Feature

For a couple of weeks this spring, it looked like New Mexico was a dark horse moving up to become the first state to enact prescription privileges for psychologists. And the New Mexico Psychological Association (NMPA) succeeded in pushing the legislation further in the legislative process than any other state has.

In the two-month session of the legislature, the bill was introduced, passed through two House committees and a Senate committee twice and at the end of the session was waiting to be taken up on the Senate floor. That's lightening speed for a process in which proponents in several states expect a gradual education of legislators, possibly over several years.

The news that the bill had passed the state House of Representatives--the first time the legislation has passed either chamber in any state--came as the APA Practice Organization's State Leadership Conference met in Washington (see pages 66­73). Cheers went up room-by-room as the announcement was made in various sessions.

In addition to the fast progress through the legislature, New Mexico's psychologist proponents believed they had enough votes in the Senate for passage, says long-time advocate of privileges Elaine LeVine, PhD, of Las Cruces, N.M.

But in a cliff-hanger, time ran out for the legislative session the day the Senate was to consider the bill, a fact LeVine and other proponents say was aided by delays arranged at the behest of the opposition.

Opponents of the bill, according to LeVine, were the New Mexico Psychiatric Association, the medical school at the University of New Mexico and the New Mexico Medical Society.

Despite the clock rundown, says LeVine, "We consider it a resounding success because we never lost a vote."

"We salute New Mexico for their tremendous effort in moving so far through their legislative process," says Russ Newman, PhD, JD, APA's executive director for practice.

Rochelle Jennings, APA prescription privileges coordinator, added, "This has helped energize people on this issue all over the country."

Michael Sullivan, PhD, APA assistant executive director for state advocacy, says, "It has been very important for proponents of prescription privileges to see this. People in other states are saying we can do what New Mexico did."

Factors in pushing a bill

How was the NMPA able to move the bill so quickly?

"One factor is that we have such a crisis in mental health in this state," says LeVine. "There are so many underserved populations in the rural areas and among the urban poor and the elderly. I think that, partly because of some of the economic problems in New Mexico, our legislators have been willing to look at some creative and courageous ways to meet the needs in the state."

LeVine also notes, however, that although the action seemed fast in the legislature, the NMPA has been laying the groundwork for introducing the legislation for years, including building an internal consensus for the effort and creating a psychopharmocology training program. And over some time the association has earned the support of a range of legislators and advocacy groups, as well as a number of physicians from the rural areas and several psychiatrists.

The New Mexico legislation had endorsements from organizations including consumer mental health groups, organizations on developmental disabilities, the state NAACP and the state attorney general. At one point the secretary of state helped continue discussions in a Senate committee hearing so supporting legislators could arrive before the vote, says LeVine.

Over the past several years APA's Committee on the Advancement of Professional Practice (CAPP) and Practice Directorate have supported the development of NMPA's prescriptive authority initiative by assisting with internal consensus-building, legislative strategizing and community support building.

Through the fight, emphasizes LeVine, one of the main lessons was that when psychologists were able to talk to people about the issue, they were supportive.

"And where we had not had an opportunity to meet somebody or set that groundwork, we were very vulnerable to the opposition scaring them and convincing them that we would be dangerous," she says.

As for plans from this point, LeVine says the association intends to have the bill introduced in a future legislative session and, "I think we have a very good chance because people are more informed about the issue and we plan on picking up where we left off."

Action in other states

In the meantime, legislatures in seven other states are considering prescription authority legislation this spring: Connecticut, Georgia, Hawaii, Illinois, Louisiana, Tennessee and Texas.

Most state legislatures, including most of this group, schedule the end of their annual sessions before July 1. A few, including Connecticut, meet year-round.

In one example of action in the states, John Bolter, PhD, of the Louisiana Psychological Association (LPA), believes the legislation there has a strong chance of passing before the session ends June 19. Two years ago in Louisiana, a bill was headed to the floor in both houses before it became bogged down in controversy. Because the legislature meets on only financial matters on alternative years the LPA has had the time since then to do a lot of education, says Bolter, and, "We have made some new friends over the last two years."

Assessing the situation nationally, Ron Fox, PhD, chair of CAPP, says, "APA is getting much more sophisticated in working with the states on this issue. And the states are getting much more sophisticated in both their strategies and implementation efforts. At this point it's like a tide coming in: each wave is getting a little higher. It is just a matter of time before the first state enacts a prescription privileges law."