The demand for mental health services in Australia is growing, with a whopping $13.2 million spent on mental health from 2022-2023. This money is spent on community services, doctors, psychologists, support workers, and, critically, the mental health-related prescriptions that 18% of Australians received in 2023-2024. With more prescriptions being filled than ever before, are we getting the right drugs when we need them? And who should be in charge of dishing them out?
Taking A Page From the American Playbook
While we are fortunate enough to have socialised health, America does have some of the best healthcare in the world… If you can afford it. As of writing, there are seven American states that allow psychologists to gain “prescribing authority” with the proper training, of course.
In Utah, the most recent state to pass prescribing authority, registered psychologists must have a Master of Science in Clinical Psychopharmacology, complete at least two years (or 4,000 hours) of supervised clinical training under a physician, and successfully pass the Psychopharmacology Examination for Psychologists.
GP or Psychologist?
It may come as a surprise that in Australia, GPs prescribed about 85% of all mental health medications during 2021–2022. Don’t get me wrong, GPs are great, but they are busy people, and the 15 minutes (13-16 on average) you spend in their office is just not long enough for a mental health diagnosis justifying psychiatric medication. Longer appointments? That would be great, but they are 15 minutes because we have a critical shortage of GPs.
What about a psychiatrist? Isn’t it their job to prescribe psychiatric medication? Short answer: Yes, and there are several medications that require a specialist and a diagnosed psychiatric condition to be prescribed. Ritalin for attention deficit hyperactivity disorder is a good example; in most Australian states like NSW, Psychiatrists and Neurologists are generally the only ones who can diagnose and therefore prescribe.
GPs do and will continue to serve an invaluable role, especially when to comes to managing patients after a specialist has diagnosed and prescribed them with medication, but can they keep up with the demand and are they the people best suited to manage ongoing mental health problems?
The Benefits of Prescribing Rights
Specialists are few and far between, GPs are overstretched, and we simply aren’t training specialists fast enough to keep up with demand. So why not expand the capabilities of Psychologists to manage patients?
By virtue of their extensive training in mental health, psychologists already have a deep expertise in diagnosing and treating mental health disorders. The key difference is that they are not medical doctors and, as such, have not been trained in internal medicine or pharmacology, but do they really need to retrain as doctors to prescribe?
With the addition of structured postgraduate training in clinical psychopharmacology—similar to the American model—there is a good argument that psychologists could safely and effectively prescribe certain classes of psychiatric medications. This training can also be far more specific than the 5+ years a psychiatrist spends learning everything from how to deliver a baby to surgery, just to become an MD.
This would not only reduce wait times for patients but also improve continuity of care, as psychologists are often the people who spend the most time with clients, and therefore have a pretty good picture of their mental health concerns and needs over the extended periods of time many people take psychiatric medication for.
Filling the Gap
The aforementioned fact that more than 1 in 6 Australians take a psychiatric medicine represents two things. 1) a massive increase in prescription rates. 2) an increase in diagnoses. The trouble is, the people who are specialised and trained to diagnose mental health problems are generally not the ones prescribing or managing medication.
In the US, psychologists are very slowly contributing to filling the gap, but prescribing psychologists numbers is still very low, at less than 1% in many states. In Louisiana, the RxP bill was passed in 2004, and almost 15% of psychologists have prescribing rights, and in New Mexico, the bill was passed in 2002, with 8% of psychologists now registered. A 2023 study found that in both these states, there has been a 5-7% drop in suicide rates during treatment relative to states with no prescribing authority. Although more research and trained psychologists are needed, this is promising evidence.
Big Moves In Healthcare
The Australian healthcare system is world-class in so many ways, but big decisions come with bureaucracy. The current movement for prescribing authority is gaining momentum in the states, and the Australian Psychological Society or APS has commented that an expanded scope of practice is likely for psychologists here. In their recent recommendations, the APS recognise the demand and states that a group has been set up to explore how training would work and what drugs could be prescribed here.
At the end of the day, healthcare needs to be flexible to keep up with the demands of the population today and for the foreseeable future, and if today is anything to go by, demand for mental health care will only grow. This growth will demand new ways to diagnose, treat and manage problems effectively.
