Prescriptive authority for psychologists movement

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The prescriptive authority for psychologists (RxP) movement is a movement in the United States of America among certain psychologists to give prescriptive authority to psychologists with predoctoral or postdoctoral graduate-level training in clinical psychopharmacology; successful passage of a standardized, national examination (Psychopharmacology Examination for Psychologists - Second Edition; PEP-2); supervised clinical experience; or a certificate from the Department of Defense Psychopharmacology Demonstration Project; or a diploma from the Prescribing Psychologists Register (FICPP or FICPPM) to enable them, according to state law, to prescribe psychotropic medications to treat mental disorders. This approach is non-traditional medical training focused on the specialized training to prescribe for mental health disorders by a psychologist. It includes rigorous didactics and supervised clinical experience. Legislation pertaining to prescriptive authority for psychologists has been introduced over 180 times in over half of the United States. It has passed in seven states, due largely to substantial lobbying efforts by the American Psychological Association (APA), the largest professional organization of psychologists in the world with over 157,000 members. Prior to RxP legislation and in American states where it has not been passed, this role has been played by psychiatrists, who possess a medical degree and thus the authority to prescribe medication, but more frequently (60-80%) by primary care providers who can prescribe psychotropics, but lack extensive training in psychotropic drugs and in diagnosing and treating psychological disorders. According to the APA, the movement is a reaction to the growing public need for mental health services, particularly in under-resourced areas where patients have little or no access to psychiatrists. [1]

Contents

In states where RxP legislation has been passed, psychologists who seek prescriptive authority must possess a doctoral degree (PhD/PsyD), a license to practice independently, and completion of a Master of Science in clinical psychopharmacology (MSCP) degree or equivalent. Programs that offer the MSCP degree are: The California School of Professional Psychology at Alliant International University, The Chicago School of Professional Psychology, Drake University Fairleigh Dickinson University, Idaho State University, and New Mexico State University. Additional MSCP programs are in development. In some jurisdictions, completion of the training programs from the Department of Defense or the Prescribing Psychologists' Register Diplomate Certification also satisfies the licensing law requirements. The supervised clinical experience required after completing the MSCP and passing the PEP varies by jurisdiction, but typically requires a specific number of hours of supervised experience and/or a specific number of patients. Some jurisdictions then grant conditional prescribing psychology licenses or certifications, while others grant full prescribing authority after the supervised clinical experience has been successfully completed. The medications the psychologist may then prescribe are limited to those indicated for psychiatric problems; still, the specific medications that are able to be prescribed by prescribing or medical psychologists varies by jurisdiction.

Psychologists' involvement in pharmacotherapy exists on a continuum, with psychologists serving as prescribers, collaborators, and information-providers in the medical decision-making process. Psychologists may prescribe in six states: New Mexico, Louisiana, Illinois, Iowa, Idaho, Colorado, and Utah, as well as the Public Health Service, the Indian Health Service, the U.S. military, and the U.S. territory of Guam. When psychologists act only as collaborators, they lack the authority to make the final decision to prescribe; however, they may assist in the process by recommending clinically desirable treatment effects, certain classes of medications, specific medications, dosages, or other aspects of the treatment regimen. Psychologists also provide information that may be relevant to the prescribing professional. Psychologists may express concerns about treatment, refer patients for medication consultations, direct patients to referral or information sources, or discuss with patients how to address their concerns about medication with the prescriber. [2]

History

The first bill seeking to authorize prescription privileges to psychologists was introduced in Hawai'i in 1985 under Hawaii State Resolution 159. The bill would have allowed licensed psychologists there to administer and prescribe psychotropic medication for the treatment of "nervous, mental, and organic brain disorders." [3] Since then, a total of 88 prescriptive authority bills have been introduced in 21 jurisdictions. [3]

