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Psychologists in California have met defeat once again in their continuing campaign to convince state lawmakers to pass a bill that would grant psychologists the right to prescribe psychoactive drugs.
This latest in a series of attempts to gain prescribing privileges via the legislative route failed on April 27 when the bill was killed in the state senate committee that regulates professional activities and licensure.
The outcome was another success in the California Psychiatric Association's (CPA) long-term effort to educate legislators and the general public about psychiatrists' training and skills and the dangers inherent in granting prescribing privileges to mental health professionals who have not gone through formal medical training.
This most recent incarnation of the psychologist prescribing legislation was introduced by state senator Richard Polanco in the committee he chairs, the Committee on Business and Professions. When his committee voted on the bill, his vote was the only one in favor; there were three "no" votes and two abstentions, and one member was absent.
Polanco, who represents part of Los Angeles, used the access issue as his main argument in favor of psychologist prescribing. He contended that few psychiatrists choose to practice in poor, inner-city communities, denying mentally ill residents in those areas the opportunity to access psychiatric care easily. A similar argument has been made by supporters of psychologist prescribing regarding access to and availability of psychiatrists in rural areas, though data show that psychologists too are few and far between in those areas. A 1996 survey of psychiatrist distribution in California's smaller counties found, however, that there were no psychiatrists in only two of the 32 counties with populations below 220,000, and one of these had just 1,200 residents.
A similar prescribing proposal that Polanco sponsored was defeated in December. Other versions of the bill have been introduced in almost every session of the California legislature over the last several years. All have been either voted down, killed in committee, or withdrawn by the sponsor.
The demise two years ago of the Defense Department's short-lived experiment in training psychologists to prescribe psychoactive medication has also robbed supporters of psychologist prescribing of a model they could urge lawmakers to emulate.
Also at an apparent dead end-at least for now-is an initiative to place a referendum on the ballot during California's next statewide election that would have put the issue of psychologist prescribing to a popular vote. The measure was being championed by the Prescribing Psychologists' Register, a Miami-based private organization whose goal is to organize psychologists on a state-by-state basis to work toward gaining prescription privileges. The group's representatives in California failed to turn in petitions containing the signatures of registered voters by the deadline required for the measure to appear on the November ballot.
While savoring this recent victory, opponents of psychologist prescribing in California are still unable to indulge in anything resembling a sigh of relief. Polanco has suggested that he intends to introduce yet another version of the bill in a future legislative session, and psychologist organizations remain willing to fund additional attempts to get the law changed.
To prepare for this likelihood, the CPA "will continue to educate legislators and the public on why this proposal is a terrible idea and is dangerous for patient care," CPA Director of Government Affairs Conni Barker, J.D., told Psychiatric News.
The CPA will also maintain the links it has forged with a coalition of groups that came together to fight previous incarnations of the psychologist prescribing proposal, Barker noted. Among members of the coalition are the California Alliance for the Mentally Ill, the California Medical Association, several medical specialty societies, and the American Association for Applied and Preventive Psychology, which is an organization primarily made up of psychology professors.
While psychologists have yet to notch any victories at the state level in their battle for prescription privileges, the idea that military psychologists could be trained to prescribe psychoactive drugs may live another day on Capitol Hill. APA's Division of Government Relations has learned that language appears in the Senate's version of the 1999 Department of Defense Authorization Bill that "directs the Comptroller General to conduct a study to determine the extent to which. . .ten military psychologists… have been integrated into the military health system….This study is to include an assessment of "the quality of care provided to military personnel and their beneficiaries, contributions of [psychologists] to cost effectiveness, and their impact on medical readiness."
Jay Cutler, APA's director of government relations, interprets this legislative strategy as a way to keep alive the idea that psychologists can be easily trained to prescribe psychoactive drugs. Psychologists, he believes, are using one or more Senate allies to come up with a "positive cost-benefit analysis to support its claims that prescribing psychologists provide the best quality of care at lesser cost and vindication for its forcing the U.S. government to waste $6 million on" the experiment in psychologist prescribing.
Cutler along with members of the APA Joint Commission on Government Relations urged psychiatrists at the APA annual meeting to call and write their House and Senate representatives, particularly those serving on the House National Security Committee or the Senate Armed Services Committee to register their opposition to any move to resurrect the military's psychologist prescribing program.
Congress killed the experiment in 1996 when it voted to end the program's funding because of cost and failure to demonstrate a need for psychologists who were trained to prescribe psychoactive medications in the military.