Feature

In a major victory for professional psychology, the Louisiana legislature voted in April to grant prescription privileges to trained psychologists.

The bill passed 62-31 in the Louisiana House and 21-16 in the state's Senate. And then on May 6, Governor Kathleen Blanco (D) signed the bill into law, making Louisiana the second state--New Mexico became the first in 2002--to give specially trained psychologists the authorization to prescribe certain drugs related to the diagnosis and treatment of mental health disorders.

Fueling the bill's passage was legislators' overall sense that it would boost mental health care while providing cost savings--a message communicated through strong relationships psychologists had forged with key politicians, observers say. The president of the Senate, Donald E. Hines, MD (D), and the speaker of the House, Joe R. Salter (D), sponsored the bill. In fact, Hines--a physician--spoke out before the vote in support of the training psychologists must receive in order to prescribe, noting that the 50 current Louisiana psychopharmacology graduates had gone to school every other weekend for two years to obtain their postdoctoral master's degree in psychopharmacology. He also pointed out that many primary-care or family physicians already refer patients to psychologists and that the bill would ensure greater coordination of care.

Applauding such support is James Quillin, PhD, president of the Louisiana Academy of Medical Psychologists (LAMP)--a group of 50 psychopharmacology graduates that has worked hand in hand with the Louisiana Psychological Association (LPA) on RxP issues. He explains the reason behind his praise: "As in most states, front-line treatment of psychological disorders is currently managed by nonpsychiatric physicians who largely welcome the role of psychologists in assisting in the management of these conditions."

In that spirit, the law requires consulation and concurrence between psychologists and physicians.

For example, if a physician refers a patient to a psychologist, and the psychologist determines that the patient is depressed and recommends an antidepressant, the physician and psychologist must agree on the course of treatment, and then the psychologist can write the prescription. This provision, says John Bolter, PhD, LAMP's treasurer, reduces what opponents of the bill often bring up--medical risk. "And it improves patient care because it creates a collaboration. Patients benefit from that," he adds. Echoing Bolter's point that patient care is the major winner is Russ Newman, PhD, JD, APA's executive director for professional practice: "Another state is now poised to improve access to care by enabling qualified psychologists to prescribe." Newman adds that Louisiana's achievement is important because it lays to rest any sense that New Mexico's victory was a fluke. "While two laws may not constitute a critical mass, the groundbreaking ones tend to be the most difficult ones to pass," he explains.

Steady progress

Indeed, Louisiana psychologists laid the groundwork for this success for years. To be exact, they first began the push for prescription privileges in 1995 and introduced their first bill in 1997. In fact, this victory marks their fourth RxP bill introduction. "It's been a multiyear process. Nothing was done in one year--this is a cumulative effect," says Bolter. Adds Quillin, "This has been an issue of educating legislators and you have to stick with it."

And the national RxP movement wasn't built overnight. Advocates base their efforts on the belief that with appropriate training, psychologists can improve patient services by providing psychological psychopharmacological care and by collaborating with primary-care providers, especially in states like Louisiana, where much of the territory is rural and access to services is a problem. So far, 18 states have introduced RxP legislation. In 1999, Guam passed legislation and then in 2002, New Mexico gave prescribing authority to trained psychologists. Combined with these earlier developments, the Louisiana win could pave the way for additional states to gain RxP victories, some observers speculate.

"The more laws we achieve, the more it may help invigorate other states that are advocating for prescriptive authority," Newman points out.

The fact that Louisiana is such a conservative state makes this victory even more stunning, adds Bolter. "It should raise the bar of hope for everyone else," he says.

Building support

Indeed, Louisiana can serve as a model for other states, says Michael Sullivan, PhD, associate executive director for state advocacy in APA's Practice Directorate. Cathy Castille, PhD, president of LPA, adds that the keys to success were "a combination of strategic lobbying, very dedicated and hardworking psychologists and grassroots efforts." The prescriptive authority bill enjoyed the strong support of the consumer advocacy organization known as Louisiana Families for Access to Comprehensive Treatment (LaFACT), a diverse group of families and individuals from all over the state. According to Bolter, LaFACT members were very active during critical periods leading up to the bill's passage.

"It's hard to get people to talk to legislators," he says. But LaFACT made it easy; the group put members in touch with their legislators. So why did so many consumers care enough to join LaFACT? Access to mental health services is a major issue in Louisiana, which has an extreme shortage of psychiatrists. In fact, there are only 518 psychiatrists in the entire state to meet 4.5 million people's needs--that equals about one psychiatrist for every 9,000 citizens, says Quillin. The state ranks 48th in the United States in social services. And to make matters worse, many of the psychiatrists have opted out of the state's Medicare and Medicaid systems. "So there are enormous wait times for an appointment and those who can't pay for services suffer," says Bolter.

As a result, properly trained psychologists can fill an unmet need in Louisiana, he says.

At the same time, these psychologists could even save the state money. According to Bolter, the state contracts for private psychiatric services at a large cost. "So this would be a way for psychologists who are accustomed to working in state hospitals to provide additional services," he says.

Indeed, the bill's benefits to health-care costs and quality were impossible for legislators to pass up, Quillin believes. "It's hard to argue against a bill that represents good, quality health care," says Quillin. "This [will] allow us to begin to address the problem of inadequate access. The alternative is to allow the powerful medical lobby to dictate all policy while they reject safe and meaningful alternatives that could address the present health-care needs."