Examining psychologist prescriptive authority as a cost-effective strategy for reducing suicide rates.

Abstract

Six states (New Mexico, Louisiana, Illinois, Iowa, Idaho, and Colorado) grant prescriptive authority to qualified psychologists, and research has shown that these policies are associated with a reduction in suicides. In this study, we assess the cost-effectiveness of these policies in reducing suicide rates. This study used a Markov model with a time horizon of 20 years to estimate the incremental net monetary benefit (INMB) of the policy from the societal perspective with a simulated cohort of 100,000 people. Transition probabilities and utilities were collected from the literature, and costs were assessed using a mixed macro-and microcosting approach. Using this approach, we found that the 20-year INMB for the policy was estimated to be $12.81 million (U.S. dollars) per quality-adjusted life year (QALY). The probability of cost-effectiveness was greater than 50% at a willingness-to-pay threshold as low as $10,000 per QALY. The probability of costeffectiveness was only modestly associated with the implementation costs of the policy but was sensitive to the estimated effect of the policy intervention. The models estimated in this study support prescriptive authority for psychologists as a cost-effective strategy for reducing state-level suicide rates. A considerable amount of research is needed to understand the impact of this policy with finer granularity. Public Significance StatementPrescriptive authority for psychologists may be a cost-effective means to reduce suicide deaths at the policy level. However, this study also highlights several important knowledge gaps that should be addressed regarding the patient outcomes associated with psychologist prescriptive authority.

Simulating the impact of psychologist prescribing authority policies on mental health prescriber shortages.

“…Based on our findings, state-level governing bodies should reexamine the policies outlining the scope of practice for psychologists and consider the addition of prescribing authority in a manner similar to New Mexico and Louisiana. Our results suggest that codifying prescribing authority for psychologists would be a step toward achieving the “Triple Aim” of health care (Berwick et al, 2008), especially given that recent studies found that the passage of RxP policies produced cost-effective reductions in mental health-related mortality (Choudhury & Plemmons, 2023; Hughes, McGrath, & Thomas, 2023; Hughes, Phillips, et al, 2023). Such a policy would promote an improvement in the health of the population via more widely available mental health care without necessarily increasing the cost per capita.…”

“…One of the driving factors of this continued debate, as highlighted by McGrath (2020), is that there has been minimal research to date on the patient or workforce outcomes associated with these policies. To date, two studies have demonstrated a decrease in mental health-related mortality following the implementation of these policies (Choudhury & Plemmons, 2023; Hughes, McGrath, & Thomas, 2023) and a third found that this is a cost-effective policy strategy for reducing suicide rates (Hughes, Phillips, et al, 2023); however, the mechanisms underlying those decreases remain unexplored. This study serves as an early step toward empirically estimating the impact of this policy by simulating the changes in the prescriber shortages at the state and national level under policies similar to those enacted in Louisiana and New Mexico.…”

Demographics and clinical characteristics of patients of prescribing psychologists, psychiatrists, and primary care physicians.

“…Furthermore, our modeling results provide a first step toward clarifying the role of prescribing psychologists in the mental health workforce in terms of how their patient case mix and initial prescribing choices compare to those of psychiatrists and primary care physicians. Given the relatively limited literature that exists on prescribing psychologists (Choudhury & Plemmons, 2023;Hughes, Phillips, et al, 2023;Linda & McGrath, 2017;Peck et al, 2021), these findings suggest a myriad of future directions and potential policy implications.…”

“…Prescribing psychologists are a small but growing workforce, and research to date, although limited, suggests that they positively impact population’s mental health (Choudhury & Plemmons, 2023; Hughes, McGrath, et al, 2023; Hughes, Phillips, et al, 2023). The present study represents the next step in generating a robust body of evidence regarding prescribing psychology by providing the first individual-level description of the patients seen by prescribing psychologists and the medications they receive.…”

“…More recently, a small number of population-based studies have been published that demonstrated reductions in suicides and deaths attributed to mental illness following the adoption of RxP (Choudhury & Plemmons, 2021, 2023; Hughes, McGrath, et al, 2023). An additional study used these estimates to show that RxP policies are a cost-effective measure to reduce suicide rates (Hughes, Phillips, et al, 2023). However, myriad fundamental questions remain.…”