In 1988, the U.S. Department of Defense approved a pilot project to train psychologists in issuing psychotropic medications "under certain circumstances." Guam became the first U.S. territory to approve RxP legislation in 1999. New Mexico became the first state to approve RxP legislation in 2002, and Louisiana followed in 2004. In 2014, Illinois became the third state to approve RxP legislation. In 2016, Iowa became the fourth state to grant prescriptive authority, which was followed by Idaho in 2017. The rules and regulations for Illinois' RxP law were approved in 2018 and in 2019 in Iowa. In 2023, Colorado became the sixth state to pass prescriptive authority for psychologists legislation, followed by Utah in 2024. Many other states have introduced but have yet to approve RxP bills. [1] [4] As of 2024 there are approximately 250-300 active, prescribing psychologists across the United States, with over 240 graduate students and psychologists enrolled in an RxP training program. [5] Nearly 1,500 individuals have completed a master's degree in clinical psychopharmacology and over 500 have passed the PEP.

Since 2000, Division 55 of the American Psychological Association (the Society for Prescribing Psychology), has promoted prescriptive authority for psychologists across the country. Division 55 petitioned APA through its Commission for the Recognition of Specialties and Subspecialties in Professional Psychology (CRSSPP) for official recognition of clinical psychopharmacology as a specialty in psychology. At its meeting in August 2020, the APA Council of Representatives gave final approval to this petition, adding clinical psychopharmacology to 17 other APA-recognized psychological specialties. Division 55 is in the process of becoming a member of the Council of Specialties (CoS) in Professional Psychology, Council of Chairs of Training Councils (CCTC), and creating a board certification in clinical psychopharmacology through the American Board of Professional Psychology (ABPP).

The State of New Mexico was the first to enact a Psychologists prescribing law. Louisiana's legislature went on to establish medical psychology as a separate and distinct healthcare profession and transferred the regulation of its practice to the Louisiana State Board of Medical Examiners. The entire practice of psychology for medical psychologists, including psychotherapy and psychological testing, was also transferred to the Louisiana Board of Medical Examiners, effectively making Louisiana the only state in the U.S. where, for some psychologists, a medical board has authority over their entire practice. Because of this, several national organizations, including the American Psychological Association and the Association of State and Provincial Psychology Boards have expressed concern over the practice of psychology being regulated by another profession (i.e., medicine). The Louisiana Psychological Association has strongly echoed such concerns. However, the Louisiana Academy of Medical Psychologists (LAMP), a Political Action Committee representing medical psychologists in the state, strongly endorsed the change of regulation.

Prescribing rights for psychologists are being negotiated in South Africa, Canada, [6] the United Kingdom, [7] and Australia. [8]

APA Guidelines

In December 2011, the American Psychological Association (APA) published a list of practice guidelines that apply to all prescribing activities, with some also applicable to collaborating and information providing activities. The list is categorized according to the area of psychologists' involvement in pharmacological issues (general, education, assessment, intervention and consultation). The following list summarizes the guidelines by section. [9] These practice guidelines are in process of being revised and updated as of 2023.

*General

*Education

*Assessment

*Intervention and Consultation

*Relationships

Supporting arguments

There are several core arguments put forth by RxP advocates, including the following:

According to a survey assessing the views of psychology interns, residents, and psychologists published in the journal Professional Psychology: Research and Practice, significant support exists regarding the APA's prescriptive authority initiative. [9] Proponents of the prescriptive authority initiative believe that it would improve the economic stability of the profession, provide better opportunities to underserved populations, and enhance psychologists' clinical skills through a better understanding of biopsychosocial interactions. [18] Support for the prescriptive authority initiative also appears higher amongst those with PsyDs and early career psychologists (within 10 years of receiving doctorate) than those with PhDs and mid- and late-career psychologists. Demographically, females and Caucasians expressed more willingness to seek prescription privileges. [9] Also, those who attended a clinical or counseling graduate program, received a PhD degree, and those employed in a university counseling center, medical school hospital, or independent practice tend to demonstrate higher levels of support for the initiative. In terms of training, an overwhelming majority of those surveyed believe training should begin at the graduate level, but prior to completion of a doctorate. Accordingly, in February 2019, the APA Council of Representatives overwhelmingly voted to approve changes to APA policy that allows psychopharmacology training to begin at the graduate level; previously, APA policy only allowed for this training to occur at the postdoctoral level. In Illinois, one of the jurisdictions where RxP is law, there are already psychopharmacology programs in place that offer this education and training at the predoctoral level. Additionally, respondents preferred that training occur on a part-time basis, be completed within two to two-and-a-half years and cost $12,000-$18,000. [9]

