There's no doubt that psychologists will gain the right to prescribe medications, believes APA Past-president Pat DeLeon, PhD, who calls prescription privileges for the profession "a quality-of-care, social issue."
And, say DeLeon and other proponents of prescription authority, who better than a psychologist who provides therapy to monitor patients' medications--or possibly discontinue them?
"It will happen," said DeLeon, speaking of strategies for achieving prescriptive authority at an APA 2001 Annual Convention symposium on the topic. "Bright people will go where they want to go."
Certainly, the near success in New Mexico's legislature this year inspired many advocates to keep plugging along. Meanwhile, nine states have introduced bills calling for appropriately trained psychologists to be able to prescribe: Hawaii, Missouri, Illinois, Tennessee, Georgia, Louisiana, New Mexico, Texas and Connecticut.
But dealing with legislators is not the only means to achieving the goal. Several speakers shared their creative strategies:
Jennifer Kelly, PhD, past-president of the Georgia Psychological Association (GPA), told the audience about GPA's continuing tactics to generate support for the issue, which they initially introduced to the state legislature three years ago. Georgia psychologists have gained the backing of concerned coalitions like the Georgia Alliance for the Mentally Ill and the state Mental Health Association and have met with newspaper editors across the state "to give them a clear picture of the issue." GPA members also went right to the legislature to build relationships through one-on-one discussions, formal presentations, campaign contributions and fund-raising assistance.
Like Kelly, Mamie Balajadia, EdD, of the Department of Mental Health and Substance Abuse in Tamuning, Guam, espoused the importance of building personal relationships and connections, which were instrumental in gaining prescriptive privileges in Guam in 1998. "We had to be well-connected and follow up with our connections," she said.
Psychologists in Hawaii are being trained to prescribe, thanks to a program developed by Raymond Folen, PhD, of the American School of Professional Psychology in Honolulu. The six-year program combines a nursing and psychology degree to train psychology students to prescribe, awarding graduates a PsyD in psychology, a bachelor's in nursing and a master's of science in nursing. Folen shared the course requirements with the audience, illustrating that students gain the necessary psychological foundation through typical coursework and internship training, along with courses and labs in physiology, microbiology and chemistry, to name a few.
Some Army psychologists have carved out practices in which they manage patients' prescriptions. Michael Kellar, PsyD, of Tripler Army Medical Center in Honolulu and Larry James, PhD, of Walter Reed Army Medical Center in Washington, D.C., both prescribe within specialized Army programs. Kellar runs a smoking-cessation program that combines medications with a psychosocial component. A family physician orders medications such as buproprion and a psychologist manages who receives those medications as well as the dosage levels. The program boasts a 32 percent abstinence rate after six months. James runs a program to combat obesity in which patients receive a combination of cognitive behavioral therapy and Orlistat. Psychologists order all lab work, do health assessments, take medical histories and "home in on things like family situation or substance abuse issues."
Michael Enright, PhD, a psychology practitioner in Wyoming, took what he calls the "open door" approach and went to nursing school to gain the right to prescribe. Now, as a member of a multidisciplinary practice, he collaborates with other health providers on patients' medications, "but the process is much simpler" now that he can write his own prescriptions and manage patients' medications, he said.
The key to achieving prescription privileges, agreed the speakers, is expanding psychologists' visions of what they can accomplish.
"We've got to move beyond seeing ourselves solely as mental health providers and see ourselves as health-care providers," said James. These psychologists are doing just that.