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.
The 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.
The 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.