Today, evidence exists to indicate a continual and growing level of support for the American Psychological Association's prescriptive authority initiative. Such support reflects psychologists' willingness to open their minds to learning about psychotropic medications, incorporating pharmacological treatment with therapy, and adapting to the demands of a rapidly changing health care world. [9]

Opposition

Prescriptive authority for psychologists has been controversial, even within the healthcare community, which has created entire organizations dedicated to objecting to prescriptive authority for clinical psychologists. Specifically, critics within the medical profession have expressed concern that they have no medical training. The current RxP model explicitly states that this movement includes no medical training, but this can be accomplished with a master's degree in psychopharmacology, typically from a postdoctoral education program at a professional school. Some opponents claim this would culminate in substantially fewer years and hours compared to physician assistants and nurse practitioners, who are granted full prescriptive authority, and can elect to specialize in psychiatry, unlike the majority of psychologists. [19] [20] However, proponents have rebutted this assertion by describing their sequence of training (e.g., 4-year undergraduate degree, 5-year doctoral degree, 1-year internship, 1-year residency/fellowship, 2-year master's degree in psychopharmacology, national psychopharmacology exam, supervised clinical experience). In addition, survey research comparing prescribing psychologists' training against that of nurse practitioners and physician assistants has demonstrated that when presented with un-labeled training programs side-by-side, prescribing psychologists' training is perceived to be more rigorous overall than that of psychiatric nurse practitioners or physicians assistants in their ability to prescribe psychiatric medication. [21] This perception was found to be true of physicians, mid-level providers, psychologists, non-prescribing therapists, and general members of the public.

Psychologists who have extensively researched the effects of psychopharmacology

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<span class="mw-page-title-main">American Psychological Association</span> Scientific and professional organization

The American Psychological Association (APA) is the main professional organization of psychologists in the United States, and the largest psychological association in the world. It has over 157,000 members, including scientists, educators, clinicians, consultants, and students. It has 54 divisions—interest groups for different subspecialties of psychology or topical areas. The APA has an annual budget of around $125 million.

A psychiatric or psychotropic medication is a psychoactive drug taken to exert an effect on the chemical makeup of the brain and nervous system. Thus, these medications are used to treat mental illnesses. These medications are typically made of synthetic chemical compounds and are usually prescribed in psychiatric settings, potentially involuntarily during commitment. Since the mid-20th century, such medications have been leading treatments for a broad range of mental disorders and have decreased the need for long-term hospitalization, thereby lowering the cost of mental health care. The recidivism or rehospitalization of the mentally ill is at a high rate in many countries, and the reasons for the relapses are under research.

<span class="mw-page-title-main">Psychologist</span> Professional who evaluates, diagnoses, treats and studies behavior and mental processes

A psychologist is a professional who practices psychology and studies mental states, perceptual, cognitive, emotional, and social processes and behavior. Their work often involves the experimentation, observation, and interpretation of how individuals relate to each other and to their environments.

<span class="mw-page-title-main">Pharmacy</span> Clinical health science

Pharmacy is the science and practice of discovering, producing, preparing, dispensing, reviewing and monitoring medications, aiming to ensure the safe, effective, and affordable use of medicines. It is a miscellaneous science as it links health sciences with pharmaceutical sciences and natural sciences. The professional practice is becoming more clinically oriented as most of the drugs are now manufactured by pharmaceutical industries. Based on the setting, pharmacy practice is either classified as community or institutional pharmacy. Providing direct patient care in the community of institutional pharmacies is considered clinical pharmacy.

<span class="mw-page-title-main">Medical prescription</span> Health-care communication from a physician to a pharmacist

A prescription, often abbreviated ℞ or Rx, is a formal communication from a physician or other registered healthcare professional to a pharmacist, authorizing them to dispense a specific prescription drug for a specific patient. Historically, it was a physician's instruction to an apothecary listing the materials to be compounded into a treatment—the symbol ℞ comes from the first word of a medieval prescription, Latin recipere, that gave the list of the materials to be compounded.

