Prescriptive authority for psychologists movement
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The prescriptive authority for psychologists (RxP) movement is a movement in the United States of America among certain
psychologist A psychologist is a professional who practices psychology and studies mental states, perceptual, cognitive, emotional, and social processes and behavior. Their work often involves the experimentation, observation, and interpretation of how indi ...
s to give prescriptive authority to psychologists with predoctoral or postdoctoral graduate-level training in clinical psychopharmacology; successful passage of a standardized, national examination (Psychopharmacology Examination for Psychologists - Second Edition; PEP-2); supervised clinical experience; or a certificate from the
Department of Defense Department of Defence or Department of Defense may refer to: Current departments of defence * Department of Defence (Australia) * Department of National Defence (Canada) * Department of Defence (Ireland) * Department of National Defense (Philippin ...
Psychopharmacology Demonstration Project; or a diploma from the Prescribing Psychologists Register (FICPP or FICPPM) to enable them, according to state law, to prescribe
psychotropic A psychoactive drug, psychopharmaceutical, psychoactive agent or psychotropic drug is a chemical substance, that changes functions of the nervous system, and results in alterations in perception, mood, consciousness, cognition or behavior. Th ...
medications to treat
mental disorders A mental disorder, also referred to as a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing and remitti ...
. This approach is non-traditional medical training focused on the specialized training to prescribe for mental health disorders by a psychologist. It includes rigorous
didactics A didactic method ( el, διδάσκειν ''didáskein'', "to teach") is a teaching method that follows a consistent scientific approach or educational style to present information to students. The didactic method of instruction is often contra ...
and supervised clinical experience. Legislation pertaining to prescriptive authority for psychologists has been introduced over 180 times in over half of the United States. It has passed in five states, due largely to substantial lobbying efforts by the
American Psychological Association The American Psychological Association (APA) is the largest scientific and professional organization of psychologists in the United States, with over 133,000 members, including scientists, educators, clinicians, consultants, and students. It ha ...
(APA), the largest professional organization of psychologists in the United States with over 133,000 members. Prior to RxP legislation and in American states where it has not been passed, this role has been played by
psychiatrists A psychiatrist is a physician who specializes in psychiatry, the branch of medicine devoted to the diagnosis, prevention, study, and treatment of mental disorders. Psychiatrists are physicians and evaluate patients to determine whether their sy ...
, who possess a medical degree and thus the authority to prescribe medication, but more frequently by primary care providers who can prescribe psychotropics, but lack extensive training in psychotropic drugs and in diagnosing and treating psychological disorders. According to the APA, the movement is a reaction to the growing public need for mental health services, particularly in under-resourced areas where patients have little or no access to psychiatrists. Currently, in states where RxP legislation has been passed, psychologists who seek prescriptive authority must possess a doctoral degree (
PhD PHD or PhD may refer to: * Doctor of Philosophy (PhD), an academic qualification Entertainment * '' PhD: Phantasy Degree'', a Korean comic series * ''Piled Higher and Deeper'', a web comic * Ph.D. (band), a 1980s British group ** Ph.D. (Ph.D. albu ...
/
PsyD The Doctor of Psychology (Psy.D. or D.Psych.) is a professional doctoral degree intended to prepare graduates for careers that apply scientific knowledge of psychology and deliver empirically based service to individuals, groups and organization ...
), a license to practice independently, and completion of a Master of Science in clinical psychopharmacology (MSCP) degree or equivalent. Current programs that offer the MSCP degree are
The California School of Professional Psychology at Alliant International UniversityThe Chicago School of Professional PsychologyDrake UniversityFairleigh Dickinson UniversityIdaho State University
an
New Mexico State University
In some jurisdictions, completion of the training programs from the Department of Defense or the Prescribing Psychologists' Register Diplomate Certification also satisfies the licensing law requirements. The supervised clinical experience required after completing the MSCP and passing the PEP varies by jurisdiction, but typically requires a specific number of hours of supervised experience and/or a specific number of patients. Some jurisdictions then grant conditional prescribing psychology licenses or certifications, while others grant full prescribing authority after the supervised clinical experience has been successfully completed. The medications the psychologist may then prescribe are limited to those indicated for psychiatric problems; still, the specific medications that are able to be prescribed by prescribing or medical psychologists varies by jurisdiction. Psychologists' involvement in
pharmacotherapy Pharmacotherapy is therapy using pharmaceutical drugs, as distinguished from therapy using surgery (surgical therapy), radiation (radiation therapy), movement ( physical therapy), or other modes. Among physicians, sometimes the term ''medical the ...
exists on a continuum, with psychologists serving as prescribers, collaborators, and information-providers in the medical decision-making process. Currently, psychologists may prescribe in five states: New Mexico, Louisiana, Illinois, Iowa, and Idaho, as well as in the Public Health Service, the Indian Health Service, the U.S. military, and the U.S. territory of Guam. When psychologists act as collaborators, they lack the authority to make the final decision to prescribe; however, they may assist in the process by recommending clinically desirable treatment effects, certain classes of medications, specific medications, dosages, or other aspects of the treatment regimen. Psychologists also provide information that may be relevant to the prescribing professional. Psychologists may express concerns about treatment, refer patients for medication consultations, direct patients to referral or information sources, or discuss with patients how to address their concerns about medication with the prescriber.American Psychological Association (2011). Practice guidelines regarding psychologists' involvement in pharmacological issues. ''
American Psychologist ''American Psychologist'' is a peer-reviewed academic journal published by the American Psychological Association. The journal publishes articles of broad interest to psychologists, including empirical reports and scholarly reviews covering science ...
'', 66(9), 835-849.


