In the last issue of "FP," president Bob Woody interviewed Gerry Davison. Among other issues, Dr. Davison was quite critical of APA's advocacy to help psychologists obtain the authority to prescribe psychopharmacological agents (aka "Prescription Privileges").

In an attempt to provide another perspective on this important issue, Larry Ritt (a past-president of FPA and former APA Council Representative) interviewed Ron Levant.

Dr. Levant was the Chair of the oversight committee for the APA Practice Directorate, the Committee for the Advancement of Professional Practice (CAPP), from 1993-95, and has served on the APA Board of Directors since 1995 (currently as Recording Secretary). He previously served on the Board of Directors of the APA Division of Independent Practice. Dr. Levant is Dean of the Center for Psychological Studies, Nova Southeastern University, Fort Lauderdale, FL.

Dr. Ritt: In his interview with Dr. Woody, Dr. Davison was quite critical of APA's support of numerous states' efforts to encourage their legislatures to enact new laws that would give psychologists the authority to prescribe psychotropic medications. Responsive to Dr. Davison's comments, Dr. Woody questioned whether FPA should be expending its resources to pursue a prescription privilege agenda. What do you think?

Dr. Levant: Larry, as you know, APA has been addressing this issue for over fifteen years and at every juncture has come out in favor of appropriately trained psychologists seeking prescriptive authority. When I hear objections from the vocal minority, I wonder where they were all these years when the issue was fully investigated, debated, and in every manner examined.

Dr. Ritt: What are some of the arguments in favor of psychologists prescribing?

Dr. Levant: The major argument is that it would improve public health. Currently, most people with a mental health or substance abuse problem are receiving psychoactive drugs that are prescribed by a primary care physician who has minimal training in mental health, which does not augur well for their being able to conduct the first prerequisite for prescribing, namely making an accurate diagnosis. Clinical psychologists obtain more training in the identification of mental disorders and illnesses than any other health care practitioner, including psychiatrists. Hence, appropriately trained prescribing psychologists will increase the public's access to comprehensive mental health care.

Equally powerful is the continuity of care argument and the fact that outcome research has demonstrated that the most effective treatment for many mental health disorders is a combination of psychotherapy and medication. Allowing appropriately trained psychologists to prescribe medication will result in increased continuity, integration, and quality of patient care. Patients who are treated by prescribing psychologists will need to see only one doctor for all of their mental health treatment and will be spared the expense, burden, and inefficiencies of seeing a psychiatrist or primary care physician solely for the purpose of receiving medications.

There is also the argument of precedent. Many non-MD health professionals currently prescribe safely (e.g., podiatrists, dentists, advanced nurse practitioners, optometrists, physician assistants), and their services are highly beneficial to the public. Throughout the course of the twentieth century, a number of health professions have successfully sought to better serve patients by expanding their scope of practice to include prescription privileges, and organized medicine has reflexively and automatically opposed any threat to what was once their monopoly over the prescription pad. Early in the century, it was dentists, osteopaths, and podiatrists who found themselves at odds with organized medicine. All can now independently prescribe medications to their patients. For the past 25 years, optometrists, nurse practitioners, and psychologists have faced the same tactics. Optometrists now have some form of prescriptive authority in all states, nurse practitioners in all 50 states, physician assistants in 46 states, and, of course, the US Department of Defense now allows properly trained military psychologists to prescribe. Fortunately, the only thing as constant as organized medicine's warnings about impending disaster if one profession or another is granted prescription privileges, is the consistency with which state legislatures have batted away these arguments.

Dr. Ritt: How can the public be assured that the psychologist who is prescribing their medications is properly trained?

Dr. Levant: In 1995 the APA officially endorsed prescription privileges for appropriately trained psychologists. APA undertook extraordinary measures to assure patient safety. A Blue Ribbon Panel, composed of nationally recognized health professionals and scientists with expertise in medicine, psychiatry, nursing, pharmacy, neuroscience, psychology, and public policy, developed a rigorous and comprehensive model curriculum for psychologists who wish to receive training to prescribe psychotropic medications. Additionally, an independent body was commissioned to create a thorough examination in psychopharmacology that effectively measures the knowledge needed for safe prescribing. We anticipate this exam being used by states as one criterion for insuring that only psychologists with proper academic and supervised training experiences are granted prescriptive authority.

Dr. Ritt: This all makes sense, but from a practical point of view, no states currently have statutes granting prescriptive authority to psychologists. Why should psychologists undertake this training now?

Dr. Levant: Larry, the short answer is that they should undertake the training in order to provide the best possible care to their patients. Since so many of our patients these days are taking psychoactive medications, we are probably doing a disservice to our clients if we do not make some efforts to fully understand how medications work, when they might be indicated and contraindicated, and do not have the knowledge necessary to understand and evaluate the appropriateness of all aspects of their current treatment. Since most of our patients are getting their prescriptions from nonpsychiatrists, there is also a huge role to be played by appropriately trained psychologists in advance of the passage of any law as consultative psychopharmacologists.

Nova Southeastern University graduated its first class of psychologists with postdoctoral masters degrees in clinical psychopharmacology on July 1, 2001. The graduates have said to a person that this training has had an enormous impact on their practice. They get more referrals, particularly from medical physicians, their testimony in court is more highly valued and sought, and in every other conceivable way, their practices have been enhanced. And we are hearing the same thing from other states.

Dr. Ritt: Ron, I am very pleased to hear that the graduates of Nova's program are reporting immediate benefits from this training. It sounds like the collaboration between NSU and FPA during Nancy Bacher's presidency has really paid off. From my perspective, FPA really hasn't done much since then to help Florida psychologists gain prescriptive authority. I am not aware of concerted efforts by FPA's lobbyists, legislative committee, or Board of Directors to develop a strategy for eventually convincing the Florida legislature to enact enabling legislation. What is happening in other states?

Dr. Levant: A lot is happening. 31 State Psychological Associations have committees focusing on prescriptive authority, and 13 bills have been introduced. There are some surprising success stories:

For example, this year we witnessed the startling success of the New Mexico Psychological Association in very nearly getting a prescriptive authority bill passed: Passage through two committees in the House… Passed on the floor of the House 37-21… Passed through a Senate Committee twice... The bill is scheduled to be heard on the floor of the Senate where New Mexico's psychology leaders knew they had the votes for passage….when psychiatry gets its way and the bill is never called for a vote, dying in the last moments of this session…but promising to be back even stronger next year.

The success of the prescriptive authority initiative has had a visible impact on our profession. Wherever I travel, I am told that this initiative is a morale builder, coming at the end of a long period of great demoralization due the excesses of managed care. Psychologists in states that enact prescriptive authority bills will experience a significant expansion in their scope of practice, plus expanded roles in primary care.

Dr Ritt: Ron, thank you for presenting a persuasive case for FPA seeking prescriptive authority for its members.

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