Federal suit seeks RxP for psychologists

By James Bradshaw Assistant Editor
March 1, 2006



A group of RxP-trained psychologists in California filed suit in the U.S. District Court in Los Angeles contending that a state law barring them from writing prescriptions denies treatment to thousands suffering from mental illness.

John Caccavale, Ph.D. president of the California Society of Clinical Psycho-pharmacologists, said the suit against the state and Los Angeles County was filed Feb. 9 on behalf of three plaintiffs – Melroy Walker, Tonia Jones and Michael Shane Larson.

“They are three African American people who have been incarcerated several times but have never been treated,” Caccavale said.

The suit contends they were denied both therapy and medication for their mental disorders because California law does not allow properly trained psychologists to write prescriptions and there are not enough psychiatrists in the state to serve the needs of either the prison system or the general public.

Caccavale said the state corrections department has 191 vacancies for psychiatrists because none are available.

Meanwhile, 295 psychologists – many of them trained in psychopharmacology – work in the prisons and could fill the void if not barred from prescribing, he said. “The law is standing in the way of patients being treated adequately.”

The suit contends the lack of treatment denies the plaintiffs their civil rights under the 14th Amendment to the U.S. Constitution and a similar provision of the California Constitution and also violates the Americans with Disabilities Act.

The suit cites a decision Oct. 3 in the U.S. District Court for Northern California in San Francisco that placed the state penal system in receivership for failing to meet the health care needs of inmates, including mental health needs.

Caccavale said although the suit is filed on behalf of three African Americans and seeks reform for the California penal system, a decision for the plaintiffs would have the broader effect of freeing adequately trained psychologists to prescribe drugs for the treatment of mental illness in general.

“The downward trend (in the number) of psychiatrists will not be reversed, and the general practitioners cannot fill the gap,” Caccavale said.

He said so few medical students in America are drawn to psychiatry that 70 percent of new psychiatrists in the nation are recruited from foreign medical schools.

The professional society Caccavale heads has about 300 members, but he said the number of RxP-trained psychologists in California is much greater than that. He said 600 psychologists underwent RxP training as soon as it became available in California and many more have taken the training as course availability expanded over the years. About 200 are currently in training, he said.

He said the case could set a precedent that could be followed nationally and might prove more effective than the current approach endorsed by the American Psychological Association of seeking legislative changes on a state-by-state basis.

Pharmacologically trained psychologists always face an uphill struggle in legislative lobbying battles because they are outnumbered and out-dollared by the medical and psychiatric communities, Caccavale said.

“The proof of that is that after 20 years of RxP we have only two states that have passed it,” he said. He said legislative arguments often center on unmet needs in rural areas but needs similarly are unmet in Los Angeles, one of the largest cities in the nation.

Caccavale said a survey of mental health needs in California showed that 19 percent of the need in Los Angeles County is unmet and 48 percent of the county’s citizens have no mental health insurance coverage.

To gauge the inability of the psychiatric community to meet those needs the Mental Health Wellness Center of Long Beach conducted a telephone poll from mid-December through the end of January using a female interviewer who said she suffered severe depression and felt suicidal. When encountering answering machines a message was left and if no call was returned the number was called back three times.

In canvassing 228 listings for psychiatrists in the L.A. phone book, the poll found:

  • Ten numbers were improperly listed and eight rang with no response.
  • Ninety-five calls reached answering machines but calls were not returned.
  • Five psychiatrists were on vacation and could not be reached.
  • Seven offices insisted on new clients filling out a screening form which would be evaluated to determine if they would be accepted.
  • Fifty-five psychiatrists said they were not accepting new patients.
  • Forty-eight said they would take new patients on a cash basis only but 20 of them could not provide an appointment date at the time of the call.
  • Of the 28 who agreed to see the client, only two could do so within a week’s time. Waiting time for the remainder ranged from two weeks to 10 weeks.
  • Among 38 psychiatrists whose offices quoted prices for an assessment, the median cost was $450.

Caccavale said the poll clearly demonstrates that psychiatrists cannot meet the needs of Los Angeles and is representative of the condition of the mental health system throughout California and the nation.

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