Planning for Future Is Critical to Protecting Our Profession and Americans’ Mental Health

Psychiatrists make up only approximately 6% of the mental health workforce in this country—a shortage that has long existed but has now been made even more evident amid today’s mental health pandemic. Most of us, as psychiatrists, have always assumed that because of our education, knowledge, training, and expertise, we would be looked to as the leaders of mental health teams and as the expert medical professionals on mental health. The reality is that numerous barriers to care and a critical shortage of psychiatrists have led patients to receive psychiatric and other medications from other medical and mental health professionals. Unfortunately, that care is often not evidence based and could even be unsafe.

These are not new issues—they are the culmination of many factors that affect our profession and the mental health of Americans, including low reimbursement, health care inequities, inadequate access to care, public health challenges, failure to focus on prevention, and social determinants of mental health. Too often policymakers are looking for the “quick fix” to improve access to care, but they give little consideration to creating a high-quality mental health system that will improve patient outcomes and ensure patient safety. We cannot confront these challenges and expect meaningful progress if we do not have a strategy to address them.

I want to illustrate the urgency of putting a strategy in place by relaying what transpired at a recent meeting of the New Mexico Medical Board that I attended. The task before the board was to determine whether to support legislation (1) licensing prescribing psychologists, who are currently licensed by the psychology board, to instead be licensed by the medical board, (2) allowing prescribing psychologists to elect their own supervisors to include supervision by other prescribing psychologists (effectively abolishing the requirement for supervision by a medically trained professional), (3) renaming prescribing psychologists as “medical psychologists,” and (4) broadening the list of medications that psychologists are allowed to prescribe to include long-acting injectable antipsychotic medications. Prescribing psychologists at the hearing also requested authority from the board to prescribe medications to counteract side effects from psychotropic medications.

Following testimony against the recommendations by Psychiatric Medical Association of New Mexico President Caitlyn Armijo, M.D., and me, the medical board supported all these recommendations except changing the name to medical psychologists.

With the ability to be licensed by a state medical board in New Mexico, prescribing psychologists continue their aggressive assault on patient safety and high-quality mental health care for every American. Pharmacology training for psychologists in the state consists of only 400 hours of didactics, a 150-question multiple-choice test, and 400 hours of total clinical supervision of at least 100 patients.

Even with evidence-based models, such as the Collaborative Care Model, improvements in technology, and new flexibilities to provide telemental health care, there are those who would use this mental health pandemic as an opportunity and cover for expanding their scope of practice without the concomitant education and training. The risk to patient safety demands action from our profession.

To prepare for the challenges of today and tomorrow, last summer I appointed the Presidential Work Group for the Future of Psychiatry and asked the members to create a road map of recommendations to lead APA’s strategic direction for psychiatric practice and research over the next decade. My road map initiative is about preparing and establishing ourselves as the leaders in the diagnosis and treatment of mental illness for the future and realizing APA’s vision of a society that has available, accessible, high-quality mental health treatment.

In the near term, securing psychiatry’s leadership means ensuring that all clinical practice guidelines are kept current and prescriptive and maintaining DSM as the essential foundation upon which psychiatric diagnoses is built. Working to establish APA as a “single stop” authoritative source of high-quality CME for our members and other medical professionals and CEUs for other members of the care team is another place for psychiatry to lead.

APA is also positioned to be a leader in data infrastructure to guide research on diagnosis and treatment through our clinical data registry, PsychPRO (“Join APA’s PsychPRO to Implement Measurement–Based Care in Your Practice”). Over the next 10 years, continuing to build PsychPRO as a national data repository whose data can be used to improve the quality of patient care and develop outcome-based quality measures for psychiatric practice will provide critical support. Another focus is advancing APA’s policy goals through advocacy efforts. Armed with data, APA will position itself and psychiatrists as leaders in a rapidly changing health care landscape and ensure that the voice of psychiatry is heard loud and clear in any debate on the investment in America’s mental health care infrastructure.

Our profession can’t just stand by and fail to take bold action and expect a different result. On our current trajectory, it is not obvious that psychiatrists will be the leaders in mental health care. If we remain complacent and do not prepare now for the next decade, then we tacitly accept the idea that not much needs to change, putting our profession and the mental health of the nation at risk. We must fully implement our strategy as soon as possible, and each of us needs to commit to it.

As always, please share your ideas for the future of psychiatry and follow the conversation on Twitter @Pres_APA. ■