Lessons From New Mexico

On March 17 in New Mexico a psychologist-prescribing bill died in the state legislature. It had, however, passed in the House and was waiting to be heard in the Senate when the legislative session ended (Psychiatric News, April 20). As President of the Psychiatric Medical Association of New Mexico (PMA), I want to help other district branches that find themselves fighting a similar battle.

The introduction of a prescribing bill came with little warning. We learned only last October that psychologists in our state were working on a bill to gain prescriptive authority. This meant we had three months to prepare before the beginning of the legislative session on January 16.

There were two steps we took immediately—contacting APA and meeting with the lobbyists representing the New Mexico Medical Society (NMMS).

The APA Division of Government Relations (DGR) immediately sent us packets containing extensive information prepared by APA and by several states that had successfully opposed psychologist-prescribing bills. The DGR staff, especially Jay Cutler, the director, and Paula Johnson, associate director for state affairs, made themselves available to us on a daily basis to educate us and provide consultation and advice.

The NMMS wanted to support us since the prescribing proposal raised obvious concerns about patient safety being compromised by allowing inadequately prepared psychologists to prescribe psychotropic medications. In talking with NMMS, it was clear that we needed their lobbying assistance. Being a small district branch, we knew we could not afford to fight the bill on our own. In addition to the lobbying expenses, we knew we would also incur increased office expenses.

We contacted the APA Commission on Public Policy, Litigation, and Advocacy and explained our financial needs. That component provided us with the financial assistance we needed to make our case to lawmakers and others around the state.

Our PMA Executive Council had several meetings to organize our plan for opposing the psychologist-prescribing bill. There were a number of steps involved in doing this. We sent a series of letters, e-mails, and faxes to psychiatrists throughout New Mexico (both members and nonmembers of APA). We began by informing them about the psychologist-prescribing issue, asking them to communicate with their legislators regarding the bill, and asking them for financial support. We similarly communicated with nonpsychiatric physicians throughout the state.

We gained the support of the New Mexico Pediatric Society, New Mexico Chapter of the American Academy of Family Practice, and New Mexico Board of Medical Examiners. We also had the active support of the University of New Mexico Health Sciences Center and its department of psychiatry.

Shortly after the legislative session began, our lobbyists advised us that we needed to have psychiatrists accompany them to the state capitol to meet with legislators. We set up a schedule to try to have at least one psychiatrist there every day, and sometimes we had two or three. For many of the legislators, our first task was to explain the difference in training between a psychiatrist and a psychologist, so they could better understand why we opposed psychologists prescribing psychotropic medications. We presented our concerns about the proposal being unsafe for the treatment of people with mental illness. Besides psychiatrists, there were many other physicians who met with legislators on our behalf.

Further, we were fortunate to have two physicians who are state senators; they did much work to educate their fellow legislators about the problems inherent in the bill.

Once the committee hearings began, they turned out to be frequently frustrating for us. The psychologists used the issue of limited access to psychiatric care in rural areas to argue that they should receive prescriptive authority. Despite our efforts to educate the legislators that the psychologist training proposed in the bill was grossly inadequate, for many lawmakers the priority issue turned out to be concern about access to mental health care. With this idea taking hold among the legislators, the bill was passed through a number of committees without recommendation for passage (with legislators stating that they were confused about the educational issues) and through others with outright recommendation for passage.

In amended form the bill eventually made it through all relevant committees. However, while the bill passed in the House, it died without being heard in the Senate—but only because time ran out before proponents were able to schedule a floor vote (Psychiatric News, April 20).

Some final thoughts: Ultimately it took a team effort to defeat this bill. It required a great deal of work, but we all saw it as our responsibility to protect the welfare of our patients and others with mental illness. In the future, psychiatrists in New Mexico and other states need to address proactively the problems in our states regarding the provision of quality mental health care. In New Mexico this means working on solving access issues for rural and indigent patients. This may require a national commitment to funding adequate care for those populations. As our experience in New Mexico demonstrated, it is important that we all stay informed and involved.