Lawmaker wants to give Texas psychologists power to write prescriptions

Dr. Cheryl Hall, a clinical psychologist in Lubbock, still vividly remembers the 30-year-old mother who had visited her in 2015 after fighting depressive episodes for more than two years.

The woman had been unknowingly prescribed the wrong dosage of antidepressants by her primary care physician. After getting advice from a friend to consult a mental health professional, the woman drove more than two hours to see Hall. And upon meeting one another, Hall knew something wasn’t right.

“Immediately I knew she needed an adjustment in her medicine. It was just suffering that could’ve been avoided,” said Hall. “I called her primary care doctor, and we consulted and we got the medicine right. In six weeks, she was better.”

Hall and others in her profession are welcoming a potential change in how they perform their jobs if the Texas Legislature gets behind a proposal to give specially trained psychologists the power to prescribe medications.

State Rep. Dustin Burrows, R-Lubbock, said his bill aims to address the state's shortage of psychiatrists, currently the only mental health doctors allowed prescription privileges. House Bill 593 would grant psychologists a prescriptive authority certificate, but only after they’ve been supervised for a year by a licensed physician and completed a postdoctoral training program in psychopharmacology, among other requirements.

Burrows said he was motivated to file the bill following his time serving on the House County Affairs Committee in the previous legislative session, during which he and his colleagues learned there was a lack of specialized doctors trained to treat mental illnesses among children in Child Protective Services and inmates in state jails. Those jails, Burrows said, were “becoming the de facto mental health providers for a lot of our counties.”

“Most people I have spoken to, even the people opposed to this bill, would agree there is a shortage of psychiatric services available out there, especially in some of the rural areas of Texas,” said Burrows. “I felt comfortable with filing this bill and taking those issues that we could hear this session and vet out.”

Currently, the U.S. military and four states — New Mexico, Louisiana, Illinois and Iowa — already allow such privileges to trained psychologists.

“Expanding the ability to have more providers with prescriptive authority necessary to help treat these patients will help provide more access to care,” said Burrows.

Burrows’ bill is not the first time the definition of a working psychologist has been debated. In 2003, former state Rep. Rick Noriega filed House Bill 3451, a similar measure that was unsuccessful. But Burrows said he’s confident that his bill will get more attention during the current session because mental health care is a “top priority” many Texans are wanting to address.

“I think it’s the right time and the right session to be talking about this,” said Burrows. “House Speaker Joe Straus has declared CPS reform and mental health to be two of the priorities of the Texas House. I think my bill is directly on point in helping find solutions to both of the issues he’s identified as being priorities.”

Despite support from some state psychologists, including Hall, others in the medical field say they worry about the implications of passing such a measure. Austin attorney and academic Mary Louise Serafine, who served on psychology faculties at Yale University and Vassar College, said the idea of giving psychologists the power to prescribe medicine is “a very bad idea.”

“My main objection to it is this: They will be doing essentially what psychiatrists, who are physicians, are doing without the proper scientific background,” said Serafine. “Not only are psychologists usually not undergraduate majors in the sciences, but also in graduate school they do very little scientific and medical coursework.”

Serafine said prescribers need both an understanding of research and in “mathematics, statistics and research design.” 

“In my view, it would not be possible to fashion a program that could provide all that to people who have never even had an undergrad major in one of the sciences,” said Serafine.

But Hall and Burrows disagree, with both saying that in states where this has been tried, there have been no examples of malpractice suits. In addition, Hall told the Tribune that “there is a crisis in the state” due to the lack of psychiatrists and roughly 125 specialized psychologists in Texas who could be helping should Burrows’ bill get passed this session.

“This is a free-market solution, it’s greater access to care, improved quality, reduced cost and improved outcome. Our motto is better medicine with psychology, and so that’s why Burrows is doing this,” said Hall. “This bill is not going to fix everything, but this is definitely one that could be powerful.”

The filing of Burrows’ bill comes amid a broader debate about how Texas defines a "psychologist" following a court ruling last year, prompted by a lawsuit by Serafine, that declared parts of the state's licensing statute unconstitutional. A January report from the Sunset Commission suggested ways for lawmakers to address that issue but did not address the subject of Burrows' bill.

According to Ken Levine, a spokesperson for the Sunset Commission, the ability of psychologists to prescribe medication to their patients was “not something considered by the Sunset Commission.” 

Read related coverage:

• A three-judge panel ruled in January 2016 that the state's definition of "psychologist" violates the First Amendment. Now, officials are working to come up with a new definition that they hope will still prove valuable to potential patients.