<span class="mw-page-title-main">Prescription drug</span> Medication legally requiring a medical prescription before it can be dispensed

A prescription drug is a pharmaceutical drug that is permitted to be dispensed only to those with a medical prescription. In contrast, over-the-counter drugs can be obtained without a prescription. The reason for this difference in substance control is the potential scope of misuse, from drug abuse to practicing medicine without a license and without sufficient education. Different jurisdictions have different definitions of what constitutes a prescription drug.

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References

  1. 1 2 Murray, Bridget (October 2003). "A Brief History of RxP". APA Monitor. Retrieved 4 November 2007.
  2. ↑ American Psychological Association (2011). Practice guidelines regarding psychologists' involvement in pharmacological issues. American Psychologist , 66(9), 835-849. doi : 10.1037/a0025890
  3. 1 2 Fox, R.E., DeLeon, P.H., Newman, R., Sammons, M.T., Dunivin, D.L., Backer, D.C.. (2009). Prescriptive authority and psychology: A status report. American Psychologist, 64(4), 257-268.
  4. ↑ Munsey, Christopher (June 2006). "RxP legislation made historic progress in Hawaii". APA Monitor. Retrieved 4 November 2007.
  5. ↑ Personal Communication, Beth Rom-Rymer, PhD
  6. ↑ Canadian Psychological Association (11 October 2011). "Prescriptive Authority Task Force" . Retrieved 27 March 2020.
  7. ↑ The British Psychological Society. "Prescribing Rights for Psychologists" . Retrieved 27 March 2020.
  8. ↑ Australian Psychological Society. "APS recommendations for health reforms" . Retrieved 27 March 2020.
  9. 1 2 3 4 5 American Psychological Association (2011). Practice guidelines regarding psychologists' involvement in pharmacological issues. American psychologist, 66(9), 838-839. doi : 10.1037/a0025890
  10. 1 2 Ericson, Robert. (2 September 2002). Prescription Privilege Based on Proven Model. Albuquerque Journal. Retrieved July 28, 2007.
  11. ↑ Muse, M., & McGrath, R. (2010). Training comparison among three professions prescribing psychoactive medications: psychiatric nurse practitioners, physicians, and pharmacologically trained psychologists. Journal of Clinical Psychology, 66(1), 96-103. doi : 10.1002/jclp.20623.
  12. ↑ Feres v. United States
  13. 1 2 Heiby, E., DeLeon, P., and Anderson, T. (2004). A Debate on Prescription Privileges for Psychologists. Professional Psychology: Research and Practice, 35(4), 336.
  14. 1 2 3 NAPPP. (2006). NAPPP Sponsors Prescriptive Authority Legislation. Retrieved July 28, 2007.
  15. ↑ King, Craig. (2006). Prescriptive Authority for Psychologists Working in the Public Sector: Is it Needed? Public Service Psychology, 31(1), 2.
  16. ↑ Medical psychology
  17. 1 2 Holloway, Jennifer. (2004). Gaining prescriptive knowledge. Monitor on Psychology, 35(6), 22
  18. ↑ Fagan, T.J., Ax, R.K, Liss, M., Resnick, R.J., Moody, S.. (2007). Prescriptive authority and preferences for training. Professional psychology: Research and practice, 38(1), 104-111.
  19. ↑ "As NPs push for expanded practice rights, physicians push back - The DO". The DO. 2010-03-19. Retrieved 2018-05-21.
  20. ↑ Daly, Rich (2006-03-03). "Psychiatrists Proactive in Scope-of-Practice Battles". Psychiatric News. 41 (5): 17–34. doi:10.1176/pn.41.5.0017.
  21. ↑ Cooper, R. R. (2019). Pulling Back the Political Curtain: Surveying Opinions and Biases on Prescribing Psychology's Training (Unpublished doctoral dissertation). University of the Cumberlands, Williamsburg, Kentucky. doi : 10.13140/RG.2.2.26055.24480.
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