By: David Shearer, PhD, Clinical and Prescribing Psychologist
APA Services, through the Practice Directorate of APA, offers grants up to $10,000 to state psychological associations to promote or defend legislation that impacts psychology. As part of our commitment to pursuing an expansion of the scope of practice for psychologists in our state, WSPA submitted a competitive grant application to the American Psychological Association (APA) for use in the support of prescribing psychology (RxP) efforts. We are pleased to announce that the APA Committee of State Leaders (CSL) awarded WSPA a grant in the amount of $5,000.
Our United Psychologist Political Action Committee (UP-PAC) will begin appealing to psychologists throughout our state for donations and to volunteer to serve as grassroots advocates to help educate our legislators about RxP issues and other mental health legislation during the 2020 session. Please contribute at this link and let Dr. Andy Benjamin know if you would be willing to serve as a grassroots advocate by email: firstname.lastname@example.org.
Many readers are probably aware of the shortage of psychiatrists nationally, but may not know that it is likely to get more problematic. In 2010 the well-known psychiatrist, Dr. Daniel Carlat, wrote in the Psychiatric Times that “…America is shy about 45,000 psychiatrists. And the shortage will get worse, because many psychiatrists are reaching retirement age”1. Satiani and colleagues wrote in 2018 in the journal Psychiatric Services that “…the psychiatrist workforce will continue to contract through 2024…it is unclear whether the shortage will be completely resolved by 2050” 2. Evidence suggests that even when patients have health insurance, psychiatric care is difficult to access3,4,5.
In Washington State we too are experiencing the shortage of psychiatrists, especially in rural areas. In fact, in the 2017 Mental Health in America Survey, Washington State ranked 42nd when considering prevalence of mental illness and access to care6. And the need for psychiatric prescribers isn’t likely to ease any time soon. As the Washington State Institute for Public Policy stated in 2015, we have one of the highest rates of adults with mental health disorders nationally7. How will we address this crisis of care?
With the supply of psychiatrists shrinking nationally, and fewer than 550 psychiatrists in our State8, the solution will have to be multifactorial. Advanced Practice Registered Nurses (APRNs) with specialty training in psychiatric services are certainly going to be part of the solution. As of early 2019 there were over 800 psychiatric APRNs licensed in our State9. Primary care providers and other prescribers whom do not have specialized training in behavioral health are also stepping up to the plate. But as most psychologists in our State know, the addition of psychiatric APRNs and a reliance on primary care providers is still not adequate. In 2018 there were almost 3,000 licensed psychologists in Washington State10. WSPA proposes that psychologists with specialty training in the prescription of psychotropic medications could make a significant contribution to solving this problem. In fact, five other states have already passed laws permitting appropriately trained psychologists to prescribe psychotropic medication (Idaho, Illinois, Iowa, Louisiana, and New Mexico). These five states have taken action to address the increasing need for psychiatric prescribers. There is no reason that Washington cannot join these other states and take a leading role in addressing the pressing need for additional prescribers of psychotropic medications.
The award of this APA grant is significant; funding is one the first steps in the pursuit of meaningful legislative change. The potential positive influence of passing an RxP bill in our State should not be underestimated. Improved access to appropriately and safely prescribed psychotropic medication would have an immense impact on health in our State. Perhaps we could stop relying on stopgap measures such as excessive use of hospital emergency departments, detention facilities, prisons, pediatricians and primary care providers to provide desperately needed behavioral health services. Rather, more patients could be seen by prescribers with specialty training in behavioral health. Not to mention that prescribing psychologists would be uniquely positioned to reduce overdependence on medication because they are trained psychotherapists. Patients could enjoy the benefits of having their medications managed by a therapist who knows them well and sees them frequently, the ultimate in “one stop shopping.” Finally, this would further cement our commitment to public health by providing much needed services to rural and underserved populations. The WSPA RxP Taskforce is grateful to the APA Committee of State Leaders (CSL) who selected our State for financial support to pursue RxP.
- Carlat, D. (2010). 45,000 more psychiatrists, anyone? Psychiatric Times, 27(8).
- Satiani et al., (2018). Projected workforce of psychiatrists in the United States: A population analysis. Psychiatric Services; 69, 710-713 doi: 10.1176/appi.ps.201700344
- Boyd, J.W. et al., (2011). The crisis in mental health care: a preliminary study of access to psychiatric care in Boston. Annals of Emergency Medicine, 58:218-219.
- Malowney, M., Keltz, S. Fischer, D., & Boyd, J.W. (2015). Availability of outpatient care from psychiatrists: A simulated-patient study in three US cities. Psychiatric Services, 66(1), 94-96.
- Rhodes, K.V. et al., (2009). Referral without access: for psychiatric services, wait for the beep. Annals of Emergency Medicine, 54: 272-278.
- 2017 Mental Health in America Survey. http://www.mentalhealthamerica.net/issues/2017-state-mental-health-america-ranking-states
- Burley, M., & Scott, A. (2015). Inpatient psychiatric capacity and utilization in Washington State (Document Number 15-01-4102). Olympia: Washington State Institute for Public Policy.
- US Dept of Labor, Bureau of Labor Statistics, Occupational Employment and Wages, May 2017,
- Washington Nursing Commission. Personal communication via email from Teresa Corrado on 23 May 2019, LPN, CPM, Licensing Manager, Washington Nursing Commission email@example.com
- Washington State Examining Board of Psychology