The Oregon House of Representatives greenlighted a path to a limited number of psychologists to prescribe medications for mental disorders, passing HB 3355 on a 43-2 vote.
If the Senate follows suit, Oregon could become just the sixth state to give psychologists this power, which is opposed by the Oregon Psychiatric Association.
Unlike psychiatrists, psychologists are not medical doctors and traditionally specialize in talk therapy.
Rep. Bill Kennemer, R-Canby, a retired psychologist and the measure’s champion, said the bill is designed to counteract a serious problem in the mental health system -- the shortage and long-term decline in psychiatrists, who are among the lowest paid medical doctors.
“I think it can be another asset in Oregon’s role as a leader in transforming healthcare,” Kennemer said. “Turf wars don’t make things better, they make things worse.”
House Bill 3355 will allow primary care clinics to embed in their practices psychologists who can prescribe psychotropic medications as well as continue talk therapy, aided by their superior knowledge of mental disorders, compared to most other front-line of healthcare, and by their diagnoses.
Kennemer said the bill will reduce the number of patients who receive improper medications from a general practice physician lacking in mental health expertise.
In terms of education and experience, psychologists who receive additional training will be similar to psychiatric nurse practitioners. Oregon has led the way in employing psychiatric nurse practitioners to deal with its shortage of psychiatrists, but these nurse practitioners are also in short supply, and the Oregon Nurses Association supports the bill.
Though retired from active psychological practice, Kennemer said he himself would not be interested in prescribing medications -- but he believed that younger psychologists might jump at the opportunity to have another tool to help their patients.
When he came out of psychology school, almost all psychologists were opposed to using medications -- a reaction to psychiatrists’ heavy reliance on tranquilizers and other crude medications that caused nearly as much harm as benefit for their patients in that era.
But as mental healthcare has evolved over the past 40 years, Kennemer said, it’s become clear that some diagnoses such as schizophrenia or bipolar disorder require medications, even as talk therapy remains an effective treatment for other disorders. The drugs to treat serious and persistent mental illness have also become greatly improved and refined, as has the understanding of the brain.
The bill received crucial support from Providence Health & Sciences, which appears poised to take advantage of the ability to utilize psychologists in this way if HB 3355 becomes law.
A Providence psychiatrist, Dr. Paul Giger, bucked the Oregon Psychiatric Association to endorse the measure: “The most important part of treatment is diagnosis,” said Giger, which psychologists already do. “These people will be connected to our medical system. Right now, family practice doctors are winging it, nurse practitioners are winging it.”
Senate Path
The bill faces a tougher test in the Senate, where Sen. Elizabeth Steiner Hayward, D-Beaverton, pulled her endorsement of HB 3355 and opposed it in the Committee on Ways & Means. Sen. Betsy Johnson, D-Scappoose, also opposes it, as do two Republican senators -- Sen. Jackie Winters, R-Salem, and Sen. Chuck Thomsen, R-Hood River.
“I don’t think the training is sufficient,” said Steiner Hayward.
“In our attempt to create more providers, we should not compromise safety,” said Johnson.
But a bipartisan group of senators, including Sen. Laurie Monnes Anderson, D-Gresham, and Sen. Jeff Kruse, R-Roseburg -- the chairwoman and vice-chairman of the Senate Health Committee, are still sponsoring the bill.
“My issue is capacity. We do not have enough mental health providers in this state,” said Sen. Lew Frederick, D-Portland.
A similar bill with fewer safeguards passed in 2010, only to be vetoed by Gov. Ted Kulongoski.
Kennemer hopes to avoid that fate by endorsing the restrictions on psychologists who want to prescribe psychotropic medication -- they’ll need a master’s degree in pharmacology, 2,000 hours of supervised clinical experience, and they’ll only be able to practice within a medical clinic as part of a team with family practice physicians and nurse practitioners.
Rep. Mitch Greenlick, D-Portland, supported Kennemer’s efforts and said it was an approach to closing the gap in the mental healthcare system he had advocated for several years.
“The training requirements kept getting better and their use more narrow,” he said, improving the program. He imagined only about 100 psychologists in the state would be prescribing medicine when the opportunity is fully available. “It’s going to be an effort to get it.”
Chris Gray can be reached at [email protected].
