Concern over Mental Health Provider Shortage

by David Gorn

TOPIC ALERT:

Legislation introduced last week would expand the scope of practice for nurse practitioners, optometrists and pharmacists. Separate legislation looks to expand scope of practice for physician assistants, as well.

The bills hope to address the dearth of primary care providers in California by allowing some mid-level health care providers to do more. With the Affordable Care Act's expansion of Medi-Cal and introduction of the state exchange starting in 2014, there is expected to be a much greater need for primary care services.

Some mental health providers are citing a similar access concern for mental health professionals. Since the state's essential health benefits include mental health coverage, the demand for mental health services is going to take a big leap, according to psychologist John Caccavale, executive director of the National Alliance of Professional Psychology Providers.

"Mental health professionals have been left out," Caccavale said. "That's very weird from a policy perspective. I mean, the majority of mental health care takes place in primary care settings. With the implementation of the ACA, there will be more of a shortage for mental health care. It's clear you have to include mental health professionals," he said, when considering expansion of the scope of practice as a possible remedy to access concerns.

According to Steve Maviglio, spokesperson for Californians for Accessible Health Care -- a group that announced its formation last week to support expansion of the scope of practice for some primary care professionals  -- mental health scope of practice may be considered in some future legislation.

"We are initially focused on these providers because we feel they will make the biggest difference in terms of delivering primary care services," Maviglio said. "This package of bills is the beginning, and we'll explore looking at barriers to quality care for additional providers in subsequent years."

According to Caccavale, there are 20,000 psychologists in the state who could ease mental health access concerns immediately if they were allowed to prescribe medication. California has roughly 4,000 credentialed psychiatrists who can prescribe medication.

"If they were really looking at health care access, you would talk about mental health," Caccavale said. "If we're looking at health care, not including mental health is a big policy mistake that can put Californians in real jeopardy. Physicians can't do the job. NPs can't do the job. Pharmacists can't do it, and certainly optometrists can't do that job."

Catherine Mone
I know you his is a huge blaspheme, but it would be more useful to give internists a protocol for evaluating people for brain disorders, and then have the brain comprehensively managed with the rest of the body. If the physician doesn't see a physically based disease, like schizophrenia or bipolar disorder or epilepsy or debilitating clinical depression, etc., then the person could move to the next level of care and work with behavioral health staff, of which there are plenty in California. This hierarchy of care would actually be safer, and it might lead to real advances in care. Right now, a seriously ill young person with a mild form of epilepsy, for example, might very well see a psychologist and be diagnosed with reactive attachment disorder. We are smarter than we were in 1960, and we should begin with the body first. Also, anyone who is on psychiatric medication should be monitored by an internist anyway. Like I said, I know this is blasphemy...

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