Reduce Suicide Rates by Expanding Psychologists’ Prescriptive Authority

Introduction

Approximately one in four U.S. adults lives with a mental illness, and suicide remains among the most severe consequences of untreated or undertreated conditions. Yet millions of Americans live too far from a mental health provider to receive timely care, especially in rural and low-access counties.

Occupational licensing and scope-of-practice laws contribute to this gap. Psychiatrists, who have MDs, hold the broadest authority to prescribe controlled substances, but they are in short supply. Psychologists often provide the bulk of psychotherapy, yet most states bar them from prescribing, despite having additional pharmacology training. These restrictions limit where psychologists practice and how mental health teams deliver care.

Beginning in 2002, a handful of states began granting psychologists prescriptive authority, or RxP. RxP is the legal right to prescribe certain controlled substances after meeting additional training requirements. As of our study period, only five states implemented RxP: New Mexico, Louisiana, Illinois, Iowa, and Idaho. Our results indicate that RxP laws improve access to providers, lowering suicide rates.

Key Findings

• Scope-of-practice expansion improves access. States that grant psychologists prescriptive authority report higher county-level access to mental health facilities, especially when we measure access by driving distance and driving time.
• Improved access lowers suicide rates. A 1% increase in access reduces county suicide mortality by about 0.3%. A 10% increase in access, roughly three additional providers per mile within a 70-mile radius, corresponds to about a 3% decline in suicide rates, or about 1.6 fewer deaths per 100,000 residents.
• Suicide declines track access to the full mental health workforce, not psychologists alone. RxP raises prescribing by psychologists, but suicide reductions line up most closely with wider access that includes psychiatrists as well.
• RxP laws change prescribing behavior. Medicare Part D records show that after RxP implementation, clinical psychologists prescribe more antidepressants and serve more beneficiaries.

Policy Recommendations

1. Expand prescriptive authority for psychologists in states that have not yet adopted RxP. Scope-of-practice reforms that follow existing RxP models are associated with higher geographic access and lower suicide mortality.
2. Pair scope-of-practice expansion with policies that support the full mental health workforce. Reforms should not treat psychologist prescribing as a substitute for psychiatrist recruitment or telehealth expansion.
3. Reduce interstate licensing barriers for mental health professionals. States should adopt universal license recognition, interstate compacts, and expedited processing for providers who move across state lines.
4. Base scope-of-practice rules on training and competency, not outdated guild restrictions. State licensing boards should set requirements according to demonstrated competency rather than blanket prohibitions that restrict supply without clear safety gains.

Summary

Mental health provider shortages reflect licensing rules as well as workforce size. Restrictions on psychologists’ scope of practice limit where providers practice, how teams deliver care, and whether patients receive timely treatment. In county-level data from 2016 to 2019, we find that states expanding psychologist prescriptive authority report higher access to mental health services and lower suicide rates.

Scope-of-practice reform alone will not close every access gap. Psychologists and psychiatrists serve different but related roles, and the size of the access gain depends on how states implement reform. Faster license transfers and wider interstate recognition matter alongside RxP. Updating licensing rules to match current training and patient needs can expand access to mental health care and reduce preventable deaths.

Download the full report.

Source: Shakya, Shishir, and Agnitra Roy Choudhury. 2026. Access to Mental Health Care Services & Suicide Rates in the United States. Journal of Policy Analysis and Management. Vol 45, No. 3. E70110.