While no longer "breaking news," New Mexico's prescription privileges law continues to receive much attention from psychologists, from the media and from organized psychiatry. Almost unbelievably, the New Mexico Psychological Association's (NMPA) bill resulted in the new law on only its second time before the legislature. By contrast, virtually all 13 states that have filed a prescriptive-authority bill in the last 10 years, including New Mexico, have anticipated that the time necessary to succeed would be lengthy. After all, the prescription privileges agenda is an evolutionary one for the profession, not a revolutionary one. Education of legislators and the public about how and why properly trained psychologists can and should prescribe psychoactive medication safely and effectively is an ongoing process expected to take years. So what happened in New Mexico that led to such rapid success?
An essential ingredient in this recipe for success was a state psychological association with the leadership, the personnel, the political sophistication and the resolve to get the job done. A progressive NMPA Board of Directors, a supportive membership, a small number of psychologist-members on a mission--including Elaine LeVine and Mario Marquez--skilled lobbyists and some financial and strategic support from the APA was a good starting point. The presence of a U.S. Department of Defense prescribing psychologist practicing in a military facility in the state of New Mexico, no doubt, helped as well. Also, the existence of a psychology postdoctoral training program in psychopharmacology offered by the Prescribing Psychologists' Register in collaboration with the College of Education and the Nursing Department of New Mexico State University added to the mix, as did the roughly 30 New Mexico psychologists currently enrolled in this training. That the New Mexico Medical Society endorsed the bill, and that a respected local psychiatrist testified in favor of the legislation, didn't hurt either.
Improving patient care
But perhaps the most significant ingredient of all was the unmet mental health service needs of New Mexico's residents. According to the data, only 18 psychiatrists are available to serve the 72 percent of New Mexicans who live outside the Albuquerque and Santa Fe areas. Waiting time to see a psychiatrist ranges anywhere from six weeks to five months in these areas. Suicide in New Mexico, in the age range of 15 to 24, is 75 percent higher than the national average. And, reportedly, 75 percent of people with mental health disorders in New Mexico are not receiving treatment. It would seem likely that both the state's legislature and the governor would be quite interested in finding effective ways to respond to this unmet need. As much as any factor responsible for the rapid enactment of a RxP law, this may explain why New Mexico is the first state in the country to authorize appropriately trained psychologists to prescribe.
A 2001 study by the Fordham Institute for Innovation in Social Policy lends additional weight to this conclusion. The study looked at the "social health" of all 50 states, as measured by a cumulative performance of 16 indicators representing the well-being of people at different stages of life, including child abuse, teen-age suicide, health insurance coverage and suicide among those over 65. The last year for which complete data are available, 1999, finds New Mexico ranked last in its performance on these social health indicators. Remarkably, 10 of the 13 states where psychologists' prescription privileges efforts have progressed to the point of legislation can be found among the bottom half of the country's social health rankings.
Repeating New Mexico's achievement
While no New Mexican can be pleased to find his or her state trailing the field according to this measure of social health, the state of New Mexico should be applauded for taking active steps to address its unmet mental health needs. Although some legislators around the country where prescriptive authority bills are pending may back away from what they believe to be controversial measures, New Mexico has moved above the controversy and beyond the turf battles stimulated by organized psychiatry. It is hoped that other states will follow in putting health service needs above turf and special-interest issues.
Currently, four other states--Georgia, Illinois, Hawaii and Tennessee--have pending legislation on prescription privileges for psychologists. In addition, 31 state psychological associations have prescription privileges task forces working toward legislation. Psychology looks forward to these states repeating New Mexico's recipe for success.