In Washington State, Psychiatrists Firmly Back Patient Safety

During a recent hearing held by Washington state’s Senate Committee on Health and Long-Term Care, APA President Petros Levounis, M.D., M.A., emphasized that protecting patient safety must be paramount in legislators’ minds when they are considering changing laws related to the medical profession.

Allowing psychologists to prescribe medications, he argued, would indeed jeopardize patient safety. “Psychologists simply do not have the medical training needed to understand the effects of psychotropic mdications on an individual,” he said.

Levounis was among numerous psychiatrists and other physicians who urged the committee to vote against the bill (SB 6144) during the January hearing. The legislation would allow psychologists to prescribe psychotropic medications to patients, as well as order any necessary laboratory tests and diagnostic examinations.

Similar bills have been filed across the country this year. As of January, bills that would allow psychologists to prescribe have been introduced in Arizona, Florida, Hawaii, and Oklahoma. A bill to expand existing prescribing privileges in New Mexico has also been introduced.

In Washington state, Levounis and others opposing the bill argued that it would not increase access to care, as proponents claim. They pointed to other, evidence-based methods to improve access to care, such as the Collaborative Care Model, as better alternatives.

To gain prescribing privileges, the bill requires psychologists to have a master’s degree in clinical psychopharmacology, have at least 80 hours of supervised clinical experience, complete a clinical prescribing fellowship that includes no less than 500 hours, and pass an examination conducted by the state’s Board of Psychology.

“Psychiatrists spend four years in medical school and four years in residency, and have over 12,000 hours of training in the medical treatment of mental health and substance use disorders,” Levounis pointed out. “On the other hand, psychologists are often trained in research, clinical practice, psychological testing, and evaluation.”

During the Senate committee hearing, Robin Berger, M.D., told the senators about a patient he had recently seen. “I cared for a teenager who developed psychosis and addiction after being prescribed a dangerous combination of medications, including an opioid, by a provider with insufficient training and whose diagnosis was simply wrong,” said Berger, who co-chairs the Washington State Psychiatric Association’s (WSPA) Government Relations Committee with Jennifer Piel, M.D., J.D.

“While I deeply respect my psychologist colleagues, I know they lack experience in managing medical illnesses,” Berger continued. “The state needs more psychologists providing therapy, not more providers with less training prescribing medications.”

The bill has yet to be scheduled for a vote by the committee. Last year, similar legislation was introduced, but because the committee’s vote was tied, it never made it to the Senate floor. Piel told Psychiatric News that WSPA learned from last year’s experience and was prepared to oppose the bill this year. In preparing the advocacy effort, she noted the importance of working closely with APA, reaching out to states that have fought similar legislation to learn from their experiences and having a skilled lobbyist who understands the intricacies of the legislative process.

“One thing we tried to do really early was involve other organizations with similar ideologies that understand scope issues, protecting patients, and different models of care that are more appropriate to improve access to care,” she said.

WSPA members reached out to a variety of organizations, and many provided testimony opposing the bill, including the Washington chapter of the American Academy of Pediatrics, the Family Alliance for Mental Health, and the AMA.

Piel said WSPA has also made a concerted effort to raise awareness about the bill among its members, encourage participation in the Government Relations Committee, and urge members to reach out to their own representatives.

“This is an issue that so many of our members care deeply about,” she said, adding that many have taken the opportunity to connect with each other and share their expertise with their lawmakers. Piel and Berger especially encouraged trainees to get involved and found many of them eager to be part of the advocacy process.

“We were ready for this bill, and we sent out a call to action and tried to get the word out,” Piel said. “Luckily, even on short notice, a lot of people responded.” ■