Dylan, a 14-year-old high school freshman in a rural area, has recently been diagnosed with major depressive disorder and generalized anxiety by his psychologist. His mother, Mary, who raises him and his two younger siblings by herself, knows that he must have psychotherapeutic treatment, which includes the psychotherapy he's currently receiving, as well as psychotropic medication to manage his disabling conditions. To effectively implement the therapeutic strategies his psychologist has discussed with him through their sessions, he must first have the help of an antidepressant to gather the strength and motive to get out of bed in the mornings and to slow down his constant suicidal ideation. Dylan fully trusts his psychologist and has an excellent rapport with him. Once the psychologist diagnosed Dylan, he referred them to the nearest child psychiatrist who could prescribe the antidepressant – a 2-hour drive away. Mary also trusts the psychologist and knows her son needs this medication and that his life potentially depends on it to help manage these illnesses. Still, she's apprehensive about taking her son to someone new that doesn't know him or his situation well. Dylan is also very nervous about having to tell someone new about the severe daily struggles he faces. Once the psychiatrist's office received the referral three days later, they called Mary to make a new-patient appointment for Dylan. However, the psychiatrist was booked out for another eight weeks, further complicating their situation and exacerbating their feelings of hopelessness. Having finally seen a possible glimmer of light at the end of this dark tunnel, only to have been a mirage, they now wait even longer for a chance at hope. 

Many people see their local primary care physicians for psychotropic medication prescriptions out of convenience and cost. Seeing any specialist can get expensive, especially with a lack of insurance coverage. However, the issue with this is that primary care doctors don't have the extensive knowledge and education in diagnosing or treating mental health disorders that psychologists do. Psychologists are doctors who go through immense doctoral programs focused on human behavior and the diagnosis and treatment of mental disorders. 

Although psychiatrists are medical doctors that can prescribe, they don't typically offer therapy and only handle the medication aspect of treatment. Graduate school for psychologists typically takes 6-7 years to complete, not including the bachelor's degree beforehand. They also must have somewhere between 1,500 and 2,000 hours of supervised clinical practice and take national board exams to become licensed. Aside from state requirements, psychologists can further their degree of knowledge and education in psychopharmacology and successfully and confidently prescribe medications to their patients.

A handful of U.S. states have already granted psychologists the authority to prescribe psychotropic medications under specific guidelines, to better serve their communities and to have the capability to treat every aspect of a patient's condition. Rather than send a patient to another specialist for medications in a different area that requires yet another copay, psychologists could prescribe a needed medication themselves since they know the patient's history, have established a rapport with them, and won't have to worry about a lack of collaborative care. Although challenging, many clinicians have had unique opportunities to relocate to another state with prescribing rights so they can offer greater access to care for people in a different community. It takes jumping through several hoops, but it isn't impossible, and many have already done so. However, with psychologists taking these opportunities and moving to different locations to better serve another community, many individuals in the original state have even less access to care. 

Another significant and common issue is the time it takes to find the proper medication or combination of medications. If someone has difficulty seeing a psychiatrist for a prescription, when they finally make it to their appointment and receive the drug, it isn't a "one and done" deal. It can often take a few tries with different medications to find the right one that meets the patient's needs. Not to mention if it takes more than a single medication to treat all the symptoms. This common issue requires more appointments and more follow-ups with the psychiatrist. Giving psychologists the authority to prescribe takes these burdens from the patient. It also decreases the extremely high demand for psychiatric appointments, reducing appointment wait times so everyone can receive more expeditious treatment.

In 2006, Missouri State Senate Bill No. 1128 was introduced but never enacted. With this petition, I hope to gain momentum to reintroduce this bill to the Missouri state senate and give Missouri-licensed psychologists the chance to offer the best access to care to the citizens. I have linked a copy of bill No. 1128 below.

• Missouri Senate Bill No. 1128

Granting Missouri psychologists the right to prescribe psychotropic medications would be a giant leap forward in mental health treatment and reform statewide. Giving this authority to psychologists would provide thousands of psychiatric patients greater access to comprehensive mental health treatment. It would be a significant victory in the long battle against the mental health crisis we face in this state.

My name is Elizabeth Rivers, and I am a Missouri state citizen from a rural area with limited access to quality mental health care. I am currently pursuing and advancing toward a Ph.D. in Psychology. I plan to practice clinically treating clients while also conducting and furthering research within the field. I am a compassionate and empathetic helper by nature with a purpose in life to help those in need reach a solid mental balance. This is the very reason God put me on this planet; I strive to change our world for the better, one person at a time, with the ultimate goal of directly contributing to lowering suicide statistics Nationwide. The science of Psychology, human behavior, and psychopathology are my passions in life, and I am highly fervid about passing this bill for the sake of our Missouri state mental health community.

Thank you for your time.
Elizabeth C. Rivers

• APA's Designation Process for Psychopharmacology Programs for Psychologists
• Psychologist RxP: A Chronology