History

The first bill seeking to authorize prescription privileges to psychologists was introduced in Hawai'i in 1985 under Hawaii State Resolution 159. The bill allowed licensed psychologists in the State of Hawai'i to administer and prescribe psychotropic medication for the treatment of "nervous, mental, and organic brain disorders."Fox, R.E., DeLeon, P.H., Newman, R., Sammons, M.T., Dunivin, D.L., Backer, D.C.. (2009). Prescriptive authority and psychology: A status report. American Psychologist, 64(4), 257-268. A total of 88 prescriptive authority bills have been introduced in 21 jurisdictions since then. In 1988, the
U.S. Department of Defense The United States Department of Defense (DoD, USDOD or DOD) is an executive branch department of the federal government charged with coordinating and supervising all agencies and functions of the government directly related to national secur ...
approved a pilot project to train psychologists in issuing psychotropic medications "under certain circumstances."
Guam Guam (; ch, Guåhan ) is an organized, unincorporated territory of the United States in the Micronesia subregion of the western Pacific Ocean. It is the westernmost point and territory of the United States (reckoned from the geographic cent ...
became the first
U.S. territory In the United States, a territory is any extent of region under the sovereign jurisdiction of the federal government of the United States, including all waters (around islands or continental tracts). The United States asserts sovereign rights for ...
to approve RxP legislation in 1999.
New Mexico ) , population_demonym = New Mexican ( es, Neomexicano, Neomejicano, Nuevo Mexicano) , seat = Santa Fe , LargestCity = Albuquerque , LargestMetro = Tiguex , OfficialLang = None , Languages = English, Spanish ( New Mexican), Navajo, Ker ...
became the first state to approve RxP legislation in 2002, and
Louisiana Louisiana , group=pronunciation (French: ''La Louisiane'') is a state in the Deep South and South Central regions of the United States. It is the 20th-smallest by area and the 25th most populous of the 50 U.S. states. Louisiana is borde ...
followed in 2004. In 2014, Illinois became the third state to approve RxP legislation. In 2016, Iowa became the fourth state to grant prescriptive authority, which was quickly followed by Idaho in 2017. The rules and regulations for Illinois' RxP law were approved in 2018 and in 2019 in Iowa. Many other states have introduced RxP bills that are under discussion, but have yet to be approved. As of 2022, there are approximately 220 active, prescribing psychologists across the United States, with approximately 150 graduate students and psychologists in the pipeline to become prescribing psychologists in Illinois alone. Since 2000, a Division of the American Psychological Association
Division 55
(Society for Prescribing Psychology), has striven to promote efforts related to prescriptive authority for psychologists across the country. In fact, Division 55 petitioned APA through it
Commission for the Recognition of Specialties and Subspecialties in Professional Psychology (CRSSPP)
for official recognition o
clinical psychopharmacology
as a specialty in psychology. At its meeting in August 2020, the APA Council of Representatives gave final approval to this petition, adding clinical psychopharmacology to 17 others as a
APA-recognized psychological specialty
Division 55 is now in the process of becoming a member of th
Council of Specialties
(CoS) in Professional Psychology
Council of Chairs of Training Councils
(CCTC), and creating a board certification in clinical psychopharmacology through th
American Board of Professional Psychology
(ABPP). The
State of New Mexico ) , population_demonym = New Mexican ( es, Neomexicano, Neomejicano, Nuevo Mexicano) , seat = Santa Fe , LargestCity = Albuquerque , LargestMetro = Tiguex , OfficialLang = None , Languages = English, Spanish ( New Mexican), Navajo, Ker ...
was the first to enact a
Psychologists prescribing law The prescriptive authority for psychologists (RxP) movement is a movement in the United States of America among certain psychologists to give prescriptive authority to psychologists with predoctoral or postdoctoral graduate-level training in cl ...
, which is still in effect.
Louisiana's legislature The Louisiana State Legislature (french: Législature d'État de Louisiane) is the state legislature (United States), state legislature of the U.S. state of Louisiana. It is a bicameral body, comprising the lower house, the Louisiana House of ...
established medical psychology as a separate and distinct healthcare profession and transferred the regulation of their practice of medical psychology to the Louisiana State Board of Medical Examiners. At this time, the entire practice of psychology (for medical psychologists), including psychotherapy and psychological testing, was also transferred to the Louisiana Board of Medical Examiners, effectively making Louisiana the only state in the U.S. where, for some psychologists, a medical board has authority over the regulation of the entire practice of psychology. Because of this, several national organizations, including the American Psychological Association and th
Association of State and Provincial Psychology Boards
have expressed concern over the practice of psychology being regulated by another profession (i.e., medicine). The Louisiana Psychological Association has strongly echoed such concerns. However, the Louisiana Academy of Medical Psychologists (LAMP), a Political Action Committee representing medical psychologists in the state, strongly endorsed this change of regulation by another profession. Currently, prescribing rights for psychologists are being negotiated in South Africa, Canada, the United Kingdom, and Australia.


