Region’s pursuit of privileges on hiatus

While several states have active groups pursuing legislation for prescription privileges for psychologists, such efforts appear on hiatus in New England.

Dan Abrahamson, Ph.D., assistant executive director for state advocacy for the American Psychological Association, says no New England state is among the current group engaging in prescriptive authority efforts.

But, the issue is not dead yet.

Rick Barnett, Psy.D., LADC, and president of the Vermont Psychological Association, attained a master’s degree in clinical psychopharmacology in 2009.

“I have found it extremely useful since I got the training and gained the knowledge,” Barnett says. Although he can’t prescribe in Vermont, he has the authority to make recommendations to other professionals.

Barnett says psychologists have a unique model in that they see patients weekly and that would be an asset if they are given the authority to prescribe. “No other prescribing professional has that model. We would be focusing on talk therapy, but have a chance to monitor the medication more closely.”

Barnett notes that media attention has focused on “over prescribing,” and granting psychologists privileges could mitigate that concern.

“The power to prescribe comes with the power to unprescribe and because we are in position of seeing our patient weekly, I think we would have a little bit more confidence in unprescribing if necessary because we are seeing our patients more regularly.”

Barnett has been in contact with Rep. Anne Donahue (R-Washington-2) and he hopes to meet with her this summer to discuss possibly introducing legislation next session.

He conducted an informal survey of VPA membership at the 2010 annual conference and about 75 percent of respondents indicated they were supportive of prescription privileges for psychologists and that they would be supportive or remain neutral if VPA was to pursue any kind of legislative activity.

Stanley Berman, Ph.D., dean of advanced graduate study programs at the Massachusetts School of Professional Psychology (MSPP), says the psychopharmacology training program once offered at MSPP is now on hiatus. “The interest was steady but small and we felt it was difficult to run a program without larger numbers.”

But Berman says if and when the first New England state passes legislation for prescription privileges, the MSPP would be positioned to reopen the program.

Graduates of the psychopharmacology program, even though unable to prescribe in New England, still gained an increased understand of neuroscience and of medications that helped them be better generalists in their practice, he says. Berman would like to see that training at the pre-doctoral level increased.

Previously, Berman was part of an informal Massachusetts committee that pursued legislation for prescription privileges. The energy and motivation was there but the effort failed to move forward, he says. Berman believes there’s still interest and recently heard from a colleague about reviving discussions.

Jeff Matranga, Ph.D., ABPP, president of the Maine Psychological Association, says what is happening nationally helps set the stage for what can or will happen in Maine and the rest of New England.

“At this point, there are now prescribing psychologists in the Indian Health Service and National Public Health Service which means there are prescribing psychologists in places like Montana and theoretically anywhere there is an IHS facility,” he says. “Psychologists with the extra training have now been prescribing safely in the military for 17 years. Most recently, the U.S. Coast Guard has begun recruiting for prescribing psychologists. ”

“Psychologists also continue to prescribe safely in Louisiana and New Mexico – without incident,” he points out.

“What all this does is build up a track record of expanded service and access to those in need and with a documented safety record that will eventually be harder to argue with in the state legislatures – maybe even enough data to overcome the big money of organized medicine,” Matranga says.

In Connecticut, legislation was introduced in 2001 and 2006, but did not make it out of committee. The 2006 legislation would have established a psychopharmacology demonstration project to assess if a smaller number of psychologists could be given prescriptive authority, similar to what was done through the Department of Defense and assess the outcome over time.

The legislation didn’t garner enough support and faced opposition from the state medical society. More recently, interest has gone on hiatus, according to John Mehm, Ph.D., president of the Connecticut Psychological Association from 2007-2010.

“There are always a few states that are making progress…. In my opinion, one of the common denominators seem to be states that have larger pockets of rural or underserved populations,” Mehm says. “Throughout New England, it’s become more dormant, but there is still some interest.”

Mehm believes psychologists who want to go through the training and clients will benefit.

However, states need to ascertain whether or not there’s momentum enough to overcome the obstacles to get the bill passed. “One of the lessons we learned in Connecticut was that the legislature was much more focused on degrees rather than on any hours of training,” he says. “They wanted psychologists to have a certificate or some indication they completed a course of study that was nationally recognized.”

Michael J. Fitzpatrick, executive director at the National Alliance on Mental Illness (NAMI), adds the push for prescription privileges for psychologists doesn’t appear to have the same traction as a decade ago.

He notes that NAMI doesn’t typically weigh in on such issues. “The only concerns we have is that there’s not enough people available who are well-trained to prescribe psychiatric mediations,” particularly in rural areas.

“The idea of integrated care could help solve some of these problems,” he says. “With the Affordable Care Act, the environment has changed. Practices are being combined and integrated. That really changes the dialogue. It’s more about bringing behavioral health into the health care system and having more of an integrated system. I think that’s the trend.”

Collaboration is a focus in New Hampshire, which had an active RxP movement a decade ago, when legislation was introduced, but defeated, and efforts have since stalled.

“Continued efforts by psychologists in N.H. have been more recently focused on finding ways to collaborate with primary care providers for medication management, rather than on obtaining direct legislative authorization for prescribing,” says Sandra Rose, Ph.D., former committee chair for the Prescriptive Authority Committee of New Hampshire and past president of the New Hampshire Psychological Association.