If more psychologists were given the authority to administer prescriptions to patients dealing with mental health disorders, would that diminish the number of suicides in the United States?
Auburn University at Montgomery researcher Agnitra Roy Choudhury, assistant professor of economics, posed the question in his research study on the “Effects of giving psychologists prescriptive authority: Evidence from a natural experiment in the United States.” He conducted the study with co-principal researcher Alicia Plemmons, an assistant professor of general business and a research fellow in the Knee Center for the Study of Occupational Regulation at West Virginia University.
The two researchers found that with proper training, psychologists could help lower suicide rates in U.S cities with new prescriptive authority policies for psychotropic medications — such as antidepressants, anti-anxiety medications, stimulants, antipsychotics, and mood stabilizers — if approved by policymakers.
According to the Centers for Disease Control & Prevention, U.S. suicides hit an all-time high in 2022. Yet, many states still limit the ability to prescribe psychotropic medications to physicians and psychiatrists, while psychologists are only permitted to provide practice services such as diagnosing patients, providing talk therapy, and counseling, Roy Choudhury said.
“Suicide is among the leading causes of death in the U.S. Other high-income countries also report high suicide rates,” he said. “Mortality due to suicide is projected to increase post coronavirus pandemic. To make matters worse, there is a significant shortage of mental health care providers in the U.S., particularly of psychiatrists. This study sheds light on a specific policy design that can help alleviate this issue.”
For their study, the researchers examined two states, New Mexico and Louisiana, which passed prescriptive authority privileges for psychologists in 2002 and 2004, respectively. Four other states — Idaho, Illinois, Iowa and Colorado — and the U.S. Department of Defense also have granted licensed psychologists prescriptive authority. Colorado is the most recent state to grant psychologists prescriptive authority under House Bill 1071, which passed in March.
“We estimated the impact of expanding the scope of practice for specifically trained psychologists in these states to include pharmacological interventions on mortality,” he said. “We also used an event study design to detect the lagged effect of such a policy being implemented by each state.”
The researchers obtained mortality rates from the National Vital Statistics System of the National Center for Health Statistics to factor in other variables such as education, race, marital status, age, and unemployment rates to further analyze changes in mortality due to suicide before and after policy implementation in New Mexico and Louisiana.
“We found that mortality resulting from self-inflicted injury decreased by 5 to 7 percentage points in New Mexico and Louisiana following prescriptive authority expansions for psychologists,” Roy Choudhury said. “The effect is statistically significant for males, white populations, individuals who are married or single, and for people between the ages of 35 and 55. Based on our results, there is strong evidence suggesting that allowing psychologists prescriptive authority can significantly reduce suicide deaths.”
Roy Choudhury said the team’s study is the first to address how certain qualified psychologists can be utilized efficiently to improve access to mental health care services.
“Most of the public debate surrounding health care access has focused on increasing access to health insurance,” he said. “However, increasing access to insurance without addressing supply shortages will only exacerbate the problem. Our study contributes to the broader literature on scope of practice research that finds expanding or relaxing scope of practice for certain qualified non-physicians, such as nurse practitioners and psychologists, can help address this shortage problem and help keep health care costs down, while improving access to health care services.”
Opponents of policies to expand prescriptive authority to psychologists suggest that relaxing scope of practice laws for non-physicians can lead to poor health outcomes, Roy Choudhury said.
“We found no evidence to support this claim,” he said. “We also did not find any evidence to indicate worsening quality of health outcomes following expansion of such laws, and we are not aware of any ethical considerations that might arise due to this policy.”
While Roy Choudhury and Plemmons only focused on psychologists being granted prescriptive authority, their research falls in line with studies that found similar results as nurse practitioners being granted full scope of practice to improve overall health outcomes of the populations.
Psychologists would be required to complete necessary training before being able to prescribe controlled substances, which should increase the demand for such training programs in colleges, Roy Choudhury said. Additionally, expansion of scope of practice — with proper training — for non-physicians has been shown through careful research to help improve access to health care services, lower costs, and improve population health outcomes, he said.
“Prescriptive authority for psychologists is one of many recent developments occurring in the field of mental health,” he said. “The pandemic expedited the adoption of technologies such as telehealth facilities, and has resulted in some temporary expansions of scope of practice laws to combat shortages in health care professionals. The long-term maintenance of these changes is up for debate.”
Ultimately, policymakers will be the deciding factor in whether allowing psychologists prescriptive authority can help improve access to mental health care, lowering deaths due to suicide, Roy Choudhury said.
“We hope that mental health professionals might see our study’s findings reassuring, and support policy initiatives geared towards granting scope of practice privileges for qualified psychologists,” he said. “Hopefully, our findings will promote political and public support for expanding scope of practice laws for qualified psychologists.”