In 2002, New Mexico became the first state to grant prescriptive authority to specially trained psychologists, allowing them to prescribe psychotropic drugs to their clients. Two years later, Louisiana followed suit and passed a prescriptive authority (RxP) bill of its own. Many psychologists hoped these two successes would open the floodgates for psychology's RxP movement, but progress remains a state-by-state trickle.
But there is a real need for psychologists who can prescribe psychotropic medication, say members of APA's Div. 55 (Pharmacotherapy), which promotes combining psychopharmacological treatments with psychotherapy. RxP would mean more people have access to medical care, they say, especially in rural areas. Nationwide, about 70 percent of psychotropic medications are prescribed by primary-care physicians, who may not be as informed about the medicines' psychological effects or alternative psychological treatments.
Psychologists, they maintain, would be in a better position to treat these people in rural locations than local physicians.
"Because of the close nature of the relationship between psychologists and clients, medication is integrated into an overall treatment when psychologists prescribe," says Div. 55 President Elaine LeVine, PhD, one of 13 privately practicing psychologists licensed to prescribe in New Mexico. "Informed consent is very central to that relationship, so patients are made aware of all the potential side effects and become well-informed consumers."
But some physicians and psychiatrists oppose the movement because they fear psychologists will lack the proper training in medical knowledge to safely prescribe psychotropic medications. LeVine and the rest of Div. 55 work to overcome these worries by developing rigorous training programs for psychologists and promoting RxP's legitimacy to legislators and the community at large.
Of course, the first step to proving psychologists' prescriptive competency is making psychologists competent to prescribe. To that end, Div. 55 is working to establish APA-approved guidelines for postdoctoral training programs designed to give psychologists the education and experience to prescribe.
Robert McGrath, PhD, a psychology professor at Fairleigh Dickinson University in Teaneck, N.J., and former president of Div. 55, chairs the Practice Guideline Task Force within the division. His committee is working to update and improve upon APA's Recommended Postdoctoral Training in Psychopharmacology for Prescription Privileges guidelines.
"At the time [the first guidelines] were developed, there were almost no training programs in the country," McGrath says.
Now, about a dozen universities and independent training facilities are looking into establishing such programs, and the guidelines will help them know what subjects need to be covered, he says.
The original guidelines, which were approved in 1996, focused on providing a postdoctoral experience where psychologists trained in physiology and neuroscience and then interned with prescribing physicians or psychiatrists in a clinical setting. The curriculum was fairly rigid, and it required more than 350 hours of training.
But its rigidity was also its weakness, McGrath says. The program was geared toward fulfilling certain requirements, not necessarily demonstrating proficiency. The new model curriculum being developed instead holds competency up as its main standard, not hours completed.
"Rather than basing success on a potentially arbitrary set of criteria, we're thinking about what psychologists need to be able to do before he or she is qualified to prescribe," McGrath says.
Instead of subscribing to a mandated syllabus, programs will be able to get creative in their training. They'll work with APA to ensure that their curriculum adequately and competently trains students before APA ordains them a designated RxP training program.
Right now, Div. 55 and APA are hashing out the model curriculum's details. McGrath expects it to be approved by APA's Council of Representatives this month.
The tipping point
Training competent prescribing psychologists is only one half of the battle. The other is getting legislators to grant psychologists prescriptive authority. To that end, another former president of Div. 55, psychologist Beth Rom-Rymer, PhD, is organizing the fourth annual Midwinter Conference, "National Unity for RxP" held Jan. 9-12 in Jefferson City and Kansas City, Mo. Since 2004, Div. 55 has hosted yearly conferences and invited local legislators to learn about RxP's success in New Mexico and Louisiana. This year, the focus is on Missouri, which may have the best chance of enacting an RxP bill during the 2008 legislative session, Rom-Rymer says.
That's because many psychologists there are trained in psychopharmacology, and key legislators are familiar with the potential of RxP to improve access to care, she says.
"All of these factors come together to form an unstoppable force," Rom-Rymer says.
She hopes that as more states recognize RxP as a legitimate component of psychological care, psychologists will be able to demonstrate their competence to the public. When that happens, Rom-Rymer predicts that psychologists will be welcomed into the fold by other medical professionals. And once a critical number of states pass RxP bills, the rest of the states will follow suit.
"There's a growing excitement around the country, especially among early-career psychologists," Rom-Rymer says. "Slowly but surely, we're going to be on equal footing with psychiatrists in our ability to prescribe and provide comprehensive care."Div. 55 at a glance
Div. 55 (Pharmacotherapy) seeks to enhance psychological treatments combined with psychopharmacological medication, to promote public interest in pharmacotherapy by working toward high-quality statutory and regulatory standards and to support collaboration with other health professions.
The division publishes a quarterly journal, Tablet. For more information on Div. 55, visit www.division55.org.