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California psychologists appear to have identified in Governor Pete Wilson an important ally in their legislative campaign to win prescription privileges.
The governor, often mentioned as a Republican presidential candidate in 2000, signed a bill on September 24 that puts in motion a process for developing education standards for psychologists who want to learn about psychoactive medications-potentially a major step on the road to winning prescription privileges.
In what might be a troubling trend for the state's psychiatrists, the governor's endorsement came within days of his vetoing a bill that would have mandated insurance parity for mental illness treatment (see page 1).
Psychologists in California have expended enormous amounts of time and money since the beginning of this decade to convince state lawmakers that California's mentally ill citizens would benefit greatly from the option of being cared for by psychologists who could prescribe psychoactive drugs.
A major part of the psychologists' argument is that mentally ill individuals in rural and impoverished inner-city areas do not have access to psychiatrists and thus fail to receive adequate care for their disorders, a void that psychologists could fill if they were allowed to prescribe drugs. A 1996 study showed, however, that psychologists are no more willing to practice in isolated areas than are psychiatrists and other physicians.
Statistics from the California Psychiatric Association (CPA) also indicate that in only one of California's 32 largely rural counties, one with a population of just 1,200 people, is there no psychiatrist with at least a part-time practice.
A succession of nearly annual bills to grant them prescription privileges has been introduced in one of the houses of the legislature, but all have failed to win passage. The most recent attempt to gain prescription privileges through legislation went down to defeat in late April, when the bill died in the senate committee that regulates professional activities and licensure (Psychiatric News, June 19).
The CPA has been forced to remain in a constant state of battle readiness for years and, along with such allies as the California Alliance for the Mentally Ill and the California Medical Association, vigorously combats each incarnation of the prescribing legislation.
The bill the governor recently signed, which was known as SB 983, requires the state Board of Psychology to "encourage licensed psychologists to take continuing education courses in psychopharmacology and the biological basis of behavior." It also orders the psychology board to "encourage institutions offering doctoral-degree programs in psychology to include education and training in psychopharmacology and related topics including pharmacology and clinical pharmacology."
In addition, the new law requires the Board of Psychology to "develop guidelines for the basic education and training of psychologists whose practices include patients with medical conditions and patients with mental and emotional disorders who may require psychopharmacological treatment and whose management may require collaboration with physicians and other licensed prescribers."
The law goes on to describe several components, many of them traditionally part of medical school curricula, that the board is to include when it develops the educational guidelines. Among them are knowledge of the psychopharmacology of the drugs used to treat mental illnesses; evaluating responses to psychotropic drugs; "practical and theoretical knowledge of neuroanatomy, neurochemistry, and neurophysiology"; educating patients about treatment alternatives to medication; and knowledge of "the biochemical and physiological bases for mental disorders."
While wary of the original version of the bill, which was introduced by state Senator Richard Polanco of Los Angeles, the author of several of the unsuccessful psychologist prescribing bills, the CPA and its coalition partners decided against mobilizing their forces to fight the psychologist education bill, according to CPA Director of Government Relations Conni Barker, J.D.
Barker told Psychiatric News that although the CPA was initially concerned that psychologists and their prescription-privilege allies might "twist the bill to expand their scope of practice," once language was added to preclude that action, the CPA decided to "remain neutral." The additional wording states that the law is "intended to provide training of clinical psychologists to improve [their] ability to collaborate with physicians. It is not intended to provide for training psychologists to prescribe medication. Nothing in [the bill] is intended to expand the scope of licensure of psychologists."
The text of the bill can be accessed through the California Senate's Web site, http://www.sen.ca.gov/~newsen/senate.htm. Enter SB 983 when prompted for the bill number.