Suicide is the 10th-leading cause of death in the United States, claiming 47,511 lives in 2019. Since then, the coronavirus has shut down businesses, removed students from schools and caused financial instability for millions of households. Suicides are trending upward, especially within the most vulnerable and marginalized communities.
National shortages in psychiatrists, especially in rural and low-income communities, can cause wait times of six weeks or longer for individuals seeking mental health treatment. To address the problem, the American Psychological Association endorses expanding prescription privileges to psychologists who undergo extensive additional training in pharmacology. This push for prescriptive authority for psychologists is called the RxP movement. My new research, as well as evidence from a handful of states, shows how powerful it could be.
In 2002, New Mexico became the first state to allow psychologists to prescribe medication. Patients of qualified psychologists experiencing a health episode could receive comprehensive care and potentially life-saving medication weeks or months earlier than they otherwise would have been able to.
Louisiana, whose suicide rate is slightly above the national average, was also one of the earliest movers. While other southern states have seen stark increases in their suicide rates since 2005, Louisiana’s has increased much more slowly. This intervention is crucial in its most disadvantaged and hurricane-prone communities, where the dire effects of climate change have affected livelihoods and taken a large mental toll on many individuals.
Of the 63 counties in Iowa which have less than one psychiatrist per 100,000 individuals, 20 counties have available psychologists. Empowering these psychologists to prescribe medication does not replace or belittle psychiatrists – it provides mental and behavioral health medication to populations who lack access to them.
Illinois made a simple policy change in 2014. The state passed Senate Bill 2187, creating a pathway for psychologists to prescribe medication after approximately two years of additional pharmacological training and experience. This may not seem like a big difference, but for residents of the more than 50 Illinois counties with no inpatient psychiatric services for patients experiencing poor mental health episodes, it means access to care within their own communities.
Idaho, the latest state to expand the scope of practice for psychologists, made this change at a crucial time. It saw the largest drop in suicide during the pandemic of any state – a reduction of 3.5 individuals per 100,000 in 2020.
Even more dramatically, in new research for the Center for Growth and Opportunity at Utah State University, Agnitra Roy Choudhury and I find that states that expanded the toolkit of psychologists in this way have seen a 5 to 7 percentage point decrease in the loss of life resulting from suicide.
This represents thousands of American lives that can be saved by a simple, common sense policy change. Waiting for weeks on end for a psychiatrist recommendation and visit is not fast enough for someone experiencing a crisis.
Prior to the pandemic, 5.2% of the adult population had experienced serious mental illness in the past year. Of these, nearly 12 million had serious thoughts of committing suicide, and these rates are growing among young adults and within minority groups. And only 65.5% of the adults experiencing serious mental illness receive mental health services. Empowering trained psychologists to intervene earlier in these cases through the ability to incorporate both talk therapy and psychotropic medication helps people at a time when they are the most vulnerable. It saves lives.
While nearly a dozen other states have considered expanding the prescriptive authority of psychologists, no new legislative changes have happened since 2017. Yet, during the coronavirus pandemic, nearly 30 states suspended limitations or expanded the responsibilities and tasks of nurse practitioners, physician assistants, telehealth workers and many other primary care providers. These changes helped address the immediate needs of people afflicted by the coronavirus, but little attention has been given to the long-term mental health healing process.
Granting psychologists the right to use their training and education to a fuller extent can provide stability in unprecedented times. This policy change should not be put on the backburner, as it takes years for a psychologist to complete the education, training and testing in clinical psychopharmacology. The sooner more states take action, the more lives we can save.