RxP has history of slow but sustained progress

By Steve Ragusea, Psy.D.
December 1, 2014



RxP has history of slow but sustained progressIt was way back in 1972, when Nicholas Cummings, Ph.D., first proposed to the APA that we pursue training in psychopharmacology for psychologists in pursuit of prescription privileges. An APA committee deliberated for a year but decided against the initiative.

Within the academic psychology community of the era, the very idea of psychologists being licensed for independent practice was still very controversial. Many psychologists considered licensure to be both inappropriate and unethical. After all, some reasoned, psychologists had no medical training and weren’t real doctors.

The issue died at APA for a time, but just a few years later, in 1977, I was completing my Psy.D. program at Baylor University when I wrote a paper arguing that psychologists should seek the authority to write prescriptions. I reasoned that with a little additional training, psychologists would certainly be able to do as good a job of prescribing psychoactive medications as physicians who often had little or no training in mental illness or psychology.

I reasoned that doctors of psychology would be better overall providers of mental health care because they were much more appropriately trained than physicians. My professor was aghast and suggested that I might be very, very wrong. I may have been premature but I sure wasn’t wrong.

In 1989, the APA Board of Professional Affairs, under the leadership of Norma Simon, Ed.D., strongly endorsed the development of appropriate curricula in psychopharmacology so that psychologists might more effectively meet the mental health needs of society. And, it was recommended that this be made APA’s highest priority.

The really big break came when the late U.S. Sen. Daniel K. Inouye, DHawaii, urged a Department of Defense (DoD) pilot program to train psychologists to prescribe in the military. Five years later, in June 1994, Cmdr. John Sexton, Ph.D., and Lt. Cmdr. Morgan Sammons, Ph.D., became the first graduates of the DoD psychopharmacology training program at Walter Reed Army Medical Center.

Once that program was operational, it was only a matter of time before psychologists would have prescription privileges all over the country. Certainly, the glacial movement we have sometimes experienced has been frustrating, but I always believed it was just a matter of time before the fruit of that pilot program dropped into the hands of psychology.

Well, the fruit has ripened now in three states, Louisiana, New Mexico, and most recently, Illinois. In addition to the 100 psychologists already prescribing in New Mexico and Louisiana, there have been 30 to 100 psychologists prescribing safely and effectively in the military and on Native American reservations (APA unfortunately not having accurate data) for almost 20 years now.

There is no longer any doubt that psychologists, with some additional training, can safely and effectively prescribe – or un-prescribe – psychoactive medications within the context of good psychological practice. It’s not theoretical. It’s not even debatable; it’s simply a matter of fact. Indeed, even the Illinois Medical Board didn’t contest that point.

Yes, there is still some debate within the body politic of psychology, but I remind everyone that this is the same pattern we experienced when psychologists first sought to be independently licensed professionals. Georgia was the first state to pass a psychology licensing law in 1951 and the last state was Missouri in 1977. That’s 26 years from start to finish.

Just as we gradually achieved the ability to practice independently in all 50 states, we will eventually be prescribing in all 50 states. The only question is: When?

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