Calif. Psychologists Handed Setback In Practice-Expansion Effort

Despite their early optimism, psychologists in California will not soon be gaining the right to discharge seriously mentally ill patients without the concurrence of a psychiatrist.

With the backing of influential state lawmakers, psychologists again attempted to take the legislative route to expanding their scope of practice in California, as they have with mixed results on the issues of prescribing authority and independent hospital privileges.

The bill in question, AB 470, would have granted psychologists the authority to release disabled or gravely ill psychiatric patients from a 72-hour involuntary hold without waiting for the full confinement period to elapse. Psychiatrists are currently the only ones allowed to authorize an early discharge to persons committed because they were deemed to be a danger to themselves or others or “gravely disabled as a result of a mental disorder.”

The bill would have allowed a psychologist directly responsible for an individual’s treatment to release him or her prematurely from a court-ordered commitment if the psychologist believes “as a result of his or her personal observations that the person no longer requires evaluation or treatment.”

In addition, as is the case with psychiatrists in California, the bill would have made psychologists who authorize an early release of a person on 72-hour hold exempt from civil or criminal liability for any act by the person being released. The same would apply to psychologists who approve the release of such an individual at the end of the 72-hour period.

The same provisions governing 72-hour involuntary holds would also have applied to psychologists treating people committed under a 14-day, 30-day, or 180-day “period of intensive treatment.”

Another provision would have affected the care of suicidal patients. The bill said that a psychologist treating an involuntarily committed suicidal patient could terminate the hospitalization for “imminently suicidal persons if the psychologist believes, as a result of his or her personal observations, that the person has improved sufficiently for him or her to leave or is prepared to voluntarily accept treatment on referral or to remain on a voluntary basis in the facility providing intensive treatment.”

Under current state law, only psychiatrists have this right.

The bill passed the California Senate in August and was on its way to passage in the Assembly when it was derailed through the efforts of Assembly member Helen Thomson, a long-time champion of the mentally ill and psychiatry and chair of the Assembly’s Health Committee.

Unfortunately, the Assembly’s failure to pass the bill “is likely to be a temporary achievement, since Helen Thomson’s term in office ends in November, and the likely new chair is supporting the bill,” San Jose psychiatrist Maurice Rappaport, M.D., told Psychiatric News.

Rappaport, who represents Area 6 on the APA Board of Trustees, added, “The psychologists, through their political action committee and personal contacts with legislators, seem to have garnered majority support for the bill.”

The bill had been vigorously opposed by the California Psychiatric Association and the California Medical Association, among others. The medical association told legislators that the bill “dangerously increases the scope of practice of psychologists” and that decisions about whether a potentially dangerous mentally ill person is released must be made in light of the individual’s entire medical condition.

The bill had the backing of a coalition of state psychologist groups and the California Mental Health Directors Association, which maintains that such a law would improve the efficiency of an often cumbersome public mental health system.

Rappaport said that he doubted that the lawmakers considering this bill had grasped the serious quality-of-care issues that would be incurred by such a law. “For example, since there are many underlying physical and medical problems that can cause or contribute to serious mental impairment,” he emphasized, where and when will psychologists gain the medical training to conduct “an adequate medical examination to identify important medical problems before a patient is discharged?”

He has no doubt that this bill “is part of the strategy of psychologists to be able to practice medicine by ultimately getting prescriptive authority.”

The California Psychiatric Association, Rappaport noted, “is launching a drive aimed at both member and nonmember psychiatrists to raise funds to support an education program for the public and legislators that will provide information” about why the proposal is unwise from the standpoints of public safety and quality of care. This is in preparation for the bill’s likely reappearance in the next legislative session. ▪