APA Guidelines

In December 2011, the
American Psychological Association The American Psychological Association (APA) is the largest scientific and professional organization of psychologists in the United States, with over 133,000 members, including scientists, educators, clinicians, consultants, and students. It ha ...
(APA) published a list of practice guidelines that apply to all prescribing activities, with some also applicable to collaborating and information providing activities. The list is categorized according to the area of psychologists' involvement in pharmacological issues (general, education, assessment, intervention and consultation). The following list summarizes the guidelines by section.American Psychological Association (2011). Practice guidelines regarding psychologists' involvement in pharmacological issues. American psychologist, 66(9), 838-839. These practice guidelines are in process of being revised and updated as of 2022. *General * Guidelines 1 through 3 encourage psychologists to act within the scope of their practice with regards to prescribing psychotropic medications, which includes seeking consultation before recommending certain medications; emphasize that psychologists' evaluate their own views and opinions towards prescribing medications in light of how it may affect communication with patients; and expect that psychologists involved in medication prescription or collaboration be wary of developmental, age, educational, sex, gender, language, health status, and cultural factors involved in populations a psychologist may serve, with regards to pharmacotherapy. *Education * Guidelines 4 through 6 require that psychologists attain a level of education specific to pharmacotherapy in order to serve their clients; expect that psychologists be wary of potential adverse side effects of psychotropic medications; and ask that psychologists that prescribe or collaborate with regards to medication prescription be aware of helpful technological resources that are available. *Assessment * Guidelines 7 through 9 require that psychologists familiarize themselves with procedures for monitoring the physiological and psychological effects of medications; expect that psychologists who prescribe medications consider other physiological disorders or underlying diseases that the patient may have that could affect the effectiveness of medications; and encourage psychologists to consider issues about patient adherence and concerns about medications. *Intervention and Consultation * Guidelines 10 through 15 require that psychologists employ a biopsychosocial approach when prescribing medications and that they also use informed consent procedures, act in the best interest of the patient, and consider current research; emphasize that psychologists be wary of commercial influences regarding medications; and encourage psychologists to consider the patient's interpersonal behaviors. *Relationships * Guidelines 16 and 17 expect that psychologists maintain appropriate relationships with other providers of psychological services and biological interventions.


