As longtime Oak Park residents, we respect state Sen. Don Harmon and consider him a forward-thinking, progressive legislator. But as doctors, we are troubled by Sen. Harmon's support for a bill that would allow psychologists — who have no medical training — to prescribe medication. The Illinois Senate passed this legislation last year before it foundered in the House. Sometimes called "RxP," the bill is certain to resurface this year.
In any policy discussion regarding medical treatment, the interests of patients must come first. This bill, if passed, would put patients at risk.
Like other doctors who specialize in psychiatry, we went through nine years of medical training before we were able to prescribe medication for mental illness. RxP, if it became law, would let psychologists have this power after 425 to 450 hours of training, which could be completed online. It would replace nine years of training with five months of it.
Imagine if we allowed people to perform root canal after taking an online course; imagine if we allowed vets with only online training to treat our pets. RxP would do something akin to this in the treatment of mental illness. It would, in effect, say that a lower standard of treatment is acceptable for those who suffer from mental illness.
Maybe that is why the nation's pre-eminent mental health advocacy organization — the National Alliance for Mental Illness — opposes RxP. The Illinois chapter of this national organization has also come out against the bill.
Under current law, physician assistants, nurse practitioners and advanced practice nurses — all of whom have medical training — can prescribe medication under a collaborative agreement with a physician. Medically trained professionals understand the relationship between the body and the brain. During their training, they treat infants and the elderly, they attend at births and deaths, and they see the extremes of life. They learn the importance of treating the whole patient.
To truncate that training in one fell swoop, with the passage of RxP, would be a grave mistake. Some of the most powerful drugs in modern medicine, drugs used to treat bipolar illness and schizophrenia, can create dangerous side effects as well as risky interactions with other drugs and pre-existing medical conditions. It is of the utmost importance that this bill not become law.
RxP's proponents assert that the bill expands access to mental health care by allowing more psychologists in rural and underserved communities to prescribe. That is false. Few psychologists practice in underserved areas, and there are safer, more effective solutions for administering mental health care in remote regions of the state. One solution is "tele-psychiatry," which uses videoconferencing for counseling and treating patients. There are also collaborative, integrated health-care models that would increase access to mental health care without putting patients at risk.
Working together, we need to address the shortage of mental health services in some parts of our state. As psychiatrists, we are committed to being part of the solution, as are many of our fellow physicians. But in crafting a solution, we must be mindful of our obligation to do no harm. The interests of patients and their families must come first — before those of any particular professional group.
Dr. Rone practices psychiatry in Chicago and is clinical assistant professor of psychiatry at Northwestern University. Dr. Fore practices psychiatry in Chicago and is clinical associate professor of psychiatry at the University of Illinois.
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