Quest for prescribing privileges stalls in New England

Quest for prescribing privileges stalls
in New England
(May 2009 Issue)

By Catherine Robertson Souter

In the quest for legally allowing prescription privileges for psychologists, the battle seems to have stalled on most fronts. At one point, winning the privilege was gaining momentum. The American Psychological Association started a division in 2001 (Division 55) in response to interest in the issue. But, while properly trained psychologists have had the right to prescribe in New Mexico (since 2002), Louisiana (2005) and the Territory of Guam (1998), bills brought forth in other states have not had much success. In 2007, attempts to win the rights for psychologists failed in 10 states.

In New England, advocates of prescription privileges (RxP), last took the battle to a state legislature in New Hampshire in 2003. That bill, defeated in committee, did not have the support from state psychologists that it needed to pass, according to past president of the New Hampshire Psychological Association, Sandy Rose, Ph.D. A stronger grass roots drive was needed to push the bills through.

Today, in New Hampshire, the NHPA has become more focused on integrating psychology with the rest of the medical field.

"We are more focused on how psychologists can fit in with health care in general such as moving forward in integrated care capacities, where psychologists work alongside medical professionals offering consultation about diagnosis and management strategies for patients with medical problems and/or co-morbid (mental health and medical) diagnoses," Rose says.

Working for mental health parity has also edged out the drive for RxP in New Hampshire, she adds.

In Connecticut, the only other New England state to have had a bill brought before the legislature, the bill failed in 2001 and has not been reintroduced.

At the Massachusetts School of Professional Psychology, interest in the psychopharmacology training program has diminished significantly, to a point where the program is not planning to enroll new students in the next year.

"The number of applicants has declined since three years ago," says Stan Berman, Ph.D. dean of the Program of Advanced Graduate Study.

Still, though stalled, the drive is not dead. Advocates realize that this may not be a banner year for the RxP initiative, but that these things can take time. They hold up the success of psychologists in New Mexico, where there are nearly two dozen prescribing psychologists, in Louisiana (approximately 45 RxP psychologists), and Guam (two completing training). In addition, the Department of Defense has 14 prescribing psychologists, both active and active reserves.

"Overall, approximately 75 appropriately trained psychologists have been prescribing and un-prescribing for over 15 years in a safe and effective manner," says Jeff Matranga, Ph.D., ABPP of Waterville, Maine and editor of The Tablet, the newsletter for Division 55.

The hope is that the push for RxP will regain momentum over the next few years.

"With optometrists," Matranga says, "I believe that they initially succeeded in obtaining prescriptive authority in three states and then there was a seven-year lull. After that doldrums period, however, the rest of the states went very quickly."

In the meantime, advocates focus on demonstrating the benefits to the medical field and to patients, that pharmacologically trained psychologists can offer. From offering supplementary counseling to increase the effectiveness of medications to picking up on signs that a medication may not be working or needed, a psychologist often has a unique and up close, view of the client that a medical doctor doesn't have.

"As an extra set of eyes, psychologists with psychopharmacology training are sometimes the first ones to pick up on a clinically significant medication interaction and alert the treating physician so that changes can be made," says Matranga. "I think that we - being trained in both therapy and medications - are in a good place to guide treatment decisions as to the relative efficacy of medications versus therapy versus a combination approach."

Unlike some opponents, who fear that giving psychologists the legal rights to prescribe medications will only result in more pharmacological solutions being applied to mental health problems, advocates feel that psychologists can help to reduce the amount of medications given.

"Hopefully, gone are the days of trying to treat everything with medications and not factoring in cognitive behavior therapy (CBT) or other forms of therapy." Matranga adds. "I personally like to think of our set of skills as PRUM: Psychologists for the Responsible Use of Medications."