Paul L. Herndon

On March 10, 2001 the New Mexico House of Representatives passed by a vote of 37 to 21 a bill that would grant prescriptive authority (RxP) to properly trained licensed psychologists. It was history in the making, as this milestone for professional psychology involved several "firsts."

It was the first time an RxP bill for psychologists was voted on and passed by a full chamber of the state legislature. The 2001 state legislative session was the first in which New Mexico psychologists had introduced an RxP bill. And the House victory offered a unique opportunity for APA Executive Director for Professional Practice Russ Newman, Ph.D., J.D., to share welcome news of RxP before an enthusiastic crowd of psychology leaders - on opening day of the Practice Directorate's 2001 State Leadership Conference. "It's exciting to share with colleagues a major step forward in an agenda that involves the growth and expansion of psychology," reflected Dr. Newman. He contrasted the New Mexico development to "the many activities that the profession currently must pursue to defend and protect ourselves and the quality services we provide to patients."

One week later, on March 17, time ran out before the New Mexico Senate took up the RxP bill for a vote. The prescription privileges bill, which the Senate Majority Leader had scheduled last in the sequence among dozens of bills for consideration on the final day of the session, did not reach the Senate floor.

Many attribute the House passage on the first attempt to psychology leaders in New Mexico strategically laying the groundwork and building the necessary support. "They did their homework, and it showed," said Ron Fox, Ph.D., chair of the Committee for the Advancement of Professional Practice (CAPP)."

Dr. Fox believes a number of combined factors are responsible for the state legislative success. "They had a well-thought-out campaign, solid backing from state psychological association leaders, very good lobbyists, and excellent coordination among the various elements of their multifaceted campaign strategy." The APA Board of Directors, CAPP and the Practice Directorate aided the New Mexico RxP initiative with strategic consultation, technical assistance and financial support.

Elaine LeVine, Ph.D., chair of the New Mexico Psychological Association's Prescription Privileges Task Force, elaborated on how she and other state advocates for RxP built the necessary community support for introducing a bill. Dr. LeVine said they took a consultative approach in working with legislators, business leaders and health advocacy groups. "We sought their advice and ideas, and let them know we respected their opinions." They started with individuals and local groups, and built on their accomplishments to help enlist the support of statewide organizations and public officials.

New Mexico advocates started several years ago to help legislators and others understand the quality of care and patient access issues at stake. The gradual relationship building paid off. Those at the forefront of the RxP effort in New Mexico secured the support and endorsement of many influential organizations and citizens, including New Mexico Attorney General Patricia Madrid. On the legislative front, Dr. LeVine chaired a group of health professionals who testified before the state Health and Human Services Committee during an October 2000 hearing on RxP for psychologists. She and her colleagues substantiated the crisis health care situation in New Mexico, reflecting on physician flight from the state and the small number of psychiatrists providing care to Medicaid recipients. The testimony helped demonstrate how psychologists were working with underserved populations.

Consumer groups that endorsed the New Mexico Psychological Assocation's efforts also spoke to unmet health needs among New Mexico residents. For example, the Arc of New Mexico, which advocates for persons with developmental disabilities and their families, noted that, "There are large areas of the state where the services of a physician or psychiatrist to prescribe psychotropic drugs are nonexistent."

Dr. LeVine said it also helped to have an RxP training program in place so state leaders could draw on a number of psychologists to speak with some experience about receiving appropriate training as part of the process of building support among potential legislative allies. Early in 2001, as the state legislature convened, a dozen of the 25 enrolled students had nearly completed a postdoctoral training program based on the APA model curriculum under the auspices of the New Mexico State University's College of Education and Department and Nursing and the Prescribing Psychologist Register (PPR is a private training and credentialing organization that provides psychopharmacology education for psychologists). According to Dr. Levine, students in this program played an important role in calling on their legislators and organizing other psychologists to do the same in support of the House RxP bill.

Of course, not all the voices seeking to influence legislators and other potential allies for psychology were supportive. According to Dr. LeVine, the House RxP bill's primary opponents included the New Mexico Psychiatric Association, the New Mexico Medical Society, and the medical school at the University of New Mexico.

Psychology leaders observed that, while the RxP battleground is relatively new, the essence of the psychiatry's warnings was reminiscent of bygone attacks. "Organized medicine's behavior was consistent and predictable. Psychiatry trotted out the same arguments they used when psychology began to seek licensure and reimbursement for psychological services," said Bob Resnick, Ph.D., chair of the CAPP subcommittee on prescription privileges. "Psychiatry's mantra has always been the same: psychologists are dangerous to the public, and they are inadequately trained."

"It's an understatement to say that the fights between psychology and medicine became aggressive," said Dr. LeVine. "It was very important for us to have hard data to correct the distortions and misinformation."

Yet, Dr. Resnick observed, organized medicine ultimately has never been able to stop another profession from gaining prescriptive authority. And in New Mexico, psychiatry failed to halt the House bill's forward momentum until the very end of the session. "Psychology put their opponents on the defensive from the beginning and never gave them a chance to regroup or take the offensive," said Dr. Fox.

Fresh from their recent legislative experience, the New Mexico Psychological Association is working with lobbyists to determine next steps. Meanwhile, legislatures in eight other states - Connecticut, Georgia, Hawaii, Illinois, Louisiana, Tennessee, Texas and Missouri - took up RxP legislation for psychologists during their 2001 sessions. Dr. LeVine believes that one way state psychological associations pursuing RxP can work together is to "pool their collective wisdom" to better anticipate what to expect from the opposition and then jointly develop strong, convincing ways of responding.

"We've come a long way since we started, building more and more of the grassroots support that's essential" for this effort, said Dr. Resnick. He anticipates a "domino effect" as the RxP initiative continues gathering steam nationwide, with the first state to achieve RxP being particularly important. Rochelle Jennings, the Practice Directorate's prescription privileges coordinator, reflected a similar outlook. "Once a few states have passed prescriptive authority legislation, it should help pave the way for other interested state psychological associations."