Shared Perspectives

I was not always in favor of prescriptive authority for psychologists. In fact, I was one of those who attended a 1989 APA Board of Professional Affairs (BPA) retreat on the topic, who, at the start of the retreat, thought it was among the dumbest ideas I had heard in a long time. After hearing from the likes of Drs. Floyd Jennings (a prescribing psychologist in the Indian Health Service) and Dan Egli (a rural consultative psychopharmacologist), many of us changed our views that weekend. As a result, the retreat was often referred to as the "conversion retreat."

That was just 12 years ago. It is amazing how far we have come in such a short time.

As a result of the retreat, BPA adopted the following resolution:

"BPA strongly endorsed immediate research and study regarding the feasibility and the appropriate curricula in psychopharmacology so that psychologists might provide broader service to the public and more effectively meet the psychological and mental health needs of society. Further, BPA strongly recommended that focused attention on the responsibility of preparing the profession to address current and future needs of the public for psychologically managed psychopharmacological interventions be made APA's highest priority."

This resolution inaugurated six years of efforts in APA's governance, which bore fruit in 1995 when the Council of Representatives formally endorsed prescription privileges for appropriately trained psychologists and called for the development of model legislation and a model curriculum, both of which were adopted by the Council in 1996.

Moving in the right direction

Today, 11 programs offer postdoctoral training in psychopharmacology. It is estimated that more than 900 psychologists have pursued or are pursuing such training. Over 250 graduates of such training programs requested application materials for the psychopharmacology examination for psychologists offered by the APA Practice Organization's College of Professional Psychology.

Meanwhile, 31 state psychological associations have committees focusing on prescriptive authority, and bills have been introduced in 13 state legislatures.

In 1993, the Indiana Psychology Code was rewritten in a way that could allow some appropriately trained psychologists to prescribe: "Nothing in this article shall be construed as permitting a psychologist to prescribe medication, unless a psychologist is participating in a federal government sponsored training or treatment program."

On Dec. 30, 1998, in the last hours of its session, the Guam legislature overrode a governor's veto, making B.695 public law. Guam law now states: "Section 121204. Prescriptive Authority. A clinical psychologist may administer, prescribe and dispense any licensed drug as a delegated authority of the Collaborative Practice Agreement...."

This year we witnessed the startling success of the New Mexico Psychological Association in very nearly getting a prescriptive authority bill passed. The events in New Mexico were being followed at the March APA State Leadership Conference the way one follows a close World Series baseball game: Passage through two committees in the House....First-time-ever support from a state chapter of NAMI which is then dramatically withdrawn....Two of the leaders of the state chapter of NAMI testify in support of the bill anyway....The bill is PASSED on the floor of the House 37­21. The bill is passed through a Senate Committee twice....The bill is scheduled to be heard on the floor of the Senate where New Mexico's leaders knew they had the votes....Psychiatry somehow gets its way and the bill is never called, dying in the last moments of this session, but promising to be back even stronger next time.

A visible impact on the profession

Thus, the prescriptive authority initiative has accomplished a great deal in a relatively short time. There are many people who have made this success possible, too numerous to mention here, but I would be remiss if I did not acknowledge the tremendous leadership provided by Drs. Pat DeLeon and Ron Fox.

The success of the prescriptive authority initiative has also had a visible impact on the profession in at least two major ways. First, wherever I travel, I am told that this initiative is a morale builder, coming at the end of a long period of great demoralization due to the excesses of managed care. It builds morale because it is viewed as expanding the scope of practice and facilitating our roles in primary care and serving the underserved. Second, those psychologists who have undertaken the training report tremendous enhancements to their ability to practice, whether they be prescribing psychologists in the U.S. military or civilian psychologists who function as consultative psychopharmacologists in either the public or the private sector.