Legislative and Advocacy Activities and Resources

STRATEGIC WORKING ADVOCACY ACTIVATION TEAM (S.W.A.A.T.)

Dr. Linda R. Upton, President of the Louisiana Psychological Association, reported that just after Governor Kathleen Blanco signed Louisiana's prescriptive authority legislation into law, the Louisiana Psychological Association published a special edition of its newsletter, The Louisiana Psychologist.  That issue contains five articles which tell much of the story behind the successful effort to pass the legislation.  LPA worked closely with the Louisiana Academy of Medical Psychology to bring about this victory.  The entire May 2004 issue is available on LPA's website at www.LouisianaPsychologist.org.

"Old News"

New Mexico is (was on the verge of becoming) the first state to grant psychologists prescription privileges. On February 12, New Mexico's Senate passed House Bill 170, "Prescriptive Authority to Psychologists," with a 29-9 vote, and Governor Gary Johnson (R), (will soon) decided the bill's fate. According to Gov. Johnson's office, the (estimated date for the final) decision (is) was made March 6.

E. Mario Marquez, Ph.D.
Clinical Psychologist
9316 Freedom Way NE
Albuquerque, NM 87109
(505) 821-4998

February 23, 2002

Honorable Gary E. Johnson
Office of the Governor
State Capitol
Santa Fe, NM 87503

RE: HB 170 as Amended - Prescriptive Privileges for Psychologists

Dear Governor:

Enclosed please find correspondence of support regarding prescriptive privileges for appropriately trained psychologists. These documents have been generated by a variety of physicians, psychiatrists, mid-level health care practitioners, agencies, and other interested New Mexicans. We are particularly pleased to have letters of support from the NM Board of Pharmacy, Eastern NM Family Practice Residency Program, Parents Reaching Out, ARC of New Mexico, and the NM Association of School Psychologists, among many others.

As you are aware, the New Mexico Psychological Association has pursued prescriptive privileges for psychologists during the past two legislative sessions. During our effort to be the first state in the nation to pass a law allowing psychologists to prescribe psychotropics, we have garnered overwhelming grassroots and legislative support. We are especially thankful to you for having called up our bill to the 2002 legislature.

We have debated this issue no less than 10 times with psychiatrists mostly from the University of New Mexico who are opposed to this progressive approach to treating the mentally ill and emotional disturbed in our state. Each time the vote has been in favor of psychologists prescribing. The legislative vote this year was 56 to 11 in the House of Representatives and 29 to 9 in the Senate. We won an 11 to 0 vote in House Judiciary and a 6 to 1 vote in Senate Public Affairs.

Listed below are some of the reasons why we feel it is in the best interest of New Mexicans for trained psychologists to obtain prescriptive privileges:

1. Following negotiations and the amendment of the bill, the New Mexico Medical Society and the New Mexico Psychological Association agreed on a compromise to the legislation.

2. The statute will be implemented and regulated by the New Mexico Board of Psychologists’ Examiners and the New Mexico Board of Medical Examiners. Thus, ensuring any concerns regarding public safety.

3. Only doctoral level New Mexico licensed clinical psychologists who undergo rigorous post-doctoral training in psychopharmacology will be allowed to apply for prescriptive authority.

4. The post-doctoral training includes 450 academic hours in psychopharmacology (approximately 36 graduate semester credit hours), 400 hours clinical practice in psychopharmacology with a psychiatrist or other medical doctor, and 80 hours clinical experience with a physician.

5. In addition, a comprehensive national licensing examination approved by the Psychology and Medical Boards must be passed, 2 years of prescribing under the supervision of a physician must be completed, and a peer review of the prescribing psychologists’ work must be approved by the two Boards, before a prescribing psychologist will be allowed to apply for independent practice. Following independent practice, psychotropic prescriptions can only be written in collaboration with a physician.

6. The United States Military Department of Defense Psychopharmacology Demonstration Project proved that psychologists could be trained to safely and effectively prescribe psychotropics to their patients. During the time that these military psychologists have been prescribing, not a single complaint has been registered against any of them.

7. The training program in HB 170 is modeled after the DOD-PDP and is currently being offered at New Mexico State University. NMSU is also training nurse practitioners who can prescribe independently. Furthermore, psychiatric and other medical experts are being brought in from around the country to train psychologists in safe and effective treatment with psychotropics.

8. Although a small group of psychiatrists have opposed HB 170 at the Roundhouse, many other physicians from around the state are in support.

9. Mental health services in New Mexico particularly psychiatric services, is beyond a crises mode and becoming more and more dangerously inadequate. Some alarming statistics from the NM Psychiatric Association were published in the Albuquerque Journal, September 5, 2000:

a. The suicide rate for young New Mexicans between ages 15 and 24 is 75% higher than the national average.

b. 22 child psychiatrists have left New Mexico, leaving the state with a number that is half the national average.

c. The availability of certain mental health services in New Mexico has dropped between 20% and 65%.

d. The president of the NM Psychiatric Society was quoted as saying, “We need to make it clear the psychiatric community is in crises mode,” and “It’s clear we have a shortage of psychiatrists.”

e. According to the article, the NM Psychiatric Association’s membership declined by about 50 psychiatrists during the previous 5 years.

f. The waiting time for an adult to see a psychiatrist usually is 6 weeks (and in some counties in New Mexico up to 5 months).

g. Some of the headlines in the article read: “Bleak Outlook,” “Children in Crises,” “Experts, parents grapple with fewer mental health care services for youths,” and “Mentally Ill Adults Running Out of Options as Doctors Leave New Mexico.”

h. What was most disturbing about the article, coming from the president of the NM Psychiatric Association was his comment, “It’s kind of a joke among the medical community. You see someone you haven’t seen in a while and say, ‘Oh you’re still in practice. You’re still here.’ We all know we’re becoming depleted.”

10. According to the New Mexico National Alliance of the Mentally Ill (NAMI) 75% of the mentally ill in New Mexico needing treatment are not receiving it. There are approximately 80,000 New Mexicans suffering from serious mental illness.

11. Studies indicate that approximately 75% to 80% of the psychotropic medication prescriptions are being written by health care professionals other than a psychiatrist. Generally these prescribers possess minimal training in mental illness and many are uncomfortable in making psychiatric diagnoses.

12. Many other non-physician providers with legal authority to prescribe include for example, dentists, podiatrists, advanced nurse practitioners, optometrists, physician assistants, and psychiatric nurses, in addition to the DOD psychologists. Thus, these professionals have proven unequivocally that one need not have had to attend medical school to learn how to prescribe safely and effectively.

13. According to Albuquerque Direct Marketing, 2001, there are only 18 psychiatrists residing in New Mexico outside of Albuquerque and Santa Fe. There are 176 psychologists who reside and work in communities outside of Albuquerque and Santa Fe.

14. Many of the arguments that the psychiatrists are using against psychologists prescribing were used against some of the other health care professionals, when they too were attempting to obtain their prescriptive authority. However, thanks to visionary leaders, particularly here in New Mexico, these professionals were legally granted prescriptive authority.

15. Furthermore, the jury is no longer out on these certified professionals who are prescribing. In fact, health services in our state and country have been greatly enhanced by these mid-level certified practitioners who are safely and competently prescribing medicine in each of their areas of specialty. What is ironic is that these professions fought the same battle that we are fighting today. Moreover, the same arguments that were used against them are being used against psychologists.

16. Psychology’s recognized competence in the medical and psychological aspects of mental illness and emotional disorders is exemplified by the fact that over 3,000 psychologists are employed on medical school faculties, including the University of New Mexico.

17. Psychologists possess more training than any of the other health care professionals in mental health diagnostic assessment, psychotherapy, and behavioral interventions for mentally ill and emotionally disordered individuals. Those of us who are committed to this endeavor will not change our treatment approach. Medication will be utilized only in collaboration with the primary care physician, when safe and necessary, and as an adjunct to psychotherapy. Having the authority to prescribe also means having the power not to prescribe, or to un-prescribe when appropriate.

Signing HB 170 as amended into law has the potential for creating an exemplary, interdisciplinary model that would set a new standard for mental health care, not only here in New Mexico, but around the entire United States, particularly for disenfranchised mentally ill and emotionally disturbed individuals in our country. In the past, you have shown visionary leadership in responding to the health care needs of New Mexico citizens. By enacting this legislation you will continue your legacy as it relates to mental health care. Thus, I respectfully ask that you sign HB 170 as amended into New Mexico law.

Sincerely,

E. Mario Marquez, Ph.D.
New Mexico Psychological Association Legislative Chair

To view the the text of the New Mexico legislation, view House Bill 170 in text format or HB170 as a pdf document.

For background information on this historic legislation and the efforts of all involved who have helped make it possible, see: Special Issue The New Mexico Psychologist January 2001

APA president Philip Zimbardo wrote to New Mexico governor Gary Johnson on February 17, 2002, urging him to sign this "landmark" legislation. Here is the text of Dr. Zimbardo's letter, previously distributed on a number of APA listservs:

February 17, 2002
The Honorable Gary E. Johnson
Office of the Governor State Capitol Building
Santa Fe, NM 87503

Dear Governor Johnson:

On behalf of our 483 members in New Mexico and more than 50,000 licensed psychologist members nationwide, I am writing to underscore our experience to date with successful training for psychologists to prescribe and to ask you to enact HB170, Prescriptive Authority to Psychologists.

You showed vision and leadership in responding to the health needs of the people of New Mexico by calling up this bill last month. As you know, the New Mexico Psychological Association and the New Mexico Medical Society subsequently agreed on a compromise, which has passed overwhelmingly in both the House and the Senate. I have no doubt that opponents of this legislation from the psychiatric community will be intensively pressuring you to veto this measure. They will be repeating the same claims that the legislature found unpersuasive.

We in the American Psychological Association are proud of the history of successful prescribing by the psychologists who were trained in the U.S. Department of Defense Psychopharmacology Demonstration Project (PDP). The graduates of the PDP, including Major Brian Pfeiffer of Cannon Air Force Base, have been making significant contributions to health care services in the military. The safety and effectiveness of their prescribing has been verified in several independent evaluations, including an authoritative study done by the U.S. General Accounting Office.

We believe that your signing HB 170 into law will increase quality health care for the citizens of New Mexico by enabling highly trained and dedicated psychologists to provide badly needed services, in collaboration with physicians. Therefore we respectfully urge your enactment of this landmark legislation, which will continue your legacy of leadership in health care.

Sincerely,

Philip G. Zimbardo, Ph.D. President, APA

Here is some of the information the psychiatric community is reporting about the most recent New Mexico success:

A Psychiatric Times Exclusive: New Mexico Senate Approves Psychologist Prescribing Rights. Psychiatric Times, February 2002, Vol. XIX, Issue 2 .

and articles that are helpful in understanding the extent of the opposition and the resources that were marshaled to defeat similar legislation last year:

Lessons From New Mexico Psychiatric News 2001 36: (10) 13-a, Lessons from New Mexico.

Clock Runs Out on N.M. Psychologist Prescribing Bill Psychiatric News 2001 36: (8) 1