How new PA bill will change mental healthcare in Massachusetts

A new piece of legislation would allow physician assistants in Massachusetts to place individuals in an involuntary psychiatric hold if thought to be experiencing a mental health crisis or a harm to themselves or others.

Currently, the only entities allowed to do so in the state are physicians, nurse practitioners, social workers and police officers. 

Duncan Daviau, PA-C, president of the Massachusetts Association of Physician Assistants, believes PAs are more than qualified to handle this responsibility. 

"In Massachusetts, police officers … on average have about 12 hours of mental healthcare training," Mr. Daviau said. "I, as a physician assistant, have hundreds of hours worth of mental healthcare training. I can prescribe psychotropic medicines, I can see psychiatric conditions such as depression and stuff like that and treat it. But the fact that I can't sign off on this order is a detriment to our healthcare system — and to our patient population as a whole."

Under current laws, if a patient needs to be admitted to an inpatient unit, a PA has to call and wait for one of these other entities in order to get them into care.

"I work clinically in emergency medicine and sometimes we see people who wait up to 300 hours for a bed or even longer," Mr. Daviau said. "You can imagine what it's like to be able to sit in a hospital bed or a stretcher for 300 hours. There's no natural sunlight. There's very little activity, accessing showers and stuff like that, and sometimes it's very difficult."

Another concern for Mr. Daviau is having to involve law enforcement in the event where a physician or NP is not available, which he said can sometimes be more upsetting for patients. 

The mother of one of his former patients came in one day experiencing a mental health crisis while he was the only provider at the clinic. He had to call law enforcement in order to get her admitted for treatment. 

"I knew this woman very well," Mr. Daviau said. "She was not in the right state of mind, and it's really sad that we have to get police officers involved in the care, because I actually haven't seen this woman since. And I wonder if calling a police officer stigmatized her mental health so much that she no longer wants to come to that clinic."

He added that not having to involve law enforcement by allowing PAs to admit patients may also help to remove the stigma around mental health. 

"I think we should be treating mental health conditions like we do every other condition," Mr. Daviau said. "Could you imagine a situation where a patient has cancer and is having some sort of complication from the chemotherapy, and a police officer has to step in? That seems asinine. Or has a heart attack and a police officer has to step in? We don't have police officers treat other health conditions, but we have them involved very much when it comes to mental health conditions." 

This order is one of a few PA-related bills in the state's legislative session this year. Other measures up to be passed include allowing PAs to practice without a supervising physician and working in limited service clinics. 

"PAs are more than adequately qualified to sign section 12 orders and take care of the mentally ill population," Mr. Daviau said. " It's just [that] our scope of practice at the present moment is prohibiting us."

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