Psychologist Prescribing Bills Defeated in Many States

APA members in state psychiatric societies, working with staff of APA’s Department of Government Relations, have beat back a number of bills this year that would have allowed psychologists to prescribe medications. And although a bill was passed in Idaho, it mandates what many APA members strongly fought for—very stringent standards of training for psychologists who seek prescribing privileges.

Evidence from New Mexico and Louisiana, which have had prescribing laws on the books since 2002 and 2004, respectively, show little, if any, expansion of access to mental health care in rural or other underserved areas, one of the main arguments of psychologists who favor prescribing.

“As physicians, we will continue to fight to protect our patients,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “We will also continue to provide support to district branches in educating legislators about the importance of advocating for people with mental illnesses and substance use disorders and ensuring that the care they receive is medically based.”

Advocacy activity at the state level is aimed at patient safety; prescribing is not a right, it is a privilege earned after stringent education requirements are met. That means not just short courses or online training but medically based classes in biology, chemistry, biochemistry, physiology, and other science-based courses and clinical experience necessary to understand the human body, its interaction with medication and comorbid illness.

Because of the potent advocacy activity in state capitols, bills have been slowed or their introduction deferred in Florida, Kentucky, Minnesota, New Jersey, New York, North Dakota, Ohio, Texas, and Vermont, among others, said Amanda Blecha, J.D., APA’s Midwest regional field director for state government affairs, in an interview. “The Nebraska Psychiatric Society is leading the effort to oppose the psychologist prescribing application through the credentialing process, in hopes that the technical review committee will not recommend it to the state legislature in advance of 2018.”

APA’s district branches and state associations are working hard to educate lawmakers and the public that there are existing options to increasing access to care, added Blecha.

“We also promote evidence-based alternatives in many states to mental health access challenges, like expansion of collaborative care models, telepsychiatry implementation, improving network adequacy, and parity enforcement. Collaborative care, for example, leverages the relative scarcity of psychiatrists by having them provide consultations to primary care physicians. Collaborative care allows up to 20 patient cases to be handled by a psychiatrist in a morning as opposed to traditionally four.”

Advocacy efforts have also been stepped up in the battle against opioid addiction and overdoses, which now is taking up much legislative attention on the state level, said Angela Gochenaur, M.P.A., APA’s Northeast regional field director.

“We argue that if legislators are putting new restrictions on prescribing practices, why add yet more prescribers with even less experience?” said Gochenaur. Furthermore, important medications (such as naloxone) used to treat substance use disorders can be dispensed only by specially trained and certified physicians, which would rule out a role for psychologists, in any case, she said. ■