Some of California's neediest mental health patients stand to benefit from a recent regulatory development in that state. Psychologists in California now can manage the care of patients with serious mental illnesses in acute-care hospitals, thanks to new state regulations that recognize psychologists' expertise in diagnosing and treating mental disorders.

The new regulations, issued by the state's Department of Health Services (DHS) in April, allow psychologists to direct patient care as medical staff members at acute-care hospitals in the state. For example, they can now independently make such decisions as when to admit, transfer and discharge patients. Previously, the regulations allowed only psychiatrists to do this work and to serve as attending clinicians, despite a 1978 state law that granted psychologists full clinical privileges.

"California psychologists working in hospital settings, and well within the scope of their licenses, will be able to fully serve their patients as attending clinicians," says Russ Newman, PhD, JD, APA's executive director for professional practice.

Fighting for enforcement

The rule change follows longstanding efforts by psychologists, including APA and the California Psychological Association (CPA), to enforce the 1978 law and a 1990 California Supreme Court affirmation of the law in a case filed by the California Association of Psychology Providers (CAPP), says psychologist Bill Safarjan, PhD, of Psychology Shield, a nonprofit organization of psychologists and other health-care advocates devoted to improving patient care in California's state-operated mental hospitals. The California Supreme Court ruled in the 1990 case, CAPP v. Rank, that psychologists have the legal authority to practice independently in both private and public health facilities. However, state regulations still prevented psychologists from directing patient care in California state mental hospitals.

So, in 1996, CPA pushed through the state legislature a bill requiring state-owned and state-operated health-care facilities to establish procedures enabling psychologists to apply for medical staff membership and clinical privileges. However, state hospitals resisted change. So in 1998, the state legislature passed even tougher CPA-backed legislation that mandated medical staff status for psychologists and prohibited discrimination against them. However, psychologists were still prevented from directing patient care in state hospitals.

Recent negotiations between DHS and Psychology Shield, supported by a number of organizations and individuals, including the APA Practice Organization, CPA and the psychologists' union (AFSCME Local 2620), brought about the new regulations, Safarjan says. Psychologists' new ability to direct patient care improves the outlook for people with serious mental illnesses, Safarjan says.

"In a lot of psychiatric hospitals, treatments are primarily medications that just suppress symptoms," Safarjan says. "But psychologists take a much different tack on this. Psychologists use methods that are better at improving quality of life and looking for recovery, including anger management techniques and social learning approaches."

There's also a budgetary argument for allowing psychologists to manage care for state hospital patients, says psychologist Charles Faltz, PhD, CPA director of professional affairs. Based on state salaries, psychiatrists cost taxpayers two or three times more than psychologists for the same mental health services.

"CPA has made progress by educating state legislators that more cost-effective care could be provided by psychologists," Faltz says. "And key state legislators, especially Judy Chu, a psychologist, were invaluable to our efforts."

Following suit

The California legislature and courts have been leaders in recognizing the important role that psychologists can and should play in mental hospitals, Newman says. Seventeen other states and the District of Columbia have enacted laws allowing psychologists hospital privileges, he adds.

California is setting an example for the rest of the country, Faltz says. Because the California law mandates that psychologists be placed on hospital staffs and used in the full scope of their practice, the law sets a strong example, he says.

"The fact that this is a law that has a mandate, instead of being permissive, means that if this law is upheld in California, it strengthens psychology laws throughout the country," says Faltz.

Despite the progress marked by the rule change, California psychologists can't let up their guard quite yet, says Alan Nessman, special counsel in the Practice Organization's Office of Legal and Regulatory Affairs. First, at press time, Psychology Shield was still negotiating with DHS regarding regulations that need to be changed for other types of facilities to give psychologists full privileges in accordance with the law (the current regulations only cover acute-care hospitals). Second, the Union of American Physicians and Dentists and the California Psychiatric Association filed a lawsuit against the state in May challenging the new regulations.