really irritating because they barely knew me and Ihad to squeeze in a whole month of problems and experiences.Having such short appointments left no time to build a relationshipand connectedness with my psychiatrist, let alone communicate whatwas happening regarding my medications”

“If everything went as wished, there would be one person who would

provide both medication and psychotherapy—and that would save

money.”— a representative of the Tennessee Psychiatric

Association, testifying before a Tennessee

House Subcommittee in 2003

Ihad frantically tried to get her help but there were no

child psychiatrists in our city.

I took her to a psychologist she liked but Tennessee

law wouldn’t allow her psychologist—the doctor who

knew her best—to prescribe the medication she needed.

I simply couldn’t wait the six weeks to three months it

took to see a psychiatrist. (And even when she did

finally find a psychiatrist, he wouldn’t take my

insurance or her dad’s TennCare.)

The situation forced us to go to her family doctor

for medication. Her psychologist was concerned about

Becky being prescribed certain antidepressants because

of our family history, but her family doctor persisted

and the next thing we knew Becky was out of control,

suicidal, driving recklessly. Thank God we didn’t

lose her.

Since that scare, she’s been on all sorts of

medicines—sometimes four or five at once—all given to

her piecemeal, one medicine for each symptom, rather

than someone taking the time to understand her as a

whole person before prescribing.

In a psychiatrist’s office, it comes down to ten to

fifteen minutes every month or two without the doctor

really knowing what’s going on with her in any kind of

meaningful way.

It’s just a lot of drugs; no lifestyle changes, just lots

of drugs, lots of expense, lots of side effects, no

prescriber with time to listen.

Now she’s 50 pounds heavier and I’m still not sure

she’s on the right medications.

The one person who knows her best and who

would be the best person to decide what medication to

give her—and which ones not to give her—is not allowed

to do so by Tennessee law, even though other

providers—doctors, nurses and physician assistants,

even her gynecologist—can do so.

In my mind the system is broken—and people are

getting hurt—every day.

Wouldn’t you want someone in your family to

be given medications by a person who both knows

the person and knows the medicines? It just

seems practical, reasonable and a good solution for

everyone involved.

a mother’s story.

MY DAUGHTER BECKY WAS 16 YEARS OLD

WHEN WE NEARLY LOST HER.

“Access (to psychiatrists) may actually be even worse that the survey reflects.”

— a representative of the Tennessee Psychiatric

Association, testifying before a Tennessee

House Subcommittee in 2003

The rigorous program we have set forth for

Prescribing Psychologists would require five years

of prescriptive pharmacology coursework and

supervised training after seven years of graduate training

as psychologists, at least meeting or exceeding the

pharmacology training given psychiatrists and well

beyond nurses and physician’s assistants in both

content and duration.

In our state, where we are experiencing a severe

shortage of psychiatrists, over 30 psychologists have

already enrolled in this intensive psychopharmacology

curriculum. These professionals average 20 years of

graduate work and clinical experience before starting

this training.

Moreover, exhaustive evaluations of Department of

Defense psychologists, trained and authorized to

prescribe medications, stated that the program

graduates’ quality of care was, without exception, “good

to excellent” and that “It is more cost effective to train

psychologists to prescribe than to use a combination of

psychologists and psychiatrists to provide the same

mental health care.”

Such holistic and integrative training makes more

than good economic sense; it shores up our endangered

mental healthcare system in Tennessee. As the U.S.

Surgeon General has said, “If we can demonstrate that

psychologists have the training to prescribe, then they

should be allowed to prescribe.”

Why appropriately trained psychologists are

THE BEST CHOICE TO FILL A CRUCIAL GAPin our system:

Leaving things as they are leaves a lot of folks in a sinking boat.

WE CAN MAKE A WORLD OF DIFFERENCE.

There are over 1.5 million Tennesseans in need of

mental health treatment. Only one third of these

citizens will receive treatment of any kind and, for

those who do, the prognosis—given our present system—

is not good.

We need your help, legislators and constituents

both, to close this large and critical gap in healthcare in

our state—a gap that delays access to effective integrated

care, overburdens primary care physicians and leads to

out-of-control pharmacy costs.

With a concerted, unified effort, we can create a sea

change that gets patients the help they need more

quickly, more efficiently and more cost effectively.

That success, in turn, will get more people back to

a productive life, a life that builds community and

self-worth rather than draining the very life force of

our state.

THANK YOU FOR YOUR INTEREST AND YOUR CARE.

Tennessee Psychological Association

P.O. Box 281296

Memphis, Tennessee 38168

www.tpaonline.org

Voice: 901.372.1015

Fax: 901.372.1015

TPA wishes to thank TFACT for the Tennessee citizen letters used in this brochure. www.tfact.org