Supporting arguments

There are several core arguments put forth by RxP advocates, including the following: * Other non-physicians have prescription privileges, such as
pharmacist A pharmacist, also known as a chemist (Commonwealth English) or a druggist (North American and, archaically, Commonwealth English), is a healthcare professional who prepares, controls and distributes medicines and provides advice and instructi ...
s,
optometrist Optometry is a specialized health care profession that involves examining the eyes and related structures for defects or abnormalities. Optometrists are health care professionals who typically provide comprehensive primary eye care. In the Uni ...
s,
nurse practitioner A nurse practitioner (NP) is an advanced practice registered nurse and a type of mid-level practitioner. NPs are trained to assess patient needs, order and interpret diagnostic and laboratory tests, diagnose disease, formulate and prescribe m ...
s, and
physician assistant A physician assistant or physician associate (PA) is a type of Mid-level practitioner, mid-level health care provider. In North America PAs may diagnose illnesses, develop and manage treatment plans, prescribe medications, and may serve as a pri ...
s. Some advocates have asserted that the latter three professions receive less training in clinical pharmacology, therapeutics, and psychopharmacology than many clinical psychologists.Ericson, Robert. (2 September 2002)
Prescription Privilege Based on Proven Model
''Albuquerque Journal''. Retrieved July 28, 2007.
* The statistics point to multiple content areas in which other professions, such as psychiatric nurse practitioners or physician assistants, are relatively deficient in comparison to pharmacologically-trained psychologists’ preparation.Muse, M., & McGrath, R. (2010). Training comparison among three professions prescribing psychoactive medications: psychiatric nurse practitioners, physicians, and pharmacologically trained psychologists. Journal of Clinical Psychology, 66(1), 96-103. . * The training model is supported by a complete lack of legal complaint after eight years regarding the practice of the initial ten psychologists trained by the
U.S. Department of Defense The United States Department of Defense (DoD, USDOD or DOD) is an executive branch department of the federal government charged with coordinating and supervising all agencies and functions of the government directly related to national secur ...
. Legal complaints differ from legal suits, as military personnel cannot sue for redress. * Access to medication would be improved in jurisdictions with long waiting times to see a psychiatrist or other qualified physician.Heiby, E., DeLeon, P., and Anderson, T. (2004). A Debate on Prescription Privileges for Psychologists. ''Professional Psychology: Research and Practice, 35(4),'' 336. * The prescriptive authority would be enhanced by the psychologist's doctoral training in the science of psychology, assessment, and psychotherapy. This training is more extensive than that received by the average physician. In addition, the training program for psychologists would provide twice as much pharmacology training than nurse practitioners and physician assistants receive. * It would address the fact that many lack access to psychiatrists (especially in rural areas).NAPPP. (2006).
NAPPP Sponsors Prescriptive Authority Legislation
'' Retrieved July 28, 2007.
King, Craig. (2006). Prescriptive Authority for Psychologists Working in the Public Sector: Is it Needed? ''Public Service Psychology, 31(1),'' 2. * It would create a clearer distinction in psychology between doctoral and master-level practitioners, and between doctoral and post-doctoral level practitioners. * In circumstances in which the psychologist decided not to collaborate with medical colleagues, it could allow the psychologist control of the entire treatment process. In some cases, this might reduce or eliminate complications arising from interprofessional collaboration and potentially save patients money. * Psychologists with prescriptive authority would add competence to the overall mental health system by adding a resource for general practitioners who need professional consultation regarding psychological disorders and psychotropic medications when a psychiatrist is unavailable.Holloway, Jennifer. (2004)

''Monitor on Psychology'', 35(6), 22
* Psychopharmacological training allows psychologists to provide better advocacy for their clients. According to a survey assessing the views of psychology interns, residents, and psychologists published in the journal Professional Psychology: Research and Practice, significant support exists regarding the APA's prescriptive authority initiative. Proponents of the prescriptive authority initiative believe that it would improve the economic stability of the profession, provide better opportunities to underserved populations, and enhance psychologists' clinical skills through a better understanding of biopsychosocial interactions. Support for the prescriptive authority initiative also appears higher amongst those with
PsyD The Doctor of Psychology (Psy.D. or D.Psych.) is a professional doctoral degree intended to prepare graduates for careers that apply scientific knowledge of psychology and deliver empirically based service to individuals, groups and organization ...
s and early career psychologists (within 10 years of receiving doctorate) than those with PhDs and mid- and late-career psychologists. Demographically, females and Caucasians expressed more willingness to seek prescription privileges. Also, those who attended a clinical or counseling graduate program, received a PhD degree, and those employed in a
university counseling center A university counseling center (UCC) provides mental health and other services within a university or college environment. The need for these services is on the rise. Counseling center directors and other student affairs personnel have reported an i ...
, medical school hospital, or independent practice tend to demonstrate higher levels of support for the initiative. In terms of training, an overwhelming majority of those surveyed believe training should begin at the graduate level, but prior to completion of a doctorate. Accordingly, in February 2019, the APA Council of Representatives overwhelmingly voted to approve changes t
APA policy
that allows psychopharmacology training to begin at the graduate level; previously, APA policy only allowed for this training to occur at the postdoctoral level. In Illinois, one of the jurisdictions where RxP is law, there are already psychopharmacology programs in place that offer this education and training at the predoctoral level. Additionally, respondents preferred that training occur on a part-time basis, be completed within two to two-and-a-half years and cost $12,000-$18,000. Today, evidence exists to indicate a continual and growing level of support for the American Psychological Association's prescriptive authority initiative. Such support reflects psychologists' willingness to open their minds to learning about psychotropic medications, incorporating pharmacological treatment with therapy, and adapting to the demands of a rapidly changing health care world.


Opposition

Prescriptive authority for psychologists has been controversial, even within the healthcare community, which has created entire organizations dedicated to objecting to prescriptive authority for clinical psychologists. Specifically, critics within the medical profession have expressed concern that they have no medical training. The current RxP model explicitly states that this movement includes no medical training, but this can be accomplished with a master's degree in
psychopharmacology Psychopharmacology (from Greek grc, ψῡχή, psȳkhē, breath, life, soul, label=none; grc, φάρμακον, pharmakon, drug, label=none; and grc, -λογία, -logia, label=none) is the scientific study of the effects drugs have on m ...
, typically from a postdoctoral education program at a professional school. Some opponents claim this would culminate in substantially fewer years and hours compared to
physician assistants A physician assistant or physician associate (PA) is a type of mid-level health care provider. In North America PAs may diagnose illnesses, develop and manage treatment plans, prescribe medications, and may serve as a principal healthcare provi ...
and
nurse practitioner A nurse practitioner (NP) is an advanced practice registered nurse and a type of mid-level practitioner. NPs are trained to assess patient needs, order and interpret diagnostic and laboratory tests, diagnose disease, formulate and prescribe m ...
s, who are granted full prescriptive authority, and can elect to specialize in psychiatry, unlike the majority of psychologists. However, proponents have rebutted this assertion by describing their sequence of training (e.g., 4-year undergraduate degree, 5-year doctoral degree, 1-year internship, 1-year residency/fellowship, 2-year master's degree in psychopharmacology, national psychopharmacology exam, supervised clinical experience). In addition, survey research comparing prescribing psychologists' training against that of nurse practitioners and physician assistants has demonstrated that when presented with un-labeled training programs side-by-side, prescribing psychologists' training is perceived to be more rigorous overall than that of psychiatric nurse practitioners or physicians assistants in their ability to prescribe psychiatric medication.Cooper, R. R. (2019).
Pulling Back the Political Curtain: Surveying Opinions and Biases on Prescribing Psychology's Training
' (Unpublished doctoral dissertation). University of the Cumberlands, Williamsburg, Kentucky. .
This perception was found to be true of physicians, mid-level providers, psychologists, non-prescribing therapists, and general members of the public.


Psychologists who have extensively researched the effects of psychopharmacology

*
Andrew Feldmár Andrew Feldmár (''Feldmár András''; born 28 October 1940, in Budapest) is a Hungarian born psychotherapist living in Canada. He is most known as the Hungarian follower of R. D. Laing, the Scottish psychiatrist who was one of the leading fig ...
(1940) *
Bruce K. Alexander Bruce K. Alexander (born 20 December 1939)Alexander, Bruce"Curriculum Vitae ", Retrieved on 12 May 2013. is a psychologist and professor emeritus from Vancouver, BC, Canada. He has taught and conducted research on the psychology of addiction at ...
(1939) *
Betty Eisner Betty Grover Eisner (September 29, 1915 – July 1, 2004) was an American psychologist known for pioneering the use of LSD and other psychedelic drugs as adjuncts to psychotherapy. Early life and education Eisner grew up in Kansas City, Missouri ...
(1915–2004)
Charles R. Schuster
(1930 - 2011) * Corneliu E. Giurgea (1923–1995)
Duncan B. Blewett
(1920-2007) *
James Fadiman James Fadiman (born May 27, 1939) is an American writer known for his research on Psychedelic microdosing, microdosing psychedelics. He co-founded the Institute of Transpersonal Psychology, which later became Sofia University (California), Sofia ...
(1939)
Neal M. Goldsmith


*
Ralph Metzner Ralph Metzner (May 18, 1936 – March 14, 2019) was a German-born American psychologist, writer and researcher, who participated in psychedelic research at Harvard University in the early 1960s with Timothy Leary and Richard Alpert (later named ...
(1936)
Sidney Durward Shirley Spragg
(1909-1995) *
Timothy Leary Timothy Francis Leary (October 22, 1920 – May 31, 1996) was an American psychologist and author known for his strong advocacy of psychedelic drugs. Evaluations of Leary are polarized, ranging from bold oracle to publicity hound. He was "a her ...
(1920-1996)


References

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