Illinois Law Prescribing Hope for Mental Health Treatments

​​​One of the most prevalent issues in healthcare is the lack of access to medical care and necessary treatments for those that cannot afford it. Some clinical ethics professionals see the lack of access as the country’s biggest issue.  For individuals with mental health, this issue is only confounded by the lack of access to prescription medication.

stigma that follows people with a mental illness, and the resulting failure to provide treatment and supportive, is a perfect example of lack of access that needs to be addressed.  Patrick Kennedy, former congressman from Rhode Island, says that lack of care for mentally ill has “overburdened emergency rooms, crowded state and local jails and left patients to fend for themselves on city streets.” Cook County Sheriff Tom Dart compares the county jail to the state’s largest mental health care provider. However, the jail is not the appropriate venue and is not equipped or able to meet the treatment needs of the mentally ill.

Kaiser Commission on Medicaid and the Uninsured estimates that, nationwide, more than 60 percent of adults with a diagnosable mental health disorder and 70 percent of children in need of treatment do not receive mental health services. Many of these people are among low-income, minority, and rural populations, and often in dire need of mental health treatments. More than 50 counties in Illinois have no inpatient psychiatric services in their hospitals, with another 24 counties having no hospitals at all. These factors, coupled with a shortage of psychiatrists, can leave many patients without the services they need.

In an effort to bridge the difference in treatment of conventional health and mental health conditions, Congress passed the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).
MHPAEA requires group health plans and health insurance issuers to ensure parity in financial requirements and treatment limitations for mental health or substance use benefits when compared to medical/surgical benefits. Illinois followed suit, and in 2011 passed a law requiring group insurance and HMO plans to provide coverage for the treatment of “serious mental illnesses” and “substance use disorders” under the same terms and conditions as coverage for other illnesses and conditions. This law was the first step toward recognizing the necessity of mental health treatments, and showed a shift in the opinions of the lawmakers.

On June 25, 2014,
Illinois passed a law allowing licensed clinical psychologists with advanced, specialized training to prescribe medications for the treatment of mental health disorders, providing more access to mental health services. Illinois is the third state, after New Mexico in 2002, and Louisiana in 2004, to grant psychologists the right to prescribe psychotropic medication.

Only licensed clinical psychologists may apply to the Illinois Department of Financial and Professional Regulation for a
prescribing psychologist license. Psychologists are health professionals who are trained to provide behavioral and mental health services. It takes seven years of graduate education, four years of undergraduate work, and several years of supervised clinical training to satisfy the requirements for a Ph.D in psychology. After receiving a doctorate, psychologists must complete between 1,500 and 6,000 hours of supervised clinical practice and take a national examination in order to become licensed. In some states, a jurisprudence exam is also required.  

Under the
new law, psychologists must complete specific requirements in order to earn a prescribing license including: biomedical coursework, a minimum of sixty credit hours of didactic coursework, and a completion of a full time practicum of fourteen months supervised clinical training of at least thirty-six credit hours. Once they finish the additional training, the psychologists would be able to take the National Certifying Exam.

Clinical psychologists must enter into a collaborative agreement with a physician, similar to the requirement for Advanced Practice Nurses. This agreement promotes the exercise of professional judgement by the prescribing psychologist. A collaborating physician is required to be available for consultation, in person or through telecommunication, and meet with the psychologist at least monthly to review medication orders and provide collaboration and joint approval of orders. Psychologists can only prescribe medication that the collaborating physician generally provides to his or her patients. Physicians may enter into collaborative agreements with up to three prescribing psychologists.

In addition, prescribing psychologists are prohibited from writing prescriptions for minors under seventeen, seniors over sixty five years of age, patients that are pregnant, or any patient with a serious medical condition, as well as any developmental/intellectual disability. Clinical psychologists also may not prescribe benzodiazepine or Schedule II controlled substances. Finally, out-of-state clinical psychologists cannot prescribe in Illinois unless they meet the Illinois standards required for biomedical education and clinical training, and abide by Illinois patient safety measures.

The new law streamlines mental health treatment, allowing patients to see one provider, rather than a psychologist for treatment, and a physician for medication. The collaboration between physicians and psychologists will provide a comprehensive and effective treatment that gives people greater opportunity for recovery.

Nesko Radovic is pursuing his law degree at DePaul University College of Law in Chicago. Mr. Radovic obtained his B.S. in Business Administration from Strayer University in Washington, DC. He is an active member of the Health Law Institute, and a staff writer for the DePaul Journal of Health Care Law. Mr. Radovic hopes to focus his career in
health care-related finance, strategy and compliance issues, after graduating in May of 2017.​​​