Until psychology gets its house in order, there is little reason to discuss prescribing privileges, reacted a Hawaii legislator recently after psychologists squared off rambunctiously in the State House in Honolulu.
The defeat of prescription privileges in Hawaii occurred only weeks before a seven-member subcommittee in California killed prescription privileges by a 1-4 vote in which three Assembly members abstained in deference to the committee chair, Sen. Richard G. Polanco, the bill’s sponsor.
The near-simultaneous defeats at the committee level in two states coupled with lack of progress elsewhere in the country virtually eliminates any hope for a prescription privileges law anywhere in this century. It also offers a reality check for those advocates who have been preparing themselves for gaining prescription privileges by entering educational tracks offered during recent years.
While psychiatry has been psychology’s most vocal opponent, the greatest damage for proponents may be emanating from a small group of psychologists from academia and science who have made the prescription issue their battle cry.
They plan to continue feeding off their successes wherever and whenever the prescription issue emerges in a State House.
Rather than psychiatry, it was the American Association of Applied and Preventative Psychology (AAAPP) which was most vocal among the groups testifying against prescription privileges legislation in California and Hawaii. Both bills were defeated.
“They are our worst enemy,” said Leigh Jerome, Ph.D., president-elect of the Hawaii Psychological Assn., referring to the AAAPP.
She said the testimony from Elaine M. Heiby, Ph.D., head of the Department of Psychology at the University of Hawaii, “was extraordinarily destructive.” She added that testimony from AAAPP, despite its sparse membership, creates the impression that there is a significant split in the psychological community.
“The legislature reacted that until we get our house in order, there is little reason to discuss prescribing privileges,” she added.
The group also contributed to the defeat in April of a prescribing privilege bill in the California Assembly.
Charles Faltz, Ph.D., director of professional affairs for the California Psychological Assn., said the AAAPP’s successful effort to create the impression that the psychology community is deeply divided significantly weakens our arguments in favor of prescribing privileges.
During the late April hearing on California’s bill, which preceded the negative 1-4 vote, no psychiatrist presented testimony.
Testimony opposing the measure was presented by a San Diego psychologist representing the AAAPP; a representative from the National Alliance for the Mentally Ill; and a retired Army doctor who spoke against the Department of Defense’s Psychopharmacology Demonstration Project in which 10 psychologists now have prescription privileges.
Faltz said it is difficult to say exactly how much AAAPP’s opposition helped in killing the bill. But he did wonder how an organization that doesn’t represent psychologists in any of the Senate committee member’s district and who has no lobbyist in Sacramento could wield such influence.
Meanwhile, AAAPP has called on its resident members in Missouri and Georgia to help defeat prescribing privileges legislation in those states.
The University of Hawaii’s Heiby, chair of AAAPP’s Committee Concerned About Medicalizing Psychology, said the organization was founded in 1990 when many members disagreed with what they considered the American Psychological Assn.’s “guild agenda.”
The group wanted the APA to pay more attention to clinical science and science-based practice and prevention.
In 1995, the group declared a major offensive against any attempt to allow psychologists to prescribe medication. They have been joined in their efforts to derail prescribing privileges by the American Psychological Society; Section 3 of APA Division 12 (the Society for the Science of Clinical Psychology); the Council of University Directors of Clinical Psychology Programs; and the Council of Graduate Departments of Psychology.
“We are not alone in this fight by a long shot,” Heiby told The National Psychologist.
Heiby said she didn’t know how many members AAAPP has, but speculated it is about the consensus is around 1,600. Other estimates have been as low as 300. By contrast, APA–which endorses the prescription privileges issue–claims more than 155,000 members.
Heiby explained that in addition to presenting testimony in person during legislative hearings, legislators receive a large number of written comments from AAAPP members.
AAAPP’s opposition to prescribing privileges focuses on five points, all of which mirror concerns expressed by the psychiatric community. In a nutshell, the AAAPP position is that psychologists are not medically trained and have no business being allowed to prescribe medications.
If psychologists want prescribing privileges, they should go to medical or nursing schools, the group believes. AAAPP notes that some psychologists have earned prescription authority by becoming advanced practice nurses.
Heiby said the Psychology Department at the University of Hawaii and the Hawaii Psychological Assn. have begun talks to determine the level of interest in starting a program in the university’s school of nursing for psychologists. She added that the AAAPP has no objection to psychologists who have nursing degrees to prescribe medication.
She said this view is not in conflict with the AAAPP’s belief that psychology should remain firm in its conviction that many forms of mental health care can be treated by psychotherapy without the use of drugs.
Starting a special course for psychologists in nursing schools would relieve universities from hiring more staff and creating changes in the curriculum at the undergraduate, graduate and post-doctorate levels, Heiby said.
Meanwhile, in California, hearings began in June on the bill that was stripped of a provision allowing prescription privileges. The part of the bill that is left would encourage the California Board of Psychology to determine an appropriate curriculum for training in prescribing medicine.
The board would also be allowed to determine a curriculum for psychologists who are working with patients receiving medication. Much of the curriculum would deal with biological basis for mental illness and other bio-chemical issues.
Faltz called the language an “incremental approach” in the long road to winning prescribing privileges for psychologists.
He added that he remains optimistic that the California Assembly will pass prescribing privileges legislation some day.
“There is so much enthusiasm out there for prescribing privileges,” Faltz noted. “But one has to realize this is a major issue and that these changes don’t happen in two or three years. It will take time.”
Defeat of the California prescribing privileges legislation in April marked the third failure in the last three legislative session.
In Hawaii, Jerome said that the state organization will take a year off and determine how best to approach prescribing privileges legislation.
“We will also be working closely with legislators during the next year,” Jerome added. “We have learned that this issue is a hard sale. The issue is hard to explain to legislators. It’s hard to stay on track.”