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Bill could improve mental health care in Clark County, supporters say

A bill recently introduced in the Ohio Senate that would allow psychologists to prescribe medicine could improve much-needed access to mental health care in Clark County, local health leaders said.

However a statewide psychiatrists group believe the training requirements in the bill aren’t enough to allow them to prescribe drugs.

Senate Bill 300 was introduced earlier this year by state Sen. Bill Seitz, R-Cincinnati. It would allow psychologists to obtain a certificate from the State Board of Psychology to prescribe medications to patients, similar to physician assistants and advanced practice nurses.

The bill will address the shortage of psychiatrists in Ohio and Clark County, which puts a strain on mental health services, Springfield-based psychologist Dr. H. Owen Ward said.

Currently there’s 1,070 people for every one mental health provider in Clark County, according to the most recent County Health Rankings. That ranks behind both the state (at 640 to one) and the top performers in the United States (at 370 to one).

Four states — New Mexico, Louisiana, Illinois and Iowa — allow psychologists with appropriate training to prescribe drugs for mental health issues such as depression and anxiety.

“A number of psychiatrists that are in practice are aging and the number entering psychiatry are low,” Ward said.

Psychiatrists and psychologists are both doctors. However psychologists typically earn a doctorate degree in psychology, while psychiatrists attend medical school and are medical doctors — which allows them to write prescriptions.

About a handful of psychiatrists have private practices in Clark County, which Ward said typically have a two- to three-month waiting list. He usually works with a patient’s family doctor to write prescriptions for his patients.

Psychologists are well-trained in the field of psychotherapy and behavioral treatment. If approved, Ward said the bill would allow them to prescribe anti-depressants and anti-psychotic medications.

More than 21 percent of Clark County residents surveyed by the Clark County Combined Health District had days when their physical or mental health limited activities, according to the 2016 Community Health Assessment — which also ranks higher than both the 2013 numbers for both Ohio (20.6 percent) and the nation (19.7 percent).

Clark County adults also struggle to pay for mental health care. About 17 percent of Clark County’s population is uninsured, according to the health rankings. The recent Medicaid expansion has improved access to mental health care here, Ward said, but psychiatrists often won’t accept those types of insurance. In the past, he’s sent patients out of the county for treatment.

The training required in the proposal is equivalent to a Master’s degree in psycho-pharmacology, Ward said, including two years of education and two to three years of training and supervision — similar to physician assistants and nurse practitioners.

About 25 psychologists would be able to prescribe in the short-term, Ward said, but the bill could also lead to programs at colleges and universities offering similar programs, creating an influx of doctors who can prescribe medications.

“We’re not talking about an immediate change overnight,” Ward said. “Over the span of 10 years, it would make a huge difference and that will have an effect on Clark County.”

The Ohio Psychiatric Physicians Association opposes the bill, citing what it called an insufficient level of training set to allow psychologists to safely prescribe drugs, said President Dr. Alan Levy, a Columbus-based psychiatrist. The bill calls for a 425-hour training course, Levy said, which is all done online.

They want to see psychologists complete a two-year program similar to nurse practitioners and physician assistants, he said.

“They would be able to achieve that in a much safer fashion,” Levy said.

There are many different ways to use current resources effectively, Levy said, including tele-psychiatry options for rural patients and integrated behavioral health care at primary physician’s offices.

About 80 percent of people with depression receive medication from their family doctor, he said.

Access to care is a concern, Levy said, but the No. 1 concern is patient safety. That includes knowing the other medical systems within the body, he said, because physical illnesses can often look like mental illness.

“We wouldn’t want someone who is inadequately trained to prescribe to be able to do so just because a physician is not handy to prescribe that medication or someone needs to travel an hour to see a psychiatrist,” Levy said. “If inadequately trained (people) are prescribing, it’s not safe for the people who are getting these medications.”

No studies have been done to examine the effectiveness of psychologists prescribing drugs in New Mexico or Louisiana, he said.

“While they prescribe in those states, there’s no evidence they prescribe safely or improve access to care,” Levy said.

The legislation can provide greater access to care, Mental Health and Recovery Board of Clark, Greene and Madison Counties Chief Executive Officer Greta Mayer said.

“I am not an expert on this policy decision,” Mayer said. “However, I am in support of legislation that enhances access to safe, effective care for clients and families with mental illness and addiction. We do need to recruit and retain a highly qualified workforce in Clark County, as well as in Greene and Madison counties.”

State Sen. Bob Hackett, R-London who represents eastern Clark County, is leaning toward supporting the bill, he said, but it’s still in the process of being vetted. He would like to get the psychiatrists support on it, he said.

He worked on a similar bill that provided prescriptive authority for advanced practice nurses.

“As a businessman, it seems to make sense,” Hackett said. “We need more exposure, especially in the county I live in.”

By the numbers

17: Percent of Clark County residents who are uninsured, according to the 2016 County Health Rankings.

4: States that allow psychologists with appropriate training to prescribe drugs for mental health issues such as depression and anxiety.

21.5: Percent of people in Clark County who had days when their physical or mental health limited activities, according to the 2016 Community Health Assessment.

Healthy Springfield: About this series

Many readers responded to a report late last year that ranked Springfield as the least healthy city in Ohio. That response — including wanting to make a positive difference — prompted the Springfield News-Sun to take a closer look at the community’s health. This year the News-Sun will dig into the public health issues facing the city, including obesity and minority health disparities and efforts to improve them. Next month, the News-Sun will investigate work place wellness and how it affects public health.

Michael Cooper
Nov. 7, 2016

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