In 2002, New Mexico passed legislation to allow prescribing psychologists-licensed psychologists with appropriate training and certification-to prescribe psychotropic medications. Two years later, Louisiana followed suit with its statutory creation of medical psychologists.
Today, 31 medical psychologists practice in Louisiana and four prescribing psychologists practice in New Mexico-a boon to patients in both states, say many who've qualified.
"Patients are saving time and expense," says Louisiana medical psychologist Jim Quillin, PhD. "By design it's a much tighter treatment protocol."
Quillin explains that before acquiring prescription privileges, medical psychologists had to refer clients to physicians for medication evaluations, then jointly monitor the patient with the physician. Now medical psychologists, in consultation with physicians, provide a one-stop-shop where they can decide whether drug therapy is appropriate, or whether a different approach would work better-including a combination of psychotherapy and medication-for a particular patient.
Moreover, prescriptive privileges are helping patients in rural and urban areas gain access to quality mental health care, according to New Mexico prescribing psychologist E. Mario Marquez, PhD.
The Monitor recently spoke with three psychologists with prescriptive authority for more specifics on how their new capability affects their day-to-day work.
It used to be that most of the patients at Quillin's private practice were from Alexandria, La. However, since becoming a medical psychologist in 2005, Quillin has seen a dramatic increase in patients from outside the city.
"People had a tremendous access problem for [mental health] problems," says Quillin, whose patients are generally medically compromised adults with significant psychiatric components to their illnesses. "Medical psychologists are helping to fill that 30 monitor on psychology need."
The transformation of his practice is not limited to the geographic draw. Before last year, nearly 95 percent of his patients saw him after a physician's referral. Since last year, nearly 20 percent of his new patients have been self-referred.
The reason, Quillin suggests, is the increased efficiency of seeing a medical psychologist in cases where a prescription is necessary. In the past, such cases required a referral to another health-care provider.
"It enhances the quality of care," he says. "Since we're psychologists we have a variety of options to address an issue."
Moreover, because Louisiana's law requires medical psychologists and physicians to collaborate before medical psychologists write a prescription, the patients receive optimal treatment, as both psychologists and physicians work within their expertise, he says.
"The majority of physicians I've worked with are thrilled with [the medical psychologist statute]," he says. "Now they don't have to prescribe psychotropic medications outside their area of expertise." And with more than 60 percent of his patients on medications, that psychological expertise is essential to his patients' care, he adds.
After a year as a medical psychologist, the Baton Rouge, La., private practice of Linda Upton, PhD, remains largely unchanged.
"The patients are the same and the therapy is the same," she says, noting that many of her patients-generally teenagers and adults with mood and anxiety disorders or relationship problems-were already on psychotropic medications when she received their referrals.
The main difference is that Upton consults with the patient's physician before writing a prescription, rather than the physician-who is typically untrained in the psychological dimensions of disorders-consulting with her. She's also seen the largest upsurge in new patients seeking her services in her 16 years of private practice, possibly because she's a medical psychologist, she speculates.
"They know that I will not look to medication as the only treatment intervention," she says. "And they recognize that they need and want the psychological part of the treatment as well."
Upton emphasizes that most patients' problems are an aggregate of psychological, social, environmental and biological factors. And while she investigates the role that medication may play in treatment, with 40 percent of her patients on medications, most of her time with patients is spent working on the other variables.
The psychopharmacology training that she underwent has also helped her teach patients about how various medications work and affect the body.
"The public gets a lot of information from TV and the media about which medications they need," she says. "And my knowledge helps me educate and teach them about the limitations and potential advantages of different medications."
Although she is presently in a solo private practice, Upton and several Baton Rouge-area colleagues are in the process of forming the first independent group of medical psychologists in the country.
E. Mario Marquez
Marquez has possessed prescriptive authority for more than a year, but he has yet to issue a single new prescription.
"I'm a psychologist, not a prescriber," says Marquez, who works as a contracted school psychologist for emotionally disturbed children for a school district in Belen, N.M.-a city 38 miles south of Albuquerque. "Prescription authority is just another tool in my arsenal."
Marquez views the authority as the power to not prescribe, or to help wean patients off medications.
For instance, he recently provided services to a 13-year-old girl whose primary-care physician issued her Zoloft-a selective serotonin reuptake inhibitor indicated for depression and anxiety-because of concern that she'd lost a few pounds since her previous year's checkup. The physician failed to perform a psychological or psychiatric evaluation, and the girl's parents, who were in the midst of a custody battle, clashed over whether the prescription should be filled. Marquez insisted to the girl's mother that before taking Zoloft, the girl should be psychologically evaluated.
"Too many children are medicated," says Marquez. "It's become extremely alarming."
As such, Marquez considers a range of psychosocial treatments before writing a prescription. In fact, he will only consider writing one after the child has already undergone comprehensive psychological evaluation and psychological tests; after he has interviewed the child's parents or guardians; after he has observed the child in school; after the child's teacher has rated the child's behavior; and after he has the child's medical, school and psychological history.
His reluctance to prescribe is a reflection of his inability to monitor Belen students over the summer and his belief that social, behavioral and psychotherapy interventions are generally preferable ways of achieving lasting behavioral and emotional changes.
Marquez is setting up a private practice in Albuquerque that will include medication management for patients.