Cover Story

Hawaii's state legislature was the first to consider a bill granting prescriptive authority to appropriately trained psychologists in 1985. Since then, 21 states or territories have introduced prescriptive authority legislation-a push that will resume in legislatures across the nation this year.

The territory of Guam approved prescriptive authority in 1999. New Mexico was the first state to approve the privilege in 2002, followed by Louisiana in 2004.

Last year, Hawaii came closest to being the third state: Last May, the state's legislature approved a bill that would have allowed appropriately trained and supervised licensed psychologists who practice in federally qualified health centers to prescribe psychotropic medications in collaboration with patients' primary-care physicians. But Gov. Linda Lingle (R) vetoed the measure in July.

Besides Hawaii, bills granting prescriptive authority for appropriately trained psychologists were considered last year in California, Georgia, Illinois, Mississippi, Missouri, Montana, Oregon and Tennessee.

How it works in N.M. and La.

In New Mexico, under regulations implemented in 2005, psychologists undergo a rigorous training period, including 450 hours of instruction, followed by a supervised 400-hour practicum with a minimum of 100 patients and a national exam before they can apply for a two-year conditional prescribing certification.

During the two-year period and after, psychologists are required to maintain a collaborative relationship with patients' primary-care physicians.

As of December, 10 psychologists were prescribing under the conditional two-year certification, and three psychologists had moved beyond the two-year period and been granted unrestricted certifications, according to the New Mexico State Board of Psychologist Examiners.

In Louisiana, psychologists must complete a postdoctoral master's degree in clinical psychopharmacology and pass a national certification exam to be eligible for prescriptive authority.

Called a "medical psychologist" by Louisiana law, the psychologist prescribes in consultation and collaboration with patients' primary or attending physicians and with the concurrence of physicians. As of December, 42 psychologists had been granted prescriptive authority in Louisiana, according to the Louisiana State Board of Examiners of Psychologists.

In 2006, Louisiana amended its law to ensure that medical psychologists could prescribe in state health facilities.

New Mexico's formulary includes all psychotropic medications approved by the federal Food and Drug Administration for the treatment of mental disorders, while Louisiana's formulary includes non-narcotic drugs related to the diagnosis and treatment of mental and emotional disorders.

On the horizon

Since 1985, prescriptive authority bills have also been introduced in Alaska, Connecticut, Florida, Maine, New Hampshire, Oklahoma, Texas, Wyoming and the Virgin Islands.

While it's up to individual state associations to push for prescriptive authority, says Deborah Baker, JD, assistant director for prescriptive privileges for APA's Practice Directorate, APA provides assistance and resources to state associations pursuing prescriptive authority. These resources include the APA Model Legislation for Prescriptive Authority, recommended education and training guidelines, as well as grant funding and consultation on strategy.

--C. Munsey