A brief history of RxP

A major force driving psychologists' campaign for prescription privileges is the nation's need for better quality health care, said Patrick H. DeLeon, PhD, JD, in a presidential address at APA's 2003 Annual Convention in Toronto.

Illustrating this, he said, is the field's recent victory in New Mexico--a state that ranks last in the nation in health-care quality and access. Legislators there took note that prescription privileges (RxP) for psychologists would aid its many citizens who have little or no access to psychiatrists, said DeLeon, a former APA president and chief of staff in the office of Sen. Daniel K. Inouye (D-Hawaii).

"The psychopharmacology/RxP agenda is fundamentally a social policy agenda that has a mammoth impact on clinical services, research and training," said DeLeon. "But it's fundamentally an agenda about access and ensuring that our nation, and perhaps internationally, gets the kind of quality care that it ought to have."

The challenge facing psychologists now, he emphasized, is getting other underserved states to recognize that granting privileges to psychologists would boost their health-care quality and access too. But though much remains to be accomplished--"It usually takes longer than we anticipate to get things done," DeLeon said--much has already been achieved for the RxP movement by APA and the profession in general.

To drive this point home, DeLeon provided a time line of some of the movement's major milestones:

• 1984. Sen. Inouye urges psychologists at the annual meeting of the Hawaii Psychological Association to seek prescriptive authority.

• 1985. The Hawaii state legislature considers legislation (S. Res. 159) to study the feasibility of RxP for psychologists.

• 1988. Congressional conferees direct the U.S. Department of Defense (DoD) to establish a pilot project to train psychologists in issuing psychotropic medications "under certain circumstances" as part of the fiscal year 1989 Appropriations Bill.

• 1989. APA's Board of Professional Affairs strongly endorses immediate study on the feasibility of RxP and appropriate corresponding curricula in psychopharmacology.

• 1990. APA's Council of Representatives, at a Boston meeting, approves a motion--in a 118-2 vote--to establish an ad hoc Task Force on Psychopharmacology.

• 1992. The Task Force on Psychopharmacology issues a report to council concluding that practitioners with combined psychosocial and psychopharmacological preparation could advance treatment and, in accordance, recommends multilevel pharmacology training.

• 1994. Navy Cmdr. John Sexton, PhD, and Lt. Cmdr. Morgan Sammons, PhD, become the first graduates of the DoD psychopharmacology training program.

• 1995. Council, at its New York meeting, formally endorses prescription privileges for appropriately trained psychologists and calls for model legislation and training.

• 1996. Council formally adopts a model prescription bill and training curriculum at its Toronto meeting.

• 1997. The American Psychological Association of Graduate Students adopts a formal resolution of support for the APA stance on prescription privileges. Council authorizes the College of Professional Psychology to develop a psychopharmacology examination suitable for use by state and provincial licensing boards.

• 1998. Prescription privileges legislation is pending or about to be introduced in seven states, while five other states actively plan to introduce it. The Guam legislature passes a bill granting psychologists prescriptive authority.

• 2000. The APA Insurance Trust announces that, in any states where psychologists have prescriptive authority, it will be covered within the practice of psychology.

• 2002. New Mexico's RxP bill, with the formal support of the New Mexico Medical Association, passes the state House of Representatives and Senate. Gov. Gary Johnson signs it into law.

Since that time, noted DeLeon, psychologists have continued pushing RxP forward, gaining more ground in state legislatures and developing more model education and training programs at, for example, Alliant International University, the University of Georgia, Nova Southeastern University and the Massachusetts School of Professional Psychology.

In closing remarks, Michael Sullivan, PhD, assistant executive director for state advocacy in APA's Practice Directorate, said the field owes much of that RxP progress to DeLeon's dogged support over the years.

"He's a visionary for psychology and the patron of RxP," said Sullivan. "And he's paid a not insignificant personal price for that."

In Sullivan's view, DeLeon also embodies the philosophy of the movement, as expressed in one of his well-known sayings: "If we take care of society, society